hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|GA,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Memorial Hospital and Manor,1/17/2025,2.0.0,Memorial Hospital and Manor,"1500 E Shotwell St, Bainbridge, GA 39819",134148824,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|AETNA|COMMERCIAL|negotiated_dollar,standard_charge|AETNA|COMMERCIAL|negotiated_percentage,standard_charge|AETNA|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA|COMMERCIAL,standard_charge|AETNA|COMMERCIAL|methodology,additional_payer_notes|AETNA|COMMERCIAL,standard_charge|AETNA MEDICAL RENTAL|COMMERCIAL|negotiated_dollar,standard_charge|AETNA MEDICAL RENTAL|COMMERCIAL|negotiated_percentage,standard_charge|AETNA MEDICAL RENTAL|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA MEDICAL RENTAL|COMMERCIAL,standard_charge|AETNA MEDICAL RENTAL|COMMERCIAL|methodology,additional_payer_notes|AETNA MEDICAL RENTAL|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|ALLIANT|MEDICARE|negotiated_dollar,standard_charge|ALLIANT|MEDICARE|negotiated_percentage,standard_charge|ALLIANT|MEDICARE|negotiated_algorithm,estimated_amount|ALLIANT|MEDICARE,standard_charge|ALLIANT|MEDICARE|methodology,additional_payer_notes|ALLIANT|MEDICARE,standard_charge|AMBETTER|MEDICARE|negotiated_dollar,standard_charge|AMBETTER|MEDICARE|negotiated_percentage,standard_charge|AMBETTER|MEDICARE|negotiated_algorithm,estimated_amount|AMBETTER|MEDICARE,standard_charge|AMBETTER|MEDICARE| methodology,additional_payer_notes|AMBETTER|MEDICARE,standard_charge|AMERIGROUP|MEDICAID|negotiated_dollar,standard_charge|AMERIGROUP|MEDICAID|negotiated_percentage,standard_charge|AMERIGROUP|MEDICAID|negotiated_algorithm,estimated_amount|AMERIGROUP|MEDICAID,standard_charge|AMERIGROUP|MEDICAID|methodology,additional_payer_notes|AMERIGROUP|MEDICAID,standard_charge|ANTHEM|COMMERCIAL|negotiated_dollar,standard_charge|ANTHEM|COMMERCIAL|negotiated_percentage,standard_charge|ANTHEM|COMMERCIAL|negotiated_algorithm,estimated_amount|ANTHEM|COMMERCIAL,standard_charge|ANTHEM|COMMERCIAL|methodology,additional_payer_notes|ANTHEM|COMMERCIAL,standard_charge|CARESOURCE|MEDICAID|negotiated_dollar,standard_charge|CARESOURCE|MEDICAID|negotiated_percentage,standard_charge|CARESOURCE|MEDICAID|negotiated_algorithm,estimated_amount|CARESOURCE|MEDICAID,standard_charge|CARESOURCE|MEDICAID|methodology,additional_payer_notes|CARESOURCE|MEDICAID,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|CORVEL|COMMERCIAL|negotiated_dollar,standard_charge|CORVEL|COMMERCIAL|negotiated_percentage,standard_charge|CORVEL|COMMERCIAL|negotiated_algorithm,estimated_amount|CORVEL|COMMERCIAL,standard_charge|CORVEL|COMMERCIAL|methodology,additional_payer_notes|CORVEL|COMMERCIAL,standard_charge|HUMANA CHOICE CARE|COMMERCIAL|negotiated_dollar,standard_charge|HUMANA CHOICE CARE|COMMERCIAL|negotiated_percentage,standard_charge|HUMANA CHOICE CARE|COMMERCIAL|negotiated_algorithm,estimated_amount|HUMANA CHOICE CARE|COMMERCIAL,standard_charge|HUMANA CHOICE CARE|COMMERCIAL|methodology,additional_payer_notes|HUMANA CHOICE CARE|COMMERCIAL,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|negotiated_dollar,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|negotiated_percentage,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL|COMMERCIAL,standard_charge|HUMANA COMMERCIAL|COMMERCIAL|methodology,additional_payer_notes|HUMANA COMMERCIAL|COMMERCIAL,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_dollar,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_percentage,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA MEDICARE|MEDICARE,standard_charge|HUMANA MEDICARE|MEDICARE|methodology,additional_payer_notes|HUMANA MEDICARE|MEDICARE,standard_charge|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|NOVANET|COMMERCIAL|negotiated_dollar,standard_charge|NOVANET|COMMERCIAL|negotiated_percentage,standard_charge|NOVANET|COMMERCIAL|negotiated_algorithm,estimated_amount|NOVANET|COMMERCIAL,standard_charge|NOVANET|COMMERCIAL|methodology,additional_payer_notes|NOVANET|COMMERCIAL,standard_charge|PEACH STATE HEALTH PLAN|MEDICAID|negotiated_dollar,standard_charge|PEACH STATE HEALTH PLAN|MEDICAID|negotiated_percentage,standard_charge|PEACH STATE HEALTH PLAN|MEDICAID|negotiated_algorithm,estimated_amount|PEACH STATE HEALTH PLAN|MEDICAID,standard_charge|PEACH STATE HEALTH PLAN|MEDICAID|methodology,additional_payer_notes|PEACH STATE HEALTH PLAN|MEDICAID,standard_charge|PRIVATE HEALTHCARE SYSTEMS|COMMERCIAL|negotiated_dollar,standard_charge|PRIVATE HEALTHCARE SYSTEMS|COMMERCIAL|negotiated_percentage,standard_charge|PRIVATE HEALTHCARE SYSTEMS|COMMERCIAL|negotiated_algorithm,estimated_amount|PRIVATE HEALTHCARE SYSTEMS|COMMERCIAL,standard_charge|PRIVATE HEALTHCARE SYSTEMS|COMMERCIAL|methodology,additional_payer_notes|PRIVATE HEALTHCARE SYSTEMS|COMMERCIAL,standard_charge|TNGA|COMMERCIAL|negotiated_dollar,standard_charge|TNGA|COMMERCIAL|negotiated_percentage,standard_charge|TNGA|COMMERCIAL|negotiated_algorithm,estimated_amount|TNGA|COMMERCIAL,standard_charge|TNGA|COMMERCIAL|methodology,additional_payer_notes|TNGA|COMMERCIAL,standard_charge|TRICARE|MEDICARE|negotiated_dollar,standard_charge|TRICARE|MEDICARE|negotiated_percentage,standard_charge|TRICARE|MEDICARE|negotiated_algorithm,estimated_amount|TRICARE|MEDICARE,standard_charge|TRICARE|MEDICARE|methodology,additional_payer_notes|TRICARE|MEDICARE,standard_charge|UHC|COMMERCIAL|negotiated_dollar,standard_charge|UHC|COMMERCIAL|negotiated_percentage,standard_charge|UHC|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC|COMMERCIAL,standard_charge|UHC|COMMERCIAL|methodology,additional_payer_notes|UHC|COMMERCIAL,standard_charge|UHC MEDICARE|MEDICARE|negotiated_dollar,standard_charge|UHC MEDICARE|MEDICARE|negotiated_percentage,standard_charge|UHC MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|UHC MEDICARE|MEDICARE,standard_charge|UHC MEDICARE|MEDICARE|methodology,additional_payer_notes|UHC MEDICARE|MEDICARE,standard_charge|WELLCARE|MEDICARE|negotiated_dollar,standard_charge|WELLCARE|MEDICARE|negotiated_percentage,standard_charge|WELLCARE|MEDICARE|negotiated_algorithm,estimated_amount|WELLCARE|MEDICARE,standard_charge|WELLCARE|MEDICARE|methodology,additional_payer_notes|WELLCARE|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
RESPITE ROOM AND BOARD,100100003,CDM,100,RC,,,Inpatient,,,402,281.4,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,310.42,77.22,,248.34,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,333.66,83,,266.93,percent of total billed charges,83% of total,381.9,95,,305.52,percent of total billed charges ,95% of total billed charges,321.6,80,,257.28,percent of total billed charges,78% of total billed charges,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.54,381.9,
STANDARD R&B MEDICAL/SURG PRIV,111010002,CDM,111,RC,,,Inpatient,,,1071,749.7,,846.09,79,,676.87,percent of total billed charges,79% of total billed charges,963.9,90,,771.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,827.03,77.22,,661.62,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,888.93,83,,711.14,percent of total billed charges,83% of total,1017.45,95,,813.96,percent of total billed charges ,95% of total billed charges,856.8,80,,685.44,percent of total billed charges,78% of total billed charges,835.38,78,,668.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,910.35,85,,728.28,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,846.09,79,,676.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,827.03,1017.45,
STANDARD/PRIVATE R&B OB/GYN,111010003,CDM,111,RC,,,Inpatient,,,1392,974.4,,1099.68,79,,879.74,percent of total billed charges,79% of total billed charges,1252.8,90,,1002.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,1074.9,77.22,,859.92,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,1155.36,83,,924.29,percent of total billed charges,83% of total,1322.4,95,,1057.92,percent of total billed charges ,95% of total billed charges,1113.6,80,,890.88,percent of total billed charges,78% of total billed charges,1085.76,78,,868.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,1183.2,85,,946.56,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1099.68,79,,879.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1074.9,1322.4,
STANDARD RM MED NEC PRIVATE,111100006,CDM,111,RC,,,Inpatient,,,670,469,,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,603,90,,482.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,517.37,77.22,,413.9,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,556.1,83,,444.88,percent of total billed charges,83% of total,636.5,95,,509.2,percent of total billed charges ,95% of total billed charges,536,80,,428.8,percent of total billed charges,78% of total billed charges,522.6,78,,418.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,603,90,,482.4,percent of total billed charges,90% of total billed charges,536,80,,428.8,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,569.5,85,,455.6,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,517.37,636.5,
LTC PVT ROOM & BOARD,111100007,CDM,111,RC,,,Inpatient,,,269.26,188.48,,212.72,79,,170.18,percent of total billed charges,79% of total billed charges,242.33,90,,193.86,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,207.92,77.22,,166.34,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,223.49,83,,178.79,percent of total billed charges,83% of total,255.8,95,,204.64,percent of total billed charges ,95% of total billed charges,215.41,80,,172.33,percent of total billed charges,78% of total billed charges,210.02,78,,168.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.33,90,,193.86,percent of total billed charges,90% of total billed charges,215.41,80,,172.33,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,228.87,85,,183.096,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,212.72,79,,170.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.92,255.8,
PERSONAL CARE STANDARD PRIVATE,119500100,CDM,119,RC,,,Inpatient,,,2450,1715,,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,2205,90,,1764,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,1891.89,77.22,,1513.51,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,2033.5,83,,1626.8,percent of total billed charges,83% of total,2327.5,95,,1862,percent of total billed charges ,95% of total billed charges,1960,80,,1568,percent of total billed charges,78% of total billed charges,1911,78,,1528.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2205,90,,1764,percent of total billed charges,90% of total billed charges,1960,80,,1568,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,2082.5,85,,1666,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1891.89,2327.5,
PERSONAL CARE COUPLE ST PVT,119500130,CDM,119,RC,,,Inpatient,,,1750,1225,,1382.5,79,,1106,percent of total billed charges,79% of total billed charges,1575,90,,1260,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,1351.35,77.22,,1081.08,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,1452.5,83,,1162,percent of total billed charges,83% of total,1662.5,95,,1330,percent of total billed charges ,95% of total billed charges,1400,80,,1120,percent of total billed charges,78% of total billed charges,1365,78,,1092,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1575,90,,1260,percent of total billed charges,90% of total billed charges,1400,80,,1120,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,1487.5,85,,1190,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1382.5,79,,1106,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1351.35,1662.5,
ALF RESPITE STD PVT/DAY,119500160,CDM,119,RC,,,Inpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,84.94,104.5,
STANDARD R&B MED/SURG SEMIPRIV,121100001,CDM,121,RC,,,Inpatient,,,720,504,,568.8,79,,455.04,percent of total billed charges,79% of total billed charges,648,90,,518.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,555.98,77.22,,444.78,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,597.6,83,,478.08,percent of total billed charges,83% of total,684,95,,547.2,percent of total billed charges ,95% of total billed charges,576,80,,460.8,percent of total billed charges,78% of total billed charges,561.6,78,,449.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,612,85,,489.6,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,568.8,79,,455.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,555.98,684,
LTC SEMI PVT ROOM & BOARD,121100008,CDM,121,RC,,,Inpatient,,,259.26,181.48,,204.82,79,,163.86,percent of total billed charges,79% of total billed charges,233.33,90,,186.66,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,77.22,,160.16,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,215.19,83,,172.15,percent of total billed charges,83% of total,246.3,95,,197.04,percent of total billed charges ,95% of total billed charges,207.41,80,,165.93,percent of total billed charges,78% of total billed charges,202.22,78,,161.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.33,90,,186.66,percent of total billed charges,90% of total billed charges,207.41,80,,165.93,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,220.37,85,,176.296,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.82,79,,163.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,200.2,246.3,
PERSONAL CARE/REHAB SEMI PRIV,128500120,CDM,128,RC,,,Inpatient,,,1600,1120,,1264,79,,1011.2,percent of total billed charges,79% of total billed charges,1440,90,,1152,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,1235.52,77.22,,988.42,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,1328,83,,1062.4,percent of total billed charges,83% of total,1520,95,,1216,percent of total billed charges ,95% of total billed charges,1280,80,,1024,percent of total billed charges,78% of total billed charges,1248,78,,998.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,1360,85,,1088,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1264,79,,1011.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1235.52,1520,
ALF RESPITE/REHAB SEMI PVT/DAY,128500170,CDM,128,RC,,,Inpatient,,,58,40.6,,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,44.79,77.22,,35.83,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,48.14,83,,38.51,percent of total billed charges,83% of total,55.1,95,,44.08,percent of total billed charges ,95% of total billed charges,46.4,80,,37.12,percent of total billed charges,78% of total billed charges,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.79,55.1,
SWINGBED RM/SP AND BOARD,129100005,CDM,129,RC,,,Inpatient,,,430,301,,339.7,79,,271.76,percent of total billed charges,79% of total billed charges,387,90,,309.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,332.05,77.22,,265.64,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,356.9,83,,285.52,percent of total billed charges,83% of total,408.5,95,,326.8,percent of total billed charges ,95% of total billed charges,344,80,,275.2,percent of total billed charges,78% of total billed charges,335.4,78,,268.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,365.5,85,,292.4,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,339.7,79,,271.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,332.05,408.5,
PERSONAL CARE LARGE PRIVATE,149500110,CDM,149,RC,,,Inpatient,,,2750,1925,,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,2475,90,,1980,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,2123.55,77.22,,1698.84,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,2282.5,83,,1826,percent of total billed charges,83% of total,2612.5,95,,2090,percent of total billed charges ,95% of total billed charges,2200,80,,1760,percent of total billed charges,78% of total billed charges,2145,78,,1716,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2475,90,,1980,percent of total billed charges,90% of total billed charges,2200,80,,1760,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,2337.5,85,,1870,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2123.55,2612.5,
PERSONAL CARE COUPLE LGE PVT,149500140,CDM,149,RC,,,Inpatient,,,1900,1330,,1501,79,,1200.8,percent of total billed charges,79% of total billed charges,1710,90,,1368,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,1467.18,77.22,,1173.74,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,1577,83,,1261.6,percent of total billed charges,83% of total,1805,95,,1444,percent of total billed charges ,95% of total billed charges,1520,80,,1216,percent of total billed charges,78% of total billed charges,1482,78,,1185.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1710,90,,1368,percent of total billed charges,90% of total billed charges,1520,80,,1216,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,1615,85,,1292,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1501,79,,1200.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1467.18,1805,
ALF RESPITE LGE PVT/DAY,149500150,CDM,149,RC,,,Inpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,102,85,,81.6,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.66,114,
PERSONAL CARE SUITE PRIVATE,149500160,CDM,149,RC,,,Inpatient,,,4900,3430,,3871,79,,3096.8,percent of total billed charges,79% of total billed charges,4410,90,,3528,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,3783.78,77.22,,3027.02,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,4067,83,,3253.6,percent of total billed charges,83% of total,4655,95,,3724,percent of total billed charges ,95% of total billed charges,3920,80,,3136,percent of total billed charges,78% of total billed charges,3822,78,,3057.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4410,90,,3528,percent of total billed charges,90% of total billed charges,3920,80,,3136,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,4165,85,,3332,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3871,79,,3096.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3783.78,4655,
PERSONAL CARE SUITE CPLE PVT,149500180,CDM,149,RC,,,Inpatient,,,2450,1715,,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,2205,90,,1764,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,1891.89,77.22,,1513.51,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,2033.5,83,,1626.8,percent of total billed charges,83% of total,2327.5,95,,1862,percent of total billed charges ,95% of total billed charges,1960,80,,1568,percent of total billed charges,78% of total billed charges,1911,78,,1528.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2205,90,,1764,percent of total billed charges,90% of total billed charges,1960,80,,1568,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,2082.5,85,,1666,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1891.89,2327.5,
LTC LOA BED HOLD,111100010,CDM,169,RC,,,Inpatient,,,181.62,127.13,,143.48,79,,114.78,percent of total billed charges,79% of total billed charges,163.46,90,,130.77,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,140.25,77.22,,112.2,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,150.74,83,,120.59,percent of total billed charges,83% of total,172.54,95,,138.03,percent of total billed charges ,95% of total billed charges,145.3,80,,116.24,percent of total billed charges,78% of total billed charges,141.66,78,,113.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.46,90,,130.77,percent of total billed charges,90% of total billed charges,145.3,80,,116.24,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,154.38,85,,123.504,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.48,79,,114.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,140.25,172.54,
PERSONAL CARE PLUS FEE,EPC000001,CDM,169,RC,,,Inpatient,,,550,385,,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,495,90,,396,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,424.71,77.22,,339.77,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,456.5,83,,365.2,percent of total billed charges,83% of total,522.5,95,,418,percent of total billed charges ,95% of total billed charges,440,80,,352,percent of total billed charges,78% of total billed charges,429,78,,343.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495,90,,396,percent of total billed charges,90% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,467.5,85,,374,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,424.71,522.5,
NEWBORN ROUTINE CARE LEVEL 1,171100004,CDM,171,RC,,,Inpatient,,,560,392,,442.4,79,,353.92,percent of total billed charges,79% of total billed charges,504,90,,403.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,432.43,77.22,,345.94,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,464.8,83,,371.84,percent of total billed charges,83% of total,532,95,,425.6,percent of total billed charges ,95% of total billed charges,448,80,,358.4,percent of total billed charges,78% of total billed charges,436.8,78,,349.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,90,,403.2,percent of total billed charges,90% of total billed charges,448,80,,358.4,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,476,85,,380.8,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,442.4,79,,353.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,432.43,532,
ISOLLETTE SPECIAL CARE,171100006,CDM,172,RC,,,Inpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,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,,,,,other,not seperately reimbursable,544,85,,435.2,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,494.21,608,
ICU ROOM AND BOARD,202100002,CDM,202,RC,,,Inpatient,,,1310,917,,1034.9,79,,827.92,percent of total billed charges,79% of total billed charges,1179,90,,943.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,1011.58,77.22,,809.26,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,1087.3,83,,869.84,percent of total billed charges,83% of total,1244.5,95,,995.6,percent of total billed charges ,95% of total billed charges,1048,80,,838.4,percent of total billed charges,78% of total billed charges,1021.8,78,,817.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1179,90,,943.2,percent of total billed charges,90% of total billed charges,1048,80,,838.4,percent of total billed charges,80% of total billed charges,,,,,other,not seperately reimbursable,1113.5,85,,890.8,percent of total billed charges,85% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1034.9,79,,827.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1011.58,1244.5,
MISC TRANSFER PROCEDURE,220000555,CDM,220,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PROCEDURE INCOMPLETE,230001018,CDM,230,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ABSCESS SKIN/COMP BEDSIDE,230010061,CDM,230,RC,10061,HCPCS,outpatient,,,719,503.3,,568.01,79,,454.41,percent of total billed charges,79% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,555.21,77.22,,444.17,percent of total billed charges,77.22% of total billed charges,475.26,66.1,,380.21,percent of total billed charges,66.1% of total billed charges,596.77,83,,477.42,percent of total billed charges,83% of total,683.05,95,,546.44,percent of total billed charges ,95% of total billed charges,575.2,80,,460.16,percent of total billed charges,78% of total billed charges,560.82,78,,448.656,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,568.01,79,,454.41,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,683.05,
BEDSIDE FB REMOVAL SQ W/INC CO,230010121,CDM,230,RC,,,outpatient,,,2408,1685.6,,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,1859.46,77.22,,1487.57,percent of total billed charges,77.22% of total billed charges,1591.69,66.1,,1273.35,percent of total billed charges,66.1% of total billed charges,1998.64,83,,1598.91,percent of total billed charges,83% of total,2287.6,95,,1830.08,percent of total billed charges ,95% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,78% of total billed charges,1878.24,78,,1502.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,80% of total billed charges,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,2046.8,85,,1637.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2287.6,
BEDSIDE ASPIRATE ABSCESS/CYST,230010160,CDM,230,RC,,,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,194.04,450,
BEDSIDE SKIN BX EA ADDL LESION,230011101,CDM,230,RC,,,outpatient,,,156,109.2,,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,120.46,77.22,,96.37,percent of total billed charges,77.22% of total billed charges,103.12,66.1,,82.5,percent of total billed charges,66.1% of total billed charges,129.48,83,,103.58,percent of total billed charges,83% of total,148.2,95,,118.56,percent of total billed charges ,95% of total billed charges,124.8,80,,99.84,percent of total billed charges,78% of total billed charges,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.28,450,
TANGNTL BX SKIN SINGLE LESION,230011102,CDM,230,RC,11102,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
TANGENTIAL BX SKIN EA SEP/A,230011103,CDM,230,RC,11103,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
PUNCH BX SKIN EA SEP/ADDL,230011105,CDM,230,RC,11105,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
INCISIONAL BX SKIN SGL LESION,230011106,CDM,230,RC,11106,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,875.9,
INCISIONAL BX SKIN EA SEP/ADDL,230011107,CDM,230,RC,11107,HCPCS,outpatient,,,461,322.7,,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,414.9,90,,331.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,355.98,77.22,,284.78,percent of total billed charges,77.22% of total billed charges,304.72,66.1,,243.78,percent of total billed charges,66.1% of total billed charges,382.63,83,,306.1,percent of total billed charges,83% of total,437.95,95,,350.36,percent of total billed charges ,95% of total billed charges,368.8,80,,295.04,percent of total billed charges,78% of total billed charges,359.58,78,,287.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,391.85,85,,313.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,290.43,450,
REM SKIN TAG 1-15 LESI BEDSIDE,230011200,CDM,230,RC,11200,HCPCS,outpatient,,,437,305.9,,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,337.45,77.22,,269.96,percent of total billed charges,77.22% of total billed charges,288.86,66.1,,231.09,percent of total billed charges,66.1% of total billed charges,362.71,83,,290.17,percent of total billed charges,83% of total,415.15,95,,332.12,percent of total billed charges ,95% of total billed charges,349.6,80,,279.68,percent of total billed charges,78% of total billed charges,340.86,78,,272.688,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,349.6,80,,279.68,percent of total billed charges,80% of total billed charges,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,371.45,85,,297.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,450,
MNL PREP & INJ DP RX DLVR DEV,230020700,CDM,230,RC,20700,HCPCS,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.86,450,
RMVL DEEP RX DELIVERY DEVICE,230020701,CDM,230,RC,20701,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,118.98,66.1,,95.18,percent of total billed charges,66.1% of total billed charges,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.4,450,
MNL PREP&INSJ IMED RX DEL,230020702,CDM,230,RC,20702,HCPCS,outpatient,,,165,115.5,,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,127.41,77.22,,101.93,percent of total billed charges,77.22% of total billed charges,109.07,66.1,,87.26,percent of total billed charges,66.1% of total billed charges,136.95,83,,109.56,percent of total billed charges,83% of total,156.75,95,,125.4,percent of total billed charges ,95% of total billed charges,132,80,,105.6,percent of total billed charges,78% of total billed charges,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.95,450,
RMVL IMED RX DELIVERY DEVICE,230020703,CDM,230,RC,20703,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
MNL PRE&INS IARTIC RX DEL,230020704,CDM,230,RC,20704,HCPCS,outpatient,,,1920,1344,,1516.8,79,,1213.44,percent of total billed charges,79% of total billed charges,1728,90,,1382.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1209.6,63,,967.68,percent of total billed charges,63% of total billed charges,1482.62,77.22,,1186.1,percent of total billed charges,77.22% of total billed charges,1269.12,66.1,,1015.3,percent of total billed charges,66.1% of total billed charges,1593.6,83,,1274.88,percent of total billed charges,83% of total,1824,95,,1459.2,percent of total billed charges ,95% of total billed charges,1536,80,,1228.8,percent of total billed charges,78% of total billed charges,1497.6,78,,1198.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1209.6,63,,967.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1728,90,,1382.4,percent of total billed charges,90% of total billed charges,1536,80,,1228.8,percent of total billed charges,80% of total billed charges,1209.6,63,,967.68,percent of total billed charges,63% of total billed charges,1632,85,,1305.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1516.8,79,,1213.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1824,
RMVL IARTIC RX DELIVERY DEV,230020705,CDM,230,RC,20705,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,403.2,608,
ABSCESS FINGER COMP BEDSIDE,230026011,CDM,230,RC,26011,HCPCS,outpatient,,,3233,2263.1,,2554.07,79,,2043.26,percent of total billed charges,79% of total billed charges,2909.7,90,,2327.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2036.79,63,,1629.43,percent of total billed charges,63% of total billed charges,2496.52,77.22,,1997.22,percent of total billed charges,77.22% of total billed charges,2137.01,66.1,,1709.61,percent of total billed charges,66.1% of total billed charges,2683.39,83,,2146.71,percent of total billed charges,83% of total,3071.35,95,,2457.08,percent of total billed charges ,95% of total billed charges,2586.4,80,,2069.12,percent of total billed charges,78% of total billed charges,2521.74,78,,2017.392,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2036.79,63,,1629.43,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2909.7,90,,2327.76,percent of total billed charges,90% of total billed charges,2586.4,80,,2069.12,percent of total billed charges,80% of total billed charges,2036.79,63,,1629.43,percent of total billed charges,63% of total billed charges,2748.05,85,,2198.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2554.07,79,,2043.26,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3071.35,
BS CNTRL NOSE BLEED ANTER SIMP,230030901,CDM,230,RC,,,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,194.04,450,
BS INSRT MIDLINE CATH 3Y>US GU,230036410,CDM,230,RC,36410,HCPCS,outpatient,,,367,256.9,,289.93,79,,231.94,percent of total billed charges,79% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,283.4,77.22,,226.72,percent of total billed charges,77.22% of total billed charges,242.59,66.1,,194.07,percent of total billed charges,66.1% of total billed charges,304.61,83,,243.69,percent of total billed charges,83% of total,348.65,95,,278.92,percent of total billed charges ,95% of total billed charges,293.6,80,,234.88,percent of total billed charges,78% of total billed charges,286.26,78,,229.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,289.93,79,,231.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,231.21,450,
VENIPUNCTURE CUTDOWN 1YR OR >,230036425,CDM,230,RC,,,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,98.75,79,,79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.75,450,
INSJ PICC RS&I 5 YR+,230036573,CDM,230,RC,36573,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2250.96,77.22,,1800.77,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,2769.25,
BEDSIDE DECLOT VASCULAR DEVICE,230036593,CDM,230,RC,36593,HCPCS,outpatient,,,774,541.8,,611.46,79,,489.17,percent of total billed charges,79% of total billed charges,696.6,90,,557.28,percent of total billed charges,90% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,453.08,160,,,Fee Schedule,160% of CMS OPPS rate,368.13,130,,,Fee Schedule,130% of CMS OPPS rate,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,597.68,77.22,,478.14,percent of total billed charges,77.22% of total billed charges,511.61,66.1,,409.29,percent of total billed charges,66.1% of total billed charges,642.42,83,,513.94,percent of total billed charges,83% of total,735.3,95,,588.24,percent of total billed charges ,95% of total billed charges,619.2,80,,495.36,percent of total billed charges,78% of total billed charges,603.72,78,,482.976,percent of total billed charges,78% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,263.35,93,,,fee schedule,93% of CMS OPPS rate,611.46,79,,489.17,percent of total billed charges,79% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,263.35,735.3,
RE-EXPLORATION PELVIC WOUND,230049014,CDM,230,RC,49014,HCPCS,outpatient,,,796,557.2,,628.84,79,,503.07,percent of total billed charges,79% of total billed charges,716.4,90,,573.12,percent of total billed charges,90% of total billed charges,796,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,796,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,796,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,501.48,63,,401.18,percent of total billed charges,63% of total billed charges,614.67,77.22,,491.74,percent of total billed charges,77.22% of total billed charges,526.16,66.1,,420.93,percent of total billed charges,66.1% of total billed charges,660.68,83,,528.54,percent of total billed charges,83% of total,756.2,95,,604.96,percent of total billed charges ,95% of total billed charges,636.8,80,,509.44,percent of total billed charges,78% of total billed charges,620.88,78,,496.704,percent of total billed charges,78% of total billed charges,796,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,501.48,63,,401.18,percent of total billed charges,63% of total billed charges,796,100,,,fee schedule,100% of CMS fee schedule,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,501.48,63,,401.18,percent of total billed charges,63% of total billed charges,676.6,85,,541.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,796,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,628.84,79,,503.07,percent of total billed charges,79% of total billed charges,796,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,796,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,450,796,
BS BLADDER CATH TEMP INDWELL,230051702,CDM,230,RC,51702,HCPCS,outpatient,,,283,198.1,,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,100,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,218.53,77.22,,174.82,percent of total billed charges,77.22% of total billed charges,187.06,66.1,,149.65,percent of total billed charges,66.1% of total billed charges,234.89,83,,187.91,percent of total billed charges,83% of total,268.85,95,,215.08,percent of total billed charges ,95% of total billed charges,226.4,80,,181.12,percent of total billed charges,78% of total billed charges,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
ABSCESS VULVA/PERINEAL BEDSIDE,230056405,CDM,230,RC,,,outpatient,,,339,237.3,,267.81,79,,214.25,percent of total billed charges,79% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213.57,63,,170.86,percent of total billed charges,63% of total billed charges,261.78,77.22,,209.42,percent of total billed charges,77.22% of total billed charges,224.08,66.1,,179.26,percent of total billed charges,66.1% of total billed charges,281.37,83,,225.1,percent of total billed charges,83% of total,322.05,95,,257.64,percent of total billed charges ,95% of total billed charges,271.2,80,,216.96,percent of total billed charges,78% of total billed charges,264.42,78,,211.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,213.57,63,,170.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,213.57,63,,170.86,percent of total billed charges,63% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,267.81,79,,214.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,213.57,450,
DEBRIDE OPEN WND BS/OBS 20 SQ,230097597,CDM,230,RC,97597,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
NEG PRES WND THER<50CM BEDSIDE,230097605,CDM,230,RC,97605,HCPCS,outpatient,,,715,500.5,,564.85,79,,451.88,percent of total billed charges,79% of total billed charges,643.5,90,,514.8,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,552.12,77.22,,441.7,percent of total billed charges,77.22% of total billed charges,472.62,66.1,,378.1,percent of total billed charges,66.1% of total billed charges,593.45,83,,474.76,percent of total billed charges,83% of total,679.25,95,,543.4,percent of total billed charges ,95% of total billed charges,572,80,,457.6,percent of total billed charges,78% of total billed charges,557.7,78,,446.16,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,643.5,90,,514.8,percent of total billed charges,90% of total billed charges,572,80,,457.6,percent of total billed charges,80% of total billed charges,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,607.75,85,,486.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,564.85,79,,451.88,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,679.25,
NEG PRES WND THER>50CM BEDSIDE,230097606,CDM,230,RC,97606,HCPCS,outpatient,,,1059,741.3,,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,817.76,77.22,,654.21,percent of total billed charges,77.22% of total billed charges,700,66.1,,560,percent of total billed charges,66.1% of total billed charges,878.97,83,,703.18,percent of total billed charges,83% of total,1006.05,95,,804.84,percent of total billed charges ,95% of total billed charges,847.2,80,,677.76,percent of total billed charges,78% of total billed charges,826.02,78,,660.816,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,1006.05,
BS URINE SPEC COLL STRAIT CATH,2300P9612,CDM,230,RC,P9612,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,14.13,160,,,fee schedule,160% of CMS fee schedule,11.48,130,,,fee schedule,130% of CMS fee schedule,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,8.83,100,,,fee schedule,100% of CMS 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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.21,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.21,450,
BLOOD SUGAR DIAGNOSTIC 1 BX,250000175,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
COUMADIN CLINIC CP,250000215,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
VITAMIN A & D OINT 56GM,250015002,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
TYLENOL 5 GR SUPP,250015003,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
TYLENOL 10 GR SUPP,250015004,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
XYLOCAINE 2% 5ML VIAL INJ,250015005,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
EPINEPHrine HCL INJ 1 MG,250015010,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
EPINEPHrine HCL INJ 30MG VIAL,250015011,CDM,250,RC,,,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
AFRIN NASAL SPRAY 3ML,250015012,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
IBUPROFEN 200 MG TAB,250015013,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
BENEMID 500MG TABLET,250015017,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ALDACTONE 25MG TABLET,250015020,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
XYLOCAINE 4% TOP DOSE,250015022,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ALDOMET 0250G TABLET,250015026,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
NAPROXEN SODIUM 550 MG TAB,250015037,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ANCEF 1GM VIAL,250015039,CDM,250,RC,J0690,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.81,100,,,fee schedule,100% of GA fee schedule,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,0.85,105,,,fee schedule,105% of GA fee schedule,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.81,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.81,100,,,fee schedule,100% of GA fee schedule,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.81,450,
ANTILERUM 2ML AMP,250015043,CDM,250,RC,,,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
ANTIVERT 25MG TABLET UD,250015045,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
STARCH SUPPOSITORY,250015046,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ANUSOL HC SUPP,250015048,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
APLISOL INJECTION,250015049,CDM,250,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
APRESOLINE 50MG TABLET,250015050,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
APRESOLINE 25MG TABLET UD,250015051,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
APRESOLINE 20MG/ML VIAL,250015052,CDM,250,RC,,,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
AQUA-MEPHYTON 1 MG/0.5 ML,250015053,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
AQUA-MEPHYTON 10MG/ML AMP,250015054,CDM,250,RC,J3430,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.51,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,2.64,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.51,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.51,450,
TRIAMCINOLONE CREAM 0.025%,250015057,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ARTIFICIAL TEARS,250015060,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
ASA ENTC 325 MG TABLET,250015061,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
ASCORBIC ACID 500MG TABLET,250015062,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ASPIRIN 300MG SUPPOSITORY,250015068,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ASPIRIN 600MG SUPPOSITORY,250015069,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ASPIRIN TAB 81MG,250015070,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
ATARAX SYRUP 5ML,250015071,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ATARAX 25MG TABLET,250015072,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ATIVAN 1MG TABLET,250015073,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ATIVAN  .5MG TABLET,250015074,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
AUGMENTIN 500MG TABLET,250015077,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
AUGMENTIN 25OMG SUS 75ML,250015079,CDM,250,RC,A9270,HCPCS,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.76,450,
ATROPINE OPTH SOL 15ML,250015081,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
ATROPINE 1MG AMP,250015082,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
ATROVENT INHALER,250015083,CDM,250,RC,A9270,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
AZULFIDINE 500MG TABLET,250015089,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
"BACITRACIN 50,000U",250015090,CDM,250,RC,,,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,58.17,66.1,,46.54,percent of total billed charges,66.1% of total billed charges,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.44,450,
BACITRACIN OINT 15GM,250015091,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
THIAMINE/VIT B1 TABLET,250015092,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BACITRACIN OINT UD,250015095,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
BACTRIM DS TABLET,250015096,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BACTRIM PED SUSP 1 OZ,250015097,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
BACTRIM 10ML VIAL,250015099,CDM,250,RC,,,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
BENADRYL 50MG CAPSULE,250015100,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BENADRYL 25MG CAP,250015102,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BENADRYL CREAM,250015105,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
BENADRYL 50MG AMP,250015106,CDM,250,RC,J1200,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.75,100,,,fee schedule,100% of GA fee schedule,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,0.79,105,,,fee schedule,105% of GA fee schedule,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.75,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.75,100,,,fee schedule,100% of GA fee schedule,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.75,450,
BENEMID 500MG TABLET,250015107,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BENTYL 10MG CAP,250015108,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BENTYL 20MG CAP,250015109,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BENTYL 10 MG/ML INJECTION,250015110,CDM,250,RC,,,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
BENTYL SYRUP 5ML,250015111,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
BRETHINE 1MG/ML AMPUL,250015125,CDM,250,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
BUMEX TABLET 1MG,250015132,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BUMEX 1MG/4ML,250015134,CDM,250,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
BUMEX .5MG TABLETS,250015135,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BUSPAR 5MG TABLET,250015136,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CALAMINE LOTION 120ML,250015141,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CALAN 5MG/2ML AMPUL,250015142,CDM,250,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
CALAN 80MG TABLET,250015143,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CALAN SR 240MG CAP,250015144,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CALAN SR 180MG TABLET,250015145,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CALCIUM GLUCONATE 1000 MG VIAL,250015149,CDM,250,RC,J0610,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
VOLTRAREN 50MG TAB EC,250015151,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CAPTOEN 25MG TABLET UD,250015152,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CARAFATE 1GM TABLET,250015155,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CARDIZEM 60 MG TAB,250015158,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CARDIZEM 120 MG CAP,250015160,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CATAPRES 0.1 MG TAB,250015163,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CATAPRES 0.2 MG TAB,250015164,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CATAPRES 0.1 MG TDSY,250015166,CDM,250,RC,A9270,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
KAON ELIXIR 1 OZ BOTTLE,250015172,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CELESOL BETAMETHASONE SOD 6MG,250015176,CDM,250,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
CENTRUM TABLET,250015178,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CEPACOL THROAT LOZENGES,250015179,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CETACAINE SPRAY DOSE,250015180,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CEPASTAT LOZENGE 18'S,250015181,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHLORASEPTIC LOZENGES 18'S,250015185,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHLORASEPTIC SPRAY 6 OZ,250015186,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHRONULAC SYRUP,250015188,CDM,250,RC,A9270,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
CHRONULAC 8 OZ,250015189,CDM,250,RC,A9270,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,99.81,66.1,,79.85,percent of total billed charges,66.1% of total billed charges,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.13,450,
MAG CITRATE 10 OZ,250015190,CDM,250,RC,A9270,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
CIPRO 500MG TABLET,250015193,CDM,250,RC,A9270,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
CLAFORAN 1 GM,250015194,CDM,250,RC,J0698,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.8,100,,,fee schedule,100% of GA fee schedule,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,10.29,105,,,fee schedule,105% of GA fee schedule,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.8,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,9.8,100,,,fee schedule,100% of GA fee schedule,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.8,450,
CLEOCIN 15OMG CAPSULE,250015196,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CLEOCIN 600MG VIAL,250015198,CDM,250,RC,,,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.05,450,
CLEOCIN 90OMG IV,250015199,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
COMPAZINE 25MG SUPPOSITORY,250015213,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
COMPAZINE 5MG TABLET,250015215,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
CORGARD 40MG TABLET,250015219,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CORTISONE ACETATE 10MG TABLET,250015223,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CORTISPORIN OTIC SUSP,250015224,CDM,250,RC,A9270,HCPCS,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
CORTROSYN 0.25MG/ML 1ML,250015225,CDM,250,RC,,,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,130.88,66.1,,104.7,percent of total billed charges,66.1% of total billed charges,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.74,450,
COUMADIN 5MG TABLET UD,250015226,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
COUMADIN 2.5MG TABLET,250015227,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
COUMADIN 10MG TABLET,250015228,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CYCLOGYL 1% 2ML OPTH SOL,250015229,CDM,250,RC,A9270,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
DALMANE 15MG CAPSULE UD,250015231,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
OXYCHLOROSENE SODIUM 2 GM BTL,250015233,CDM,250,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
DEBROX OTIC GTTS,250015238,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
DECADRON 4MG AMP,250015241,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
DECADRON ELIXIR 5ML,250015246,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DECADRON ELIXIR 1 OZ,250015247,CDM,250,RC,A9270,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
DECADRON 4MG TABLET,250015249,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DEMEROL 25MG INJECTION,250015251,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
DEMEROL 50MG TABLET,250015252,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
DEMEROL PCA 30ML,250015255,CDM,250,RC,,,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
DEMEROL 50MG AMP,250015256,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
DEMEROL 75MG AMP,250015257,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
DEPAKOTE 0250G TABLET,250015259,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DEPO MEDROL 40 MG VIAL,250015262,CDM,250,RC,J1030,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
DANTRIUM 20MG VIAL,250015264,CDM,250,RC,,,outpatient,,,468,327.6,,369.72,79,,295.78,percent of total billed charges,79% of total billed charges,421.2,90,,336.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.84,63,,235.87,percent of total billed charges,63% of total billed charges,361.39,77.22,,289.11,percent of total billed charges,77.22% of total billed charges,309.35,66.1,,247.48,percent of total billed charges,66.1% of total billed charges,388.44,83,,310.75,percent of total billed charges,83% of total,444.6,95,,355.68,percent of total billed charges ,95% of total billed charges,374.4,80,,299.52,percent of total billed charges,78% of total billed charges,365.04,78,,292.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,294.84,63,,235.87,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,421.2,90,,336.96,percent of total billed charges,90% of total billed charges,374.4,80,,299.52,percent of total billed charges,80% of total billed charges,294.84,63,,235.87,percent of total billed charges,63% of total billed charges,397.8,85,,318.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,369.72,79,,295.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,294.84,450,
DESFERAL 500MG VIAL,250015266,CDM,250,RC,J0895,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.78,100,,,fee schedule,100% of GA fee schedule,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,7.12,105,,,fee schedule,105% of GA fee schedule,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.78,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,6.78,100,,,fee schedule,100% of GA fee schedule,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.78,450,
DERMAPLAST SPRAY,250015267,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
DEXTROSE 50% ISOJET,250015268,CDM,250,RC,,,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
MICRONASE 2.5MG TABLET UD,250015271,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
DIAMOX 0250G TABLET,250015273,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DIURIL SOD VIAL,250015278,CDM,250,RC,,,outpatient,,,214,149.8,,169.06,79,,135.25,percent of total billed charges,79% of total billed charges,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.82,63,,107.86,percent of total billed charges,63% of total billed charges,165.25,77.22,,132.2,percent of total billed charges,77.22% of total billed charges,141.45,66.1,,113.16,percent of total billed charges,66.1% of total billed charges,177.62,83,,142.1,percent of total billed charges,83% of total,203.3,95,,162.64,percent of total billed charges ,95% of total billed charges,171.2,80,,136.96,percent of total billed charges,78% of total billed charges,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,134.82,63,,107.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,134.82,63,,107.86,percent of total billed charges,63% of total billed charges,181.9,85,,145.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,169.06,79,,135.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.82,450,
DITROPAN 5MG TABLET,250015279,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DILANTIN 100MG CAPSULE,250015280,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DILANTIN 100MG VIAL,250015283,CDM,250,RC,J1165,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.44,100,,,fee schedule,100% of GA fee schedule,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
DILANTIN 125MG/5ML UD,250015284,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DILAUDID 2MG TABLET,250015286,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
DILANTIN 0250G VIAL,250015287,CDM,250,RC,J1165,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.44,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
DILAUDID 1MG AMP,250015289,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
DILAUDID 2MG AMP,250015290,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
DILAUDID 4MG AMP,250015292,CDM,250,RC,J1170,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.81,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,4,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.81,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,3.81,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.81,450,
DONNATAL ELIXIR 10ML,250015303,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DOPAMINE 200MG AMP,250015306,CDM,250,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
DOPRAM 20MG/ML ANESTH,250015307,CDM,250,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
DULCOLAX 10MG SUPPOSITORY,250015310,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
DULCOLAX 5MG TABLET,250015311,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
E-MYCIN 0250G TABLET,250015319,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ELAVIL 10MG TABLET,250015322,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ELAVIL 25MG TABLET UD,250015323,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DYAZIDE CAPSULE,250015324,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EMETROL 5ML DOSE,250015327,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EPHEDRINE 50MG AMP,250015333,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
EPIFOAM 10MG,250015334,CDM,250,RC,A9270,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
EPINEPHRINE HCL 1MG/10ML SYR,250015337,CDM,250,RC,J0171,HCPCS,outpatient,,,102,71.4,,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,78.76,77.22,,63.01,percent of total billed charges,77.22% of total billed charges,0.87,105,,,fee schedule,105% of GA fee schedule,84.66,83,,67.73,percent of total billed charges,83% of total,96.9,95,,77.52,percent of total billed charges ,95% of total billed charges,81.6,80,,65.28,percent of total billed charges,78% of total billed charges,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.83,100,,,fee schedule,100% of GA fee schedule,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.83,450,
EPSOM SALT 4 OZ,250015338,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
ELAVIL 50MG TABLET,250015351,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FEOSOL ELIXIR 5ML,250015354,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
FER-IN-SOL DROPS,250015356,CDM,250,RC,A9270,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
FER-IN-SOL SYRUP 5ML,250015357,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FENTANYL 2ML AMP,250015358,CDM,250,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
FERROUS SULFATE 300MG TABLET,250015360,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FLAGYL 0250G TABLET,250015364,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FLAGYL 500MG TABLET,250015365,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FLEET ENEMA,250015366,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
FLEET PEDIATRIC ENEMA,250015368,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
FLEXERIL 10MG TABLET,250015369,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
FOLIC ACID 1MG TABLET,250015372,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FUNGIZONE 50MG VIAL,250015374,CDM,250,RC,J0285,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.96,100,,,fee schedule,100% of GA fee schedule,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,51.41,105,,,fee schedule,105% of GA fee schedule,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.96,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,48.96,100,,,fee schedule,100% of GA fee schedule,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.96,450,
FORTAZ 1 GM VIAL,250015377,CDM,250,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
GARAMYCIN PED 20MG/2ML,250015378,CDM,250,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
GARAMYCIN 80MG/2ML VIAL,250015379,CDM,250,RC,J1580,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.74,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,2.88,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.74,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.74,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.74,450,
GLYCERIN INFANT R/S,250015381,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
ZINACEF 1.5 GM VIAL,250015383,CDM,250,RC,J0697,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.88,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,1.97,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.88,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.88,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.88,450,
VOLTAREN 50MG TABLET,250015384,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
GLUCOTROL 5MG TABLET,250015391,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
NULYTELY 4800ML,250015394,CDM,250,RC,A9270,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
GLYCERIN RECTAL SUPP ADULT,250015396,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
GLYCERINE RECTAL SUPP CHILD,250015397,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
HALDOL 1MG TABLET UD,250015405,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
HALDOL 5MG/ML AMP,250015406,CDM,250,RC,J1630,HCPCS,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.03,100,,,fee schedule,100% of GA fee schedule,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,1.08,105,,,fee schedule,105% of GA fee schedule,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.03,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.03,100,,,fee schedule,100% of GA fee schedule,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.03,450,
HALDOL .5MG TABLET,250015407,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
HALDOL 5MG TABLET,250015408,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
HEALON 10MG/ML .55ML,250015410,CDM,250,RC,,,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
HEPARIN FLUSH 100U/ML 5 ML SYR,250015412,CDM,250,RC,J1642,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.02,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,0.02,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.02,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.02,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.02,450,
HEPARIN 1000 U AMP,250015415,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
HEPARIN SODIUM 5MU/ML VIAL,250015416,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
HIBICLENS 4 OZ,250015418,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
HYCODAN SYRUP 5ML,250015419,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
HYDROCORTISONE CREAM 15GM 1%,250015422,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
HYDROCORTISON .5% CREAM,250015423,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
HYDROCORTONE 10MG TABLET,250015425,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
HCTZ 25MG TABLET UD,250015426,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
HCTZ 50MG TABLET,250015427,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
HURRACAINE SPRAY DOSE,250015436,CDM,250,RC,A9270,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
I N H 300MG TABLET,250015440,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ILOTYCIN 1PC OINTMENT,250015441,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
IMODIUM 2MG CAPSULE,250015443,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
IMODIUM A-D LIQUID,250015444,CDM,250,RC,A9270,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
INDERAL 10MG TABLET,250015446,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
INDERAL 1MG/ML AMPUL,250015447,CDM,250,RC,J1800,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.74,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,10.23,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.74,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,9.74,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.74,450,
INDERAL 80MG TABLET,250015448,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
INDERAL 20MG TABLET,250015449,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
INDERAL LA 60MG CAPSULE,250015450,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
INDERAL 40MG TABLET,250015451,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
INDOCIN 25MG CAPSULE,250015454,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
INDERAL LA 80MG CAPSULE,250015457,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ISORDIL 10MG TABLET,250015460,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ISORDIL TEMBID 40MG TABLET,250015462,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
K TAB 20 MEQ,250015467,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
K-LYTE/CL 25MEG,250015468,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
KAOPECTATE SUSPENSION,250015472,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
KAYEXALATE SUSP 15GM,250015473,CDM,250,RC,A9270,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
SOD POLYSTRENE SULF SUSP 15/60,250015475,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
KEFLEX 500MG CAPSULE,250015476,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
KEFLEX 250/5ML SUSP UD,250015478,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
KENALOG CREAM,250015480,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
LACTINEX GRANULES PKT,250015486,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LACTINEX TABLET,250015488,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LANOXIN .125 MG TABLET,250015489,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LANOXIN .25MG TABLET,250015490,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LANOXIN PED ELIXIR 120ML BT,250015491,CDM,250,RC,A9270,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.05,450,
LASIX 20MG VIAL,250015494,CDM,250,RC,J1940,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,0.42,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.4,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.4,450,
LASIX 40MG VIAL,250015495,CDM,250,RC,J1940,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,0.42,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.4,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.4,450,
LASIX 100MG VIAL,250015496,CDM,250,RC,J1940,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,0.42,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.4,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.4,450,
LASIX 20MG TABLET UD,250015497,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LASIX 40 MG TABLET UD,250015498,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LASIX 80MG TABLET,250015499,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LASIX LIQUID 120ML BOTTLE,250015500,CDM,250,RC,A9270,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
LEVOPHED 4ML AMP,250015501,CDM,250,RC,,,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,85.27,66.1,,68.22,percent of total billed charges,66.1% of total billed charges,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.27,450,
LEVSIN TABLET,250015503,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LEVSIN W/PB 15ML DROPS,250015504,CDM,250,RC,A9270,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
LEVSIN GTTS,250015505,CDM,250,RC,A9270,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
LIDOCAINE HCL 100MG/5 ML SYR,250015510,CDM,250,RC,J2001,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
LITHOBID 300MG TABLET,250015512,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
LOMOTIL 2.5MG TABLET,250015516,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
LOIRSEAL 10MG CAPSULE,250015517,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LOPRESSOR 50MG TABLET,250015518,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LOPRESSOR 100MG TAB,250015519,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LOPRESSOR 5MG AMP IV,250015520,CDM,250,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
LOPID 600MG CAP,250015521,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
LOZOL TABLET 2.5MG,250015526,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MTE 4 TRACE,250015533,CDM,250,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
MAGNESIUM OXIDE,250015539,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MARCAINE .75% 10ML VIAL,250015540,CDM,250,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
MARCAINE .75% 30ML VIAL,250015541,CDM,250,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
MARCAINE @ DEC AMP ANESTH,250015542,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
SENSORCAINE .25% 50 ML,250015545,CDM,250,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
MARCAINE .25% 10ML VIAL,250015546,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
MARCAINE .5% 50ML VIAL,250015547,CDM,250,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
MARCAINE .5% 10ML,250015548,CDM,250,RC,,,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,41.64,66.1,,33.31,percent of total billed charges,66.1% of total billed charges,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.69,450,
MASSE BREAST CREAM 2 OZ,250015549,CDM,250,RC,A9270,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
MAXITROL OPTH GTTS,250015550,CDM,250,RC,A9270,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
MEDROL DOSEPAK 4MG,250015553,CDM,250,RC,,,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
MEFOXIN 1GM VIAL,250015556,CDM,250,RC,,,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
MEFOXIN 2GM VIAL,250015557,CDM,250,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
METAMUCIL UD PER DOSE,250015565,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
METHERGINE TABLET,250015567,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
METHERGINE .2MG/ML AMPUL,250015568,CDM,250,RC,J2210,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.44,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.56,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.44,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.44,450,
MICRONASE 5MG TABLET UD,250015571,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MEVACOR 20MG TABLET,250015574,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
MOM 30CC,250015576,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
MINERAL OIL 30CC,250015577,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MINOCIN 100MG CAPSULE,250015581,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
MORPHINE 10MG AMP,250015588,CDM,250,RC,,,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,91.88,66.1,,73.5,percent of total billed charges,66.1% of total billed charges,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.57,450,
MONISTAT 7 VAGINAL CREAM,250015589,CDM,250,RC,A9270,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
MONISTAT 7 VAGINAL SUPPOSITORY,250015590,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MONISTAT 3 VAGINAL SUPPOSITORY,250015591,CDM,250,RC,A9270,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
MONISTAT DUO PKG,250015592,CDM,250,RC,A9270,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
MORPHINE 4MG AMP,250015594,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
MORPHINE PCA 30ML,250015596,CDM,250,RC,,,outpatient,,,155,108.5,,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,119.69,77.22,,95.75,percent of total billed charges,77.22% of total billed charges,102.46,66.1,,81.97,percent of total billed charges,66.1% of total billed charges,128.65,83,,102.92,percent of total billed charges,83% of total,147.25,95,,117.8,percent of total billed charges ,95% of total billed charges,124,80,,99.2,percent of total billed charges,78% of total billed charges,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.65,450,
MORPHINE 2MG INJECTION,250015598,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
MOTRIN 400MG TABLET,250015600,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MOTRIN 600MG TABLET UD,250015601,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MUCO MYST 20% 30ML VIAL,250015602,CDM,250,RC,,,outpatient,,,338,236.6,,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.94,63,,170.35,percent of total billed charges,63% of total billed charges,261,77.22,,208.8,percent of total billed charges,77.22% of total billed charges,223.42,66.1,,178.74,percent of total billed charges,66.1% of total billed charges,280.54,83,,224.43,percent of total billed charges,83% of total,321.1,95,,256.88,percent of total billed charges ,95% of total billed charges,270.4,80,,216.32,percent of total billed charges,78% of total billed charges,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,212.94,63,,170.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,212.94,63,,170.35,percent of total billed charges,63% of total billed charges,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,212.94,450,
MYCELEX TROCHE,250015607,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MYCOLOG CREAM 15GM,250015608,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
MYCOLOG OINT 15GM,250015609,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
MYCOSTATION CREAM,250015611,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
MYCOSTATIN ORAL SUSP,250015613,CDM,250,RC,A9270,HCPCS,outpatient,,,79,55.3,,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,61,77.22,,48.8,percent of total billed charges,77.22% of total billed charges,52.22,66.1,,41.78,percent of total billed charges,66.1% of total billed charges,65.57,83,,52.46,percent of total billed charges,83% of total,75.05,95,,60.04,percent of total billed charges ,95% of total billed charges,63.2,80,,50.56,percent of total billed charges,78% of total billed charges,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.77,450,
MYLICON 80MG TABLET,250015618,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MYLICON GTTS,250015619,CDM,250,RC,A9270,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
MYLICON GTTS DOSE,250015620,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
NARCAN .04MG/ML AMP,250015631,CDM,250,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
NESACAINE 3% 30ML VIAL,250015637,CDM,250,RC,,,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,450,
NEOSTIGMINE 1MG/ML ANESTH,250015638,CDM,250,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
NEO-SYNEPHRINE 10MG  AMP,250015643,CDM,250,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
NEODECADRON OPTH OINT,250015645,CDM,250,RC,A9270,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
NEOMYCIN 500MG TABLET,250015646,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
NEO SYN 1/4% NASAL SPRAY,250015647,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PHENYLEPHRINE 10% OPTH GTTS,250015648,CDM,250,RC,A9270,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
NEOSPORIN OPTH GTTS,250015650,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
NEOSPORIN OPTH OINT,250015651,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
NICORETTE GUM EACH PIECE,250015656,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
NOLVADEX CAPSULE,250015667,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
NORMODYNE 200MG TABLET,250015668,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
NORMODYNE 100MG TABLET,250015669,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
OCEAN NASAL SPRAY,250015675,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
NIPRIDE 10MG/ML VIAL,250015677,CDM,250,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
PANCREASE CAPSULE,250015687,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
PEN-VEE K 0250G TABLET,250015695,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PEN-VEE K 500MG TABLET,250015696,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PEPTO BISMOL 8 OZ,250015698,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
PEPTO BISMOL TABLET,250015700,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NIZORAL 200MG TABLET,250015701,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
PEPCID 20MG TABLET,250015706,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
PHENERGAN 25MG AMP,250015712,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PHENERGAN PLAIN EXP 5ML,250015715,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
PHENERGAN 25MG SUP,250015718,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
PHENERGAN 25MG TABLET,250015719,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PB 30MG TABLET,250015722,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
PB 100MG TABLET,250015723,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
PB  60MG TABLET,250015724,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
PILOCAR 2% 1ML UD OPTH,250015726,CDM,250,RC,A9270,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
PILOCAR 1% 1ML UD OPTH GTT,250015727,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
PHENERGAN 12.5MG SUPP,250015731,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PITOCIN 10U AMP,250015737,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PITRESSIN 20U AMP,250015738,CDM,250,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
POLYSPORIN OPTH OINT,250015747,CDM,250,RC,A9270,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.05,450,
PONTOCAINE 20MG AMP ANES,250015752,CDM,250,RC,,,outpatient,,,8.3,5.81,,6.56,79,,5.25,percent of total billed charges,79% of total billed charges,7.47,90,,5.98,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.23,63,,4.18,percent of total billed charges,63% of total billed charges,6.41,77.22,,5.13,percent of total billed charges,77.22% of total billed charges,5.49,66.1,,4.39,percent of total billed charges,66.1% of total billed charges,6.89,83,,5.51,percent of total billed charges,83% of total,7.89,95,,6.31,percent of total billed charges ,95% of total billed charges,6.64,80,,5.31,percent of total billed charges,78% of total billed charges,6.47,78,,5.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.23,63,,4.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7.47,90,,5.98,percent of total billed charges,90% of total billed charges,6.64,80,,5.31,percent of total billed charges,80% of total billed charges,5.23,63,,4.18,percent of total billed charges,63% of total billed charges,7.06,85,,5.648,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.56,79,,5.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.23,450,
POT ACETATE INJECTION,250015753,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
POT PHOSPHATE INJECTION,250015754,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PREMARIN VAGINAL CREAM,250015755,CDM,250,RC,A9270,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,126.25,66.1,,101,percent of total billed charges,66.1% of total billed charges,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.33,450,
PREMARIN .625MG TABLET,250015756,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PRIMAXIN 500MG VIAL,250015758,CDM,250,RC,J0743,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.96,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,7.31,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.96,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,6.96,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.96,450,
PROCARDIA 10MG CAPSULE,250015763,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PROSTAPHLIN 1GM VIAL,250015768,CDM,250,RC,J2700,HCPCS,outpatient,,,51.5,36.05,,40.69,79,,32.55,percent of total billed charges,79% of total billed charges,46.35,90,,37.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.87,100,,,fee schedule,100% of GA fee schedule,39.77,77.22,,31.82,percent of total billed charges,77.22% of total billed charges,0.91,105,,,fee schedule,105% of GA fee schedule,42.75,83,,34.2,percent of total billed charges,83% of total,48.93,95,,39.14,percent of total billed charges ,95% of total billed charges,41.2,80,,32.96,percent of total billed charges,78% of total billed charges,40.17,78,,32.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.87,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,46.35,90,,37.08,percent of total billed charges,90% of total billed charges,41.2,80,,32.96,percent of total billed charges,80% of total billed charges,0.87,100,,,fee schedule,100% of GA fee schedule,43.78,85,,35.024,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.69,79,,32.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.87,450,
HEMABATE 15M AMP,250015776,CDM,250,RC,,,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
PROVENTIL INHALER,250015780,CDM,250,RC,A9270,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
PROVERA 10MG TABLET,250015783,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
PYRIDIUM 200MG TABLET,250015785,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
REGLAN SYRUP 5MG/5ML,250015792,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
REGLAN 10MG TABLET,250015794,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
REGLAN 10MG AMP,250015796,CDM,250,RC,J2765,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.99,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,1.04,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.99,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.99,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.99,450,
RIFADIN 300MG CAPSULE,250015799,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
ROBAXIN 1000MG/10ML VIAL,250015801,CDM,250,RC,J2800,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.25,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,7.61,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.25,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,7.25,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.25,450,
ROBAXIN 500MG TABLET UD,250015802,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ROBAXIN 750MG TABLET,250015803,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ROBINUL 1MG TABLET,250015805,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ROBINUL ANES DOSE,250015806,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
SILVADENE CREAM 50GM,250015817,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
SILVADENE 400GM CREAM,250015818,CDM,250,RC,A9270,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,115.68,66.1,,92.54,percent of total billed charges,66.1% of total billed charges,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,110.25,450,
SINEMET 25/100 MG TAB,250015819,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SINEQUAN 25MG CAPSULE,250015822,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SODIUM ACETATE 20MG VIAL,250015829,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
SOD BICARB 4.2% ISOJET,250015830,CDM,250,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
SOD BICARB 8.4% CHILD,250015831,CDM,250,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
SOD BICARB ISOJET 50MEQ/50,250015832,CDM,250,RC,,,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
SODIUM BICARB 650MG TABLET,250015833,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MYSOLINE 0250G TABLET,250015834,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MYSOLINE 50MG TABLET,250015835,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SODIUM CHLORIDE 1 GM TAB,250015836,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SODIUM PHOSPHATE 3 MM/ML 15ML,250015837,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
Solu-CORTEF 1000MG INJ,250015838,CDM,250,RC,J1720,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.4,100,,,fee schedule,100% of GA fee schedule,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,20.37,105,,,fee schedule,105% of GA fee schedule,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,19.4,100,,,fee schedule,100% of GA fee schedule,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.4,450,
SOLU CORTEF 100MG VIAL,250015839,CDM,250,RC,J1720,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.4,100,,,fee schedule,100% of GA fee schedule,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,20.37,105,,,fee schedule,105% of GA fee schedule,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,19.4,100,,,fee schedule,100% of GA fee schedule,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.4,450,
Solu-CORTEF 500MG INJ,250015841,CDM,250,RC,J1720,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.4,100,,,fee schedule,100% of GA fee schedule,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,20.37,105,,,fee schedule,105% of GA fee schedule,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,19.4,100,,,fee schedule,100% of GA fee schedule,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.4,450,
SOLU MEDROL 40MG VIAL,250015842,CDM,250,RC,J2920,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
SOLU MEDROL 125MG VIAL,250015843,CDM,250,RC,J2930,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
SOLU MEDROL 500MG VIAL,250015844,CDM,250,RC,J2930,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
SOLU MEDROL 1000MG VIAL,250015845,CDM,250,RC,J2930,HCPCS,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.98,450,
SOMA-350 TABLET,250015849,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
STUARTNATAL 1+1 TABLET,250015857,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SYNTHROID .75MCG TABLET,250015858,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SYMMETREL 100MG CAPSULE,250015867,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SYNTHROID .05MCG TABLET,250015871,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SYNTHROID .15MCG TABLET,250015872,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SYNTHROID .125MG TABLET,250015873,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SYNTHROID .1MG TABLET,250015875,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TENORMIN 50MG TABLET,250015886,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TEGRETOL 200MG TABLET,250015892,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TERZOL 7 VAGINAL CREAM,250015897,CDM,250,RC,A9270,HCPCS,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.76,450,
TERAZOL 3 VAGINAL SUPPOSITORY,250015898,CDM,250,RC,A9270,HCPCS,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.76,450,
TESSILON PERLES,250015902,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
THEODUR 200MG TABLET,250015903,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
THEODUR 300MG TABLET,250015904,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
THORAZINE 25MG TABLET,250015908,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
THROMBIN TOPICAL,250015910,CDM,250,RC,A9270,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,126.25,66.1,,101,percent of total billed charges,66.1% of total billed charges,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.33,450,
TIMOPTIC .25% OPTH GTTS,250015916,CDM,250,RC,A9270,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
TIMOPTIC .5 OPTH GTTS,250015917,CDM,250,RC,A9270,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
TRIMETHOPRIM 100 MG TAB,250015918,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TRIMETHOPRIM 100MG TABLET,250015921,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TOFRANIL 25MG TABLET,250015923,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TOBREX OPTH OINT 3.5GM,250015925,CDM,250,RC,A9270,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
TOPICORT OINT 15GM,250015927,CDM,250,RC,A9270,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
TORADOL 60MG IV/IM,250015930,CDM,250,RC,J1885,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,0.71,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.68,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.68,450,
TORADOL 30MG IV/IM,250015931,CDM,250,RC,J1885,HCPCS,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,0.71,105,,,fee schedule,105% of GA fee schedule,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.68,100,,,fee schedule,100% of GA fee schedule,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.68,450,
TRANSDERM NITRO 10 PTCH,250015934,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
TRANSDERM-SCOP DISK,250015936,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
TRANDATE 5MG/ML ANESTH,250015937,CDM,250,RC,,,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,115.68,66.1,,92.54,percent of total billed charges,66.1% of total billed charges,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,110.25,450,
TRENTAL CAPSULE,250015939,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TUCKS MEDICATED PAD,250015951,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
TUMS TABLETS,250015953,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ROBITUSSIN AC 5ML,250015954,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
ROCEPHIN 1GM VIAL,250015959,CDM,250,RC,J0696,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.44,100,,,fee schedule,100% of GA fee schedule,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
ROCEPHIN 0250G VIAL,250015960,CDM,250,RC,J0696,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.44,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
TYLENOL #3 TABLET,250015970,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
TYLENOL E/S CAPLET,250015977,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
TYLENOL 5GR TABLET,250015981,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
UNASYN 1.5 GM VIAL,250015986,CDM,250,RC,J0295,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.02,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,2.12,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.02,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.02,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.02,450,
UNASYN 3 GM VIAL,250015987,CDM,250,RC,J0295,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.02,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,2.12,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.02,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.02,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.02,450,
VALIUM 2MG TABLET,250015994,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
VASELINE TUBE 30GM,250016000,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
VASOTEC 10MG TABLET,250016001,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
VASOTEC 2ML VIAL,250016003,CDM,250,RC,,,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.05,450,
VERSED 10MG AMP,250016006,CDM,250,RC,J2250,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.13,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,0.14,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.13,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.13,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.13,450,
VERSED 2MG AMP,250016007,CDM,250,RC,J2250,HCPCS,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.13,100,,,fee schedule,100% of GA fee schedule,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,0.14,105,,,fee schedule,105% of GA fee schedule,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.13,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.13,100,,,fee schedule,100% of GA fee schedule,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.13,450,
VIBRAMYCIN IV 100MG VIAL,250016009,CDM,250,RC,,,outpatient,,,144,100.8,,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,111.2,77.22,,88.96,percent of total billed charges,77.22% of total billed charges,95.18,66.1,,76.14,percent of total billed charges,66.1% of total billed charges,119.52,83,,95.62,percent of total billed charges,83% of total,136.8,95,,109.44,percent of total billed charges ,95% of total billed charges,115.2,80,,92.16,percent of total billed charges,78% of total billed charges,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.72,450,
VIBRAMYCIN UD 100MG,250016010,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
VALIUM 5MG TABLET,250016014,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
HYDROXYZINE HCL 100MG/2ML VIAL,250016017,CDM,250,RC,J3410,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.41,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,13.03,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.41,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,12.41,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.41,450,
XANAX .5 MG TABLET,250016026,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
XANAX .25 MG TABLET,250016027,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
XYLOCAINE JELLY,250016028,CDM,250,RC,A9270,HCPCS,outpatient,,,102,71.4,,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,78.76,77.22,,63.01,percent of total billed charges,77.22% of total billed charges,67.42,66.1,,53.94,percent of total billed charges,66.1% of total billed charges,84.66,83,,67.73,percent of total billed charges,83% of total,96.9,95,,77.52,percent of total billed charges ,95% of total billed charges,81.6,80,,65.28,percent of total billed charges,78% of total billed charges,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.26,450,
XYLOCAINE 2% JELLY JET,250016029,CDM,250,RC,A9270,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
XYLOCAINE VISCOUS 2PC SOL,250016030,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
XYLOCAINE/EPINEPHRINE 2% 50 ML,250016031,CDM,250,RC,J2001,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
XYLOCAINE 1% 50MG/5ML VIAL,250016033,CDM,250,RC,J2001,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
XYLOCAINE 1% 30 ML VIAL,250016034,CDM,250,RC,J2001,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
XYLOCAINE 1% 100MG/10ML VIAL,250016035,CDM,250,RC,J2001,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
XYLOCAINE 2% 50ML VIAL,250016036,CDM,250,RC,J2001,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
XYLOCAINE .5% 0250G/50ML VIAL,250016039,CDM,250,RC,J2001,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
ZANTAC TABLET 150MG,250016043,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
ZAROXOLYN 2.5MG TABLET,250016044,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ZINC OXIDE OINT,250016046,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ZOVIRAX 200MG CAPSULE,250016047,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ZOVIRAX 5PC OINTMENT,250016048,CDM,250,RC,A9270,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.85,450,
ZYLOPRIM UD 100MG TABLET,250016049,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
AMPICILLIN 500MG VIAL,250016052,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
AMPICILLIN SODIUM 2GM VIAL,250016053,CDM,250,RC,J0290,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.78,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,0.82,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.78,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.78,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.78,450,
AMPICILLIN 0250G VIAL,250016055,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
AMOXIL 125 MG/5ML SUSPEN 150ML,250016060,CDM,250,RC,A9270,HCPCS,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
AMOXIL 0250G CAPSULE,250016062,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
AMOXIL 500MG CAPSULE,250016063,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BROMOCRIPTINE 2.5 TABLET,250016066,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
AMPICILLIN 500MG CAPSULE,250016070,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
AMPICILLIN 125MG VIAL,250016074,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
GENTAMICIN SULFATE 0.1% OINT,250016077,CDM,250,RC,A9270,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
GENTAMICIN SULF 0.3% EYE OINT,250016078,CDM,250,RC,A9270,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
BACTROBAN OINT TUBE,250016082,CDM,250,RC,A9270,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
DEHYDRATED ALCOHOL 98% 1ML AMP,250016083,CDM,250,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
GARAMYCIN EYE DROPS,250016084,CDM,250,RC,A9270,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
DECADRON 10MG INJECTION,250016086,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PREDNISONE 5MG TABLET,250016087,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PREDNISONE 20MG TABLET,250016088,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PREDNISONE 10MG TABLETS,250016089,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
K TABLET 10 MEQ,250016091,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
K LYTE 25 MEQ TABLET,250016092,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
KCL IV 40 MEQ VIAL,250016093,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
MVI-12 IV ADDITIVE,250016094,CDM,250,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
NTG 1/150 SL BOTTLE 25,250016095,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
NTG 1/200 SL TAB BOTTLE 100,250016096,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
ASPIRIN 5GR TABLET,250016098,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
PRED FORTE 1% OPTH GTTS,250016100,CDM,250,RC,A9270,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
DESYREL TABLET,250016101,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
THIAMINE 100MG IM,250016102,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PENICILLIN G 5 MIL U VIAL,250016103,CDM,250,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
B12 INJECTION,250016106,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
CHARCOAL 25GM LIQUID,250016111,CDM,250,RC,A9270,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
ATROPINE 0.1 MG/ML 5 ML SYR,250016113,CDM,250,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
VALIUM 10MG AMP,250016118,CDM,250,RC,J3360,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.83,100,,,fee schedule,100% of GA fee schedule,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,6.12,105,,,fee schedule,105% of GA fee schedule,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.83,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,5.83,100,,,fee schedule,100% of GA fee schedule,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.83,450,
THORAZINE 50MG AMPS,250016121,CDM,250,RC,J3230,HCPCS,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.71,100,,,fee schedule,100% of GA fee schedule,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,29.1,105,,,fee schedule,105% of GA fee schedule,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.71,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,27.71,100,,,fee schedule,100% of GA fee schedule,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.71,450,
COLACE 100MG CAPSULE,250016127,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BICILLIN CR 900/300 IM,250016129,CDM,250,RC,J0558,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,19.52,100,,,Fee Schedule,100% of CMS OPPS rate,31.23,160,,,Fee Schedule,160% of CMS OPPS rate,25.37,130,,,Fee Schedule,130% of CMS OPPS rate,19.52,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,20.5,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,19.52,100,,,Fee Schedule,100% of CMS OPPS rate,19.52,100,,,fee schedule,100% of GA fee schedule,19.52,100,,,Fee Schedule,100% of CMS OPPS rate,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,19.52,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.14,93,,,fee schedule,93% of CMS OPPS rate,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,19.52,100,,,Fee Schedule,100% of CMS OPPS rate,19.52,100,,,Fee Schedule,100% of CMS OPPS rate,18.14,450,
TYLENOL 2GR SUPP,250016130,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
ETHYL ALCOHOL 8 OZ ELIX,250016136,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LACRI-LUBE .7MG UD,250016139,CDM,250,RC,A9270,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
SODIUM CHLORIDE INJECTION,250016140,CDM,250,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
SODIUM CHLORIDE CONC VIAL,250016141,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
DILANTIN 125 SUSP,250016142,CDM,250,RC,A9270,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
EMETROL 1 OZ BOTTLE,250016147,CDM,250,RC,A9270,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
NUIRON TABLET,250016154,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PYRIDOXINE 50MG TAB,250016158,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
DIFLUCAN 200MG PREMIXED,250016159,CDM,250,RC,,,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,281.85,77.22,,225.48,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,229.95,450,
BSS 15 ML BT,250016170,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CEFTIN 0250G TAB,250016171,CDM,250,RC,A9270,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
DIFLUCAN 100MG TAB,250016173,CDM,250,RC,A9270,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
SLO-BID 300MG CAP,250016176,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
KEFLEX 0250G/5ML 100ML BT,250016186,CDM,250,RC,A9270,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
DIAMOX 500MG SEQUELS,250016188,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
XYLOCAINE 2% 5ML VIAL,250016198,CDM,250,RC,J2001,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
PRILOSEC 20 MG CAP,250016200,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
PROZAC 20MG CAPSULE,250016201,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
NEOSPORIN IRRIGANT AMP,250016210,CDM,250,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
PROGESTRONE 50MG/ML INJ,250016212,CDM,250,RC,J2675,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.73,100,,,fee schedule,100% of GA fee schedule,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,0.77,105,,,fee schedule,105% of GA fee schedule,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.73,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.73,100,,,fee schedule,100% of GA fee schedule,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.73,450,
TORADOL 10 MG TAB,250016224,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ROMAZICON 0.5MG/5ML VIAL,250016225,CDM,250,RC,,,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
ZESTRIL 5 MG TAB,250016228,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
VANCOMYCIN 1 GM VIAL,250016232,CDM,250,RC,J3370,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,100,,,fee schedule,100% of GA fee schedule,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,2.27,105,,,fee schedule,105% of GA fee schedule,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.16,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.16,100,,,fee schedule,100% of GA fee schedule,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.16,450,
DIBUCAINE OINTMENT,250016235,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
ZOLOFT 50 MG TAB,250016237,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
STERILE WATER INJECTION 10 ML,250016240,CDM,250,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
ATROPINE 1% 2ML OPTH GTT,250016242,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
IMITREX 6MG INJ,250016244,CDM,250,RC,J3030,HCPCS,outpatient,,,196,137.2,,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.75,100,,,fee schedule,100% of GA fee schedule,151.35,77.22,,121.08,percent of total billed charges,77.22% of total billed charges,65.89,105,,,fee schedule,105% of GA fee schedule,162.68,83,,130.14,percent of total billed charges,83% of total,186.2,95,,148.96,percent of total billed charges ,95% of total billed charges,156.8,80,,125.44,percent of total billed charges,78% of total billed charges,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,62.75,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,62.75,100,,,fee schedule,100% of GA fee schedule,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.75,450,
DURAGESIC 25MCG/HR PATCH,250016249,CDM,250,RC,A9270,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
CARDIZEM 240MG CAPSULE,250016252,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
SUDAFED SYRUP 30MG/120ML,250016253,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
PROVENTIL NEBULIZING SOLUTION,250016257,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
ISOSORBIDE DINIT 20MG TABS,250016267,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BENZOIN TINC 60 ML BTL,250016268,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CARDURA 1MG TABLET,250016270,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
RESTORIL 15MG CAPSULE,250016271,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
DILTIAZEM HCL 180 MG CAPCR,250016273,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
PROCAINAMIDE HCL SR 500MG TAB,250016277,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PROSTIN VR PEDIATRIC,250016278,CDM,250,RC,,,outpatient,,,262,183.4,,206.98,79,,165.58,percent of total billed charges,79% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.06,63,,132.05,percent of total billed charges,63% of total billed charges,202.32,77.22,,161.86,percent of total billed charges,77.22% of total billed charges,173.18,66.1,,138.54,percent of total billed charges,66.1% of total billed charges,217.46,83,,173.97,percent of total billed charges,83% of total,248.9,95,,199.12,percent of total billed charges ,95% of total billed charges,209.6,80,,167.68,percent of total billed charges,78% of total billed charges,204.36,78,,163.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,165.06,63,,132.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,165.06,63,,132.05,percent of total billed charges,63% of total billed charges,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,206.98,79,,165.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165.06,450,
XYLOCAINE 1% 500MG/50ML VIAL,250016279,CDM,250,RC,J2001,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
MODURETIC TABLETS,250016280,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
TEGRETOL 100MG CHEW TABLET,250016284,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PREMARIN 0.3MG TABLETS,250016286,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PAXIL 20MG CAPSULES,250016294,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
NIZORAL CREAM 15GM,250016297,CDM,250,RC,A9270,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
MACROBID CAPSULES 100MG,250016304,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CLEOCIN 75MG/5ML PED SUSP,250016312,CDM,250,RC,A9270,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
BIAXIN 500MG CAPSULE,250016325,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
SLOW-MAG TABLETT S,250016327,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
METROGEL VAGINAL,250016328,CDM,250,RC,A9270,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
TENORMIN 25MG TABLET,250016331,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
VITAMIN E CAPSULES 400 U,250016343,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
LOTENSIN 10MG TABLETS,250016348,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CORDARONE 200MG TABLETS,250016349,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
CATAPRES 0.2 MG TDSY,250016352,CDM,250,RC,A9270,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
AZTREONAM FOR INJ 2GM VIAL,250016354,CDM,250,RC,,,outpatient,,,273,191.1,,215.67,79,,172.54,percent of total billed charges,79% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,210.81,77.22,,168.65,percent of total billed charges,77.22% of total billed charges,180.45,66.1,,144.36,percent of total billed charges,66.1% of total billed charges,226.59,83,,181.27,percent of total billed charges,83% of total,259.35,95,,207.48,percent of total billed charges ,95% of total billed charges,218.4,80,,174.72,percent of total billed charges,78% of total billed charges,212.94,78,,170.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,215.67,79,,172.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,171.99,450,
SINEMET 50/200 MG CR TAB,250016356,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
DOBUTAMINE HCL/D5W 0250G/0250L,250016357,CDM,250,RC,J1250,HCPCS,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.93,100,,,fee schedule,100% of GA fee schedule,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,8.33,105,,,fee schedule,105% of GA fee schedule,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.93,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,7.93,100,,,fee schedule,100% of GA fee schedule,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.93,450,
THYROID 130MG TABLETS,250016364,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
HYDRALAZINE 10MG TABLET,250016365,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ISMO 20MG TABLETS,250016367,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ISOPTIN SR 120MG CAPSULE,250016369,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ACYCLOVIR SOD INJ 500 MG,250016370,CDM,250,RC,J0133,HCPCS,outpatient,,,239,167.3,,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,184.56,77.22,,147.65,percent of total billed charges,77.22% of total billed charges,0.03,105,,,fee schedule,105% of GA fee schedule,198.37,83,,158.7,percent of total billed charges,83% of total,227.05,95,,181.64,percent of total billed charges ,95% of total billed charges,191.2,80,,152.96,percent of total billed charges,78% of total billed charges,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.03,100,,,fee schedule,100% of GA fee schedule,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,450,
LONITEN 10MG TABLETS,250016374,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
COUMADIN 2MG TABLET,250016375,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ZOFRAN 4MG D INJECTION,250016385,CDM,250,RC,,,outpatient,,,194,135.8,,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,149.81,77.22,,119.85,percent of total billed charges,77.22% of total billed charges,128.23,66.1,,102.58,percent of total billed charges,66.1% of total billed charges,161.02,83,,128.82,percent of total billed charges,83% of total,184.3,95,,147.44,percent of total billed charges ,95% of total billed charges,155.2,80,,124.16,percent of total billed charges,78% of total billed charges,151.32,78,,121.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.22,450,
GENTAMICIN 10MG EYE PREP,250016387,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PAMELOR 25MG CAPSULES,250016390,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
PROZAC 10MG CAPSULES,250016398,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
PRPARATION-H ONITMENT,250016399,CDM,250,RC,A9270,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
PLAQUENIL 200MG TAB,250016402,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
SODIUM BICARB 4.2% RESPIRATORY,250016405,CDM,250,RC,A9270,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
CHLORPROMAZINE HCL 25 MG TAB,250016413,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
GAMMAR 5GM INJECTION,250016418,CDM,250,RC,,,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1129.55,
PEPCID 20MG/50ML PREMIXED INJ,250016420,CDM,250,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
ZITHROMAX 0250G CAPSULE,250016424,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
KLONOPIN 0.5MG TABLETS,250016429,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TERAZOL 3 SUPPOSITORIES,250016430,CDM,250,RC,A9270,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,44.29,66.1,,35.43,percent of total billed charges,66.1% of total billed charges,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.21,450,
MONOPRIL 10MG TABLETS,250016431,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SANDIMMUNE 100MG CAPSULES,250016433,CDM,250,RC,A9270,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
METHADONE 5MG TABLETS,250016435,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
HYTRIN 1MG TABLETS,250016438,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
CARDURA 2MG TABLETS,250016439,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
FLORINEF 0.1MG TABLETS,250016442,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ATROVENT NEBULIZER SOLUTION,250016443,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
GLUCOTROL XL 5MG TABLETS,250016449,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SALINE FOR NEBULIZERS,250016455,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
TEGRETOL 100/5 SUSPENSION,250016456,CDM,250,RC,A9270,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
MAGIC MOUTHWASH 120 ML SUSP,250016469,CDM,250,RC,A9270,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
NITROGLYCERIN 25MG PREMIX DRIP,250016473,CDM,250,RC,A9270,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
ZOCOR 20MG TABLETS,250016479,CDM,250,RC,A9270,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
NU-IRON 150MG CAPSULES,250016481,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CEFTIN 125MG/5ML SUSPENSION,250016492,CDM,250,RC,A9270,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
TAMBOCOR 50MG CAPSULES,250016501,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
VALISONE 0.1% LOTION,250016502,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
DEPO-PROVERA 1MG/ML INJ.,250016509,CDM,250,RC,,,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,143.44,66.1,,114.75,percent of total billed charges,66.1% of total billed charges,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.71,450,
GAMMAR 10 GM IV,250016513,CDM,250,RC,,,outpatient,,,1124,786.8,,887.96,79,,710.37,percent of total billed charges,79% of total billed charges,1011.6,90,,809.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,708.12,63,,566.5,percent of total billed charges,63% of total billed charges,867.95,77.22,,694.36,percent of total billed charges,77.22% of total billed charges,742.96,66.1,,594.37,percent of total billed charges,66.1% of total billed charges,932.92,83,,746.34,percent of total billed charges,83% of total,1067.8,95,,854.24,percent of total billed charges ,95% of total billed charges,899.2,80,,719.36,percent of total billed charges,78% of total billed charges,876.72,78,,701.376,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,708.12,63,,566.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1011.6,90,,809.28,percent of total billed charges,90% of total billed charges,899.2,80,,719.36,percent of total billed charges,80% of total billed charges,708.12,63,,566.5,percent of total billed charges,63% of total billed charges,955.4,85,,764.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,887.96,79,,710.37,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1067.8,
ZEMURON 10MG/ML INJECTION,250016514,CDM,250,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
DIPRIVAN 1% 10MG/ML 20ML AMP.,250016515,CDM,250,RC,,,outpatient,,,665,465.5,,525.35,79,,420.28,percent of total billed charges,79% of total billed charges,598.5,90,,478.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418.95,63,,335.16,percent of total billed charges,63% of total billed charges,513.51,77.22,,410.81,percent of total billed charges,77.22% of total billed charges,439.57,66.1,,351.66,percent of total billed charges,66.1% of total billed charges,551.95,83,,441.56,percent of total billed charges,83% of total,631.75,95,,505.4,percent of total billed charges ,95% of total billed charges,532,80,,425.6,percent of total billed charges,78% of total billed charges,518.7,78,,414.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,418.95,63,,335.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,418.95,63,,335.16,percent of total billed charges,63% of total billed charges,565.25,85,,452.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,525.35,79,,420.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,418.95,631.75,
MARCAINE 0.5% EPI 10ML,250016516,CDM,250,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
NEUTONTIN 400MG CAPSULE,250016517,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
VOLTAREN EYE DROPS,250016518,CDM,250,RC,A9270,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
TOBRADEX OP SUSP 2.5 ML BTL,250016519,CDM,250,RC,A9270,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
BREVIBLOC 2.5GM INJECTION,250016523,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
HYDREA 500MG CAPSULES,250016526,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
BETAPACE 80MG TABLET,250016529,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
MEVACOR 10MG TABLET,250016533,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CALCARB/D 600 TAB,250016538,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
RISPERDAL 1MG TABLETS,250016540,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
HEMOCYTE PLUS,250016546,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ULTRAM 50MG TABLET,250016554,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
COUMADIN 1 MG TABLET,250016556,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CERVIDIL VAG. INSERTS 10MG,250016560,CDM,250,RC,A9270,HCPCS,outpatient,,,749,524.3,,591.71,79,,473.37,percent of total billed charges,79% of total billed charges,674.1,90,,539.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,471.87,63,,377.5,percent of total billed charges,63% of total billed charges,578.38,77.22,,462.7,percent of total billed charges,77.22% of total billed charges,495.09,66.1,,396.07,percent of total billed charges,66.1% of total billed charges,621.67,83,,497.34,percent of total billed charges,83% of total,711.55,95,,569.24,percent of total billed charges ,95% of total billed charges,599.2,80,,479.36,percent of total billed charges,78% of total billed charges,584.22,78,,467.376,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,471.87,63,,377.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,674.1,90,,539.28,percent of total billed charges,90% of total billed charges,599.2,80,,479.36,percent of total billed charges,80% of total billed charges,471.87,63,,377.5,percent of total billed charges,63% of total billed charges,636.65,85,,509.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,591.71,79,,473.37,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,711.55,
DESIPRAMINE 50MG TAB UD,250016564,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
VITAMIN D 50 MM U CAPSULE,250016568,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ALTACE 2.5MG CAPSULE,250016575,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
VALISONE 0.1% CREAM,250016581,CDM,250,RC,A9270,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
PRAVACHOL 20 MG TABLET,250016585,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
DOXEPIN HCL 50MG CAP U/D,250016587,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ZITHROMAX SUSP 200MG/5ML,250016588,CDM,250,RC,A9270,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
GLUCOPHAGE 500MG TABLET,250016589,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
VASOTEC 2.5MG TABLET,250016591,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
AMOXIL SUSP 125 MG/5 ML 100 ML,250016592,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
PAMELOR 10MG CAP U/D,250016595,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CEROVITE LIQUID,250016597,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
HYDROCORTISONE CREAM 2.5% 28GM,250016605,CDM,250,RC,A9270,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
SINEMET 25/250 TABLET,250016606,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
COZAAR TABLET 50MG,250016607,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
TENORETIC-50 TABLET,250016608,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
FOSAMAX 10MG TABLET,250016610,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
SOLU-CORTEF 0250G INJECTION,250016616,CDM,250,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
ACCUPRIL 10MG TABLET U/D,250016619,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MORPHINE SUL 5MG/ML INJECT,250016624,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
CHLORTHALIDONE 25MG TABLET,250016626,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PROSCAR 5MG TAB U/D,250016627,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
GLYNASE 6MG TABLET,250016628,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ZESTRIL 20MG TABL,250016629,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
IMITREX 25MG TABLETS U/D,250016631,CDM,250,RC,A9270,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
DEPAKOTE SPR. 125MG CAP.,250016632,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SINEMET 10/100 TABLET,250016644,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ISONIAZID 300MG TABLET,250016645,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
VALTREX 500MG TABLET,250016646,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PYRAZINAMIDE 500MG TABLET,250016647,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
EMLA CREAM 5 GRAM,250016651,CDM,250,RC,A9270,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
PROVERA 2.5MG TABLET,250016655,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
VITAMIN C 0250G TABLET,250016659,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CLARITIN 10 S,250016661,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
BEER,250016665,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NAPROXEN 500 MG TAB,250016674,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ZESTRIL 10MG TABLET,250016675,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ARMOUR THYROID 60MG TAB,250016677,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SULF-10 10% OP SOLUTION,250016679,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
TOBRAMYCIN 0.3% OP SOLUTION,250016681,CDM,250,RC,A9270,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
LIBRIUM 5MG CAPSULE,250016682,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
LIDOCAINE/EPIN./TETRACAINE,250016684,CDM,250,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
HYDROXYZINE PAM 50MG CAPSULE,250016686,CDM,250,RC,A9270,HCPCS,outpatient,,,2.6,1.82,,2.05,79,,1.64,percent of total billed charges,79% of total billed charges,2.34,90,,1.87,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,63,,1.31,percent of total billed charges,63% of total billed charges,2.01,77.22,,1.61,percent of total billed charges,77.22% of total billed charges,1.72,66.1,,1.38,percent of total billed charges,66.1% of total billed charges,2.16,83,,1.73,percent of total billed charges,83% of total,2.47,95,,1.98,percent of total billed charges ,95% of total billed charges,2.08,80,,1.66,percent of total billed charges,78% of total billed charges,2.03,78,,1.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.64,63,,1.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2.34,90,,1.87,percent of total billed charges,90% of total billed charges,2.08,80,,1.66,percent of total billed charges,80% of total billed charges,1.64,63,,1.31,percent of total billed charges,63% of total billed charges,2.21,85,,1.768,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.05,79,,1.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.64,450,
PREVACID 15MG CAPSULE,250016688,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
NEURONTIN 100MG CAPSULES,250016689,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MIACALCIN NASAL SPRAY,250016690,CDM,250,RC,A9270,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.18,450,
LOTRIMIN 1% CREAM,250016694,CDM,250,RC,A9270,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,58.17,66.1,,46.54,percent of total billed charges,66.1% of total billed charges,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.44,450,
COUMADIN 7.5MG TABLET,250016697,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ZOLOFT 100MG TABLET,250016698,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
MESTINON 60MG TABLET,250016701,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
ATIVAN 2MG/ML INJECTION,250016707,CDM,250,RC,,,outpatient,,,383,268.1,,302.57,79,,242.06,percent of total billed charges,79% of total billed charges,344.7,90,,275.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241.29,63,,193.03,percent of total billed charges,63% of total billed charges,295.75,77.22,,236.6,percent of total billed charges,77.22% of total billed charges,253.16,66.1,,202.53,percent of total billed charges,66.1% of total billed charges,317.89,83,,254.31,percent of total billed charges,83% of total,363.85,95,,291.08,percent of total billed charges ,95% of total billed charges,306.4,80,,245.12,percent of total billed charges,78% of total billed charges,298.74,78,,238.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,241.29,63,,193.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,241.29,63,,193.03,percent of total billed charges,63% of total billed charges,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,302.57,79,,242.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,241.29,450,
ALTACE 5MG CAP U/D,250016709,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
TRAZODONE 150MG TABLET,250016712,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ESTRACE 1MG TABLET,250016713,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CORTEF 5 MG TABLET,250016716,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FLUOROURACIL 50MG/ML INJ,250016719,CDM,250,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
DIFLUCAN 10MG/ML ORAL SUS,250016723,CDM,250,RC,A9270,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,87.91,66.1,,70.33,percent of total billed charges,66.1% of total billed charges,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.79,450,
FAMVIR 500MG TABLET,250016727,CDM,250,RC,A9270,HCPCS,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,40.32,66.1,,32.26,percent of total billed charges,66.1% of total billed charges,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.43,450,
METHOTREXATE 2.5MG TAB U/D,250016729,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
TAPAZOLE 5MG TABLET,250016731,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MEGESTROL AC 40MG TABLET,250016732,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
PRECOSE 50MG TABLET,250016734,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
SYNTHROID 0.088MG TABLET,250016736,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EPIVIR 150MG TABLET,250016737,CDM,250,RC,A9270,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
PRAVACHOL 10MG TABLET,250016738,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
MURO 128 5% OP SOL.,250016740,CDM,250,RC,A9270,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,44.29,66.1,,35.43,percent of total billed charges,66.1% of total billed charges,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.21,450,
CEREBYX 500MG INJECTION,250016751,CDM,250,RC,,,outpatient,,,842,589.4,,665.18,79,,532.14,percent of total billed charges,79% of total billed charges,757.8,90,,606.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,530.46,63,,424.37,percent of total billed charges,63% of total billed charges,650.19,77.22,,520.15,percent of total billed charges,77.22% of total billed charges,556.56,66.1,,445.25,percent of total billed charges,66.1% of total billed charges,698.86,83,,559.09,percent of total billed charges,83% of total,799.9,95,,639.92,percent of total billed charges ,95% of total billed charges,673.6,80,,538.88,percent of total billed charges,78% of total billed charges,656.76,78,,525.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,530.46,63,,424.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,530.46,63,,424.37,percent of total billed charges,63% of total billed charges,715.7,85,,572.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,665.18,79,,532.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,799.9,
LOVENOX 30MG INJECTION,250016753,CDM,250,RC,,,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
TOPROL XL 50MG TABLET,250016754,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EFFEXOR 37.5MG TABLETS,250016755,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
LAC-HYDRIN 12% LOT,250016756,CDM,250,RC,A9270,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,99.81,66.1,,79.85,percent of total billed charges,66.1% of total billed charges,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.13,450,
TEMOVATE 0.05% OINTMENT,250016757,CDM,250,RC,A9270,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,99.81,66.1,,79.85,percent of total billed charges,66.1% of total billed charges,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.13,450,
PENTASA 250 MG CAPSULE,250016760,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DEMADEX TABLET 20MG,250016762,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LIPITOR 10MG TABLETS,250016763,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
RELAFEN 500MG TAB U/D,250016764,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
AZACTAM 1 GM INJECTION,250016766,CDM,250,RC,,,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,87.25,66.1,,69.8,percent of total billed charges,66.1% of total billed charges,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.16,450,
CORDARONE 50MG/ML INJECTIO,250016767,CDM,250,RC,,,outpatient,,,329,230.3,,259.91,79,,207.93,percent of total billed charges,79% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.27,63,,165.82,percent of total billed charges,63% of total billed charges,254.05,77.22,,203.24,percent of total billed charges,77.22% of total billed charges,217.47,66.1,,173.98,percent of total billed charges,66.1% of total billed charges,273.07,83,,218.46,percent of total billed charges,83% of total,312.55,95,,250.04,percent of total billed charges ,95% of total billed charges,263.2,80,,210.56,percent of total billed charges,78% of total billed charges,256.62,78,,205.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.27,63,,165.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.27,63,,165.82,percent of total billed charges,63% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,259.91,79,,207.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.27,450,
AMBIEN 5MG TABLET,250016768,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
SANTYL OINTMENT 30 GRAM,250016769,CDM,250,RC,A9270,HCPCS,outpatient,,,258,180.6,,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,199.23,77.22,,159.38,percent of total billed charges,77.22% of total billed charges,170.54,66.1,,136.43,percent of total billed charges,66.1% of total billed charges,214.14,83,,171.31,percent of total billed charges,83% of total,245.1,95,,196.08,percent of total billed charges ,95% of total billed charges,206.4,80,,165.12,percent of total billed charges,78% of total billed charges,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,162.54,450,
BENTYL 10MG/5ML SYRUP,250016771,CDM,250,RC,A9270,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
BREVIBLOC 10MG/ML INJ U/D,250016775,CDM,250,RC,,,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,57.51,66.1,,46.01,percent of total billed charges,66.1% of total billed charges,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.81,450,
DOPAMINE/D5W 1.6MG/ML INJ,250016776,CDM,250,RC,,,outpatient,,,305,213.5,,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,235.52,77.22,,188.42,percent of total billed charges,77.22% of total billed charges,201.61,66.1,,161.29,percent of total billed charges,66.1% of total billed charges,253.15,83,,202.52,percent of total billed charges,83% of total,289.75,95,,231.8,percent of total billed charges ,95% of total billed charges,244,80,,195.2,percent of total billed charges,78% of total billed charges,237.9,78,,190.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,192.15,450,
ATARAX 10MG TABLET,250016779,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
NEURONTIN 300MG CAPSULE,250016781,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
LEVAQUIN 500MG TABLET,250016782,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
AUGMENTIN 875MG TABLET,250016783,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
INVIRASE 200MG CAPSULE,250016784,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
TOBRAMYCIN 40MG/ML INJ.U/D,250016787,CDM,250,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
MS CONTIN 15MG CR TABLET,250016788,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
DIFLUCAN 150MG TABLET,250016789,CDM,250,RC,A9270,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
PREDNISONE 1MG TAB U/D,250016793,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LOTREL 5/10 MG CAPSULES,250016794,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
PREPARATION H SUPPOSITORY,250016795,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
BETADINE 10 % OINTMENT,250016797,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
NICODERM 21MG PATCH,250016805,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
NIZORAL 2% SHAMPOO,250016808,CDM,250,RC,A9270,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,76.68,66.1,,61.34,percent of total billed charges,66.1% of total billed charges,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.08,450,
"TOBRAMYCIN SULF 1,200 MG/30 ML",250016809,CDM,250,RC,J3260,HCPCS,outpatient,,,542,379.4,,428.18,79,,342.54,percent of total billed charges,79% of total billed charges,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.27,100,,,fee schedule,100% of GA fee schedule,418.53,77.22,,334.82,percent of total billed charges,77.22% of total billed charges,2.38,105,,,fee schedule,105% of GA fee schedule,449.86,83,,359.89,percent of total billed charges,83% of total,514.9,95,,411.92,percent of total billed charges ,95% of total billed charges,433.6,80,,346.88,percent of total billed charges,78% of total billed charges,422.76,78,,338.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.27,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.27,100,,,fee schedule,100% of GA fee schedule,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,428.18,79,,342.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.27,514.9,
ARICEPT 5MG TABLETS,250016811,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
PHOS LO 667MG TABLET,250016812,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LOTREL 5/20 CAPSULE,250016813,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CONDYLOX 0.5% SOLUTION,250016814,CDM,250,RC,A9270,HCPCS,outpatient,,,392,274.4,,309.68,79,,247.74,percent of total billed charges,79% of total billed charges,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,302.7,77.22,,242.16,percent of total billed charges,77.22% of total billed charges,259.11,66.1,,207.29,percent of total billed charges,66.1% of total billed charges,325.36,83,,260.29,percent of total billed charges,83% of total,372.4,95,,297.92,percent of total billed charges ,95% of total billed charges,313.6,80,,250.88,percent of total billed charges,78% of total billed charges,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,309.68,79,,247.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,246.96,450,
ZITHROMAX 500MG INJECTION,250016815,CDM,250,RC,,,outpatient,,,185,129.5,,146.15,79,,116.92,percent of total billed charges,79% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.55,63,,93.24,percent of total billed charges,63% of total billed charges,142.86,77.22,,114.29,percent of total billed charges,77.22% of total billed charges,122.29,66.1,,97.83,percent of total billed charges,66.1% of total billed charges,153.55,83,,122.84,percent of total billed charges,83% of total,175.75,95,,140.6,percent of total billed charges ,95% of total billed charges,148,80,,118.4,percent of total billed charges,78% of total billed charges,144.3,78,,115.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,116.55,63,,93.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,116.55,63,,93.24,percent of total billed charges,63% of total billed charges,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,146.15,79,,116.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,116.55,450,
MS CONTIN 30MG CR TABLETS,250016816,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
HYTRIN 5MG TABLET,250016817,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
TAPAZOLE 10MG TABLET,250016818,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
AMARYL TABLET 2MG,250016822,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
WELLBUTRIN 150MG TABLET,250016823,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CODEINE SULF 15MG TABLET,250016825,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ROCALTROL 0.25MCG CAP,250016826,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
TRIAMCINOLON 0.1% OIN,250016830,CDM,250,RC,A9270,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
ZYPREXA 5MG TABLET,250016831,CDM,250,RC,A9270,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
ROCEPHIN 500MG INJECTION,250016832,CDM,250,RC,J0696,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.44,100,,,fee schedule,100% of GA fee schedule,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
TRUSOPT 2% OPTH SOLUTION,250016833,CDM,250,RC,A9270,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
MEXITIL 200MG CAP U/D,250016834,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ZITHROMAX 1GRAM SUSP. U/D,250016835,CDM,250,RC,A9270,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
HEMOCYTE PLUS TABLETS,250016838,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
OXYCONTIN 20MG TABLET,250016842,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
ETHAMBUTOL 400MG TABLET,250016844,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
ETHACRYNATE SODIUM/INJ 50MG VI,250016849,CDM,250,RC,,,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.05,450,
HUMALOG INSULIN 100 UNITS,250016850,CDM,250,RC,J1815,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.22,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,0.23,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.22,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.22,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.22,450,
CLARITIN-D 12 HOUR,250016853,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MS CONTIN 60MG CR TAB U/D,250016857,CDM,250,RC,A9270,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
GLUCOTROL 10MG XL TABLET,250016861,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ACCOLATE TAB 20MG,250016863,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DIOVAN CAP 80MG,250016864,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
GLUCOPHAGE 850MG TABLET,250016866,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FLONASE NASAL 0.05% SPRAY,250016867,CDM,250,RC,A9270,HCPCS,outpatient,,,208,145.6,,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,160.62,77.22,,128.5,percent of total billed charges,77.22% of total billed charges,137.49,66.1,,109.99,percent of total billed charges,66.1% of total billed charges,172.64,83,,138.11,percent of total billed charges,83% of total,197.6,95,,158.08,percent of total billed charges ,95% of total billed charges,166.4,80,,133.12,percent of total billed charges,78% of total billed charges,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,131.04,450,
ATROVENT NASAL SPRAY 0.03%,250016868,CDM,250,RC,A9270,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,450,
CARDIZEM 50MG INJECTION,250016872,CDM,250,RC,,,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
ACETIC ACID 0.25% IRR 0250L,250016876,CDM,250,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
REMERON 15MG TABLETS,250016880,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
AMYL NITRITE INHALANT USP,250016883,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ORTHO-CYCLEN 28 DAY TAB,250016884,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
RETROVIR 300MG TABLETS,250016885,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
DEPAKOTE 500MG EC TAB U/D,250016888,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
SENOKOT 187MG TABLET,250016894,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
LUVOX 50MG TABLET,250016895,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
NITROGLYCER 5MG/ML INJ U/D,250016897,CDM,250,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
MIDODRINE HCL 2.5MG TABLET,250016902,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SEDAPAP TABLETS 50/650MG,250016903,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ACETIC ACID 2% OTIC SOLN 15ML,250016905,CDM,250,RC,A9270,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
SINGULAIR 10 MG TABLET,250016910,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
SINGULAIR CHEWABLE TAB 5MG,250016914,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
PLAVIX  75 MG TABLET,250016917,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
NEPHRO-VITE TABLET,250016922,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CILOXAN 0.3% OPTH SOL 2.5ML,250016925,CDM,250,RC,A9270,HCPCS,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
SUCCINYLCHOL 20MG/ML INJ,250016926,CDM,250,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
RETROVIR 10MG/ML SYRUP,250016927,CDM,250,RC,A9270,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,57.51,66.1,,46.01,percent of total billed charges,66.1% of total billed charges,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.81,450,
ZYRTEC 10 MG TABLET,250016928,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CLEOCIN 300MG INJECTION,250016930,CDM,250,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
CIPRO IV 200/1% SOL,250016931,CDM,250,RC,,,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
ADALAT CC 30 MG TABLET,250016932,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ADALAT CC 60MG TABLET,250016933,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
ADALAT CC 90 MG TABLET,250016934,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
XALATAN 0.005% OPHTH. SOL.,250016935,CDM,250,RC,A9270,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,126.25,66.1,,101,percent of total billed charges,66.1% of total billed charges,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.33,450,
VICOPROFEN 7.5/200 TABLET,250016936,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CASODEX TABLET 50MG,250016938,CDM,250,RC,A9270,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
TOPAMAX 25 MG TABLET,250016940,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CYTOTEC 100 MCG TABLET,250016942,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ZOVIRAX 800 MG TABLET,250016944,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
SURFAK 240MG CAPSULE,250016945,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
NICODERM 14MG/24 PATCH,250016946,CDM,250,RC,A9270,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
COMBIVENT 200ACT INHALER,250016948,CDM,250,RC,A9270,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
COREG 3.125 MG TABLET,250016949,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
IMURAN 50MG TABLET,250016951,CDM,250,RC,J7500,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ELDERTONIC MULTIVIT ELIXIR,250016952,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
CEFZIL 125/5ML SUS,250016954,CDM,250,RC,A9270,HCPCS,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.76,450,
HEPARIN LOCK 10 ML VIAL,250016962,CDM,250,RC,J1642,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.02,100,,,fee schedule,100% of GA fee schedule,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,0.02,105,,,fee schedule,105% of GA fee schedule,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.02,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.02,100,,,fee schedule,100% of GA fee schedule,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.02,450,
DETROL 2 MG TABLET,250016964,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
PROPYLTHIOUR 50MG TABLET,250016968,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
CIPRO HC OTIC SUSP. 10 ML,250016974,CDM,250,RC,A9270,HCPCS,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.56,450,
LOVENOX 60MG/0.6ML INJECT.,250016976,CDM,250,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
NICARDIPINE HCL 25MG/10ML AMP,250016980,CDM,250,RC,,,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
CELEXA 20MG TABLETS,250016981,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
CELEBREX 200 MG CAPSULE,250016984,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
ZINC SULFATE 220 MG CAPSULE,250016988,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
CHLORHEXIDINE GLUCONATE 1.2 MG,250016995,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
TERBINAFINE HCL 15GM CREAM.GM.,250016996,CDM,250,RC,A9270,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,450,
ZYRTEC SYRUP 1MG/ML,250016998,CDM,250,RC,A9270,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
NASONEX NASAL SPRAY 50MCG,250017001,CDM,250,RC,A9270,HCPCS,outpatient,,,223,156.1,,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,172.2,77.22,,137.76,percent of total billed charges,77.22% of total billed charges,147.4,66.1,,117.92,percent of total billed charges,66.1% of total billed charges,185.09,83,,148.07,percent of total billed charges,83% of total,211.85,95,,169.48,percent of total billed charges ,95% of total billed charges,178.4,80,,142.72,percent of total billed charges,78% of total billed charges,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,140.49,450,
BALNCD SALT SOLN OP IRRG 15ML,250017063,CDM,250,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
TINC BENZOIN SPRAY DOSE,250017068,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CELEBREX 100MG CAPSULE,250017073,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
DITROPAN XL 5MG TABLET,250017076,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
DEPAKOTE 125MG TABLET U/D,250017077,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PROCHLORPERAZINE MAL 10MG INJ,250017083,CDM,250,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EFFEXOR XR 75 MG CAPSULE,250017084,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
EFFEXOR XR 37.5MG CAPSULE,250017085,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
LINDANE 1% LOTN 60ML BTL,250017089,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
LINDANE 1% SHAMPOO 60ML BTL,250017090,CDM,250,RC,A9270,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,80.64,66.1,,64.51,percent of total billed charges,66.1% of total billed charges,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.86,450,
ALLOPURINOL 300MG TABLET,250017092,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
VALPROATE SOD SYRUP 0250G/5ML,250017097,CDM,250,RC,A9270,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
CYTOMEL 25MG TABLET,250017101,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EFFEXOR TABLET 75MG,250017106,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
AVAPRO TABLET 150MG,250017107,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
VITAMIN B-12 500 MG TABLETS,250017110,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
NORVASC 5MG,250017112,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
QUETIAPINE FUMARATE 25MG TAB,250017120,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
MISC DRUG CHARGE,250017123,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CILOSTAZOL 100 MG TABLET,250017124,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CEFTAZIDIME PENTAHYDRATE 2GM V,250017125,CDM,250,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
CALCIUM CHLORIDE 100MG/ML SYRP,250017129,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
ATROPINE SULFATE 10ML DISP.SYR,250017130,CDM,250,RC,J0461,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,0.12,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.11,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.11,450,
AMPICILLIN 0250G/5ML BTL,250017133,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
CITRIC ACID/SOD CITRATE 30ML,250017134,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
OLOPATADINE HCL 5ML DROPS,250017136,CDM,250,RC,A9270,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,151.2,450,
LEVOTHYROXINE SODIUM 112MCG TB,250017137,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
HCTZ/TRIAMTERENE 1 TABLET,250017138,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ASPRIRIN 81 MG TABLET EC,250017140,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
HUMU 70/30 INSULIN,250017142,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
NEOMY SULF/BACITRA/POLYMYXIN,250017143,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
GENTAMICIN SULFATE 40MG/ML,250017145,CDM,250,RC,,,outpatient,,,9.5,6.65,,7.51,79,,6.01,percent of total billed charges,79% of total billed charges,8.55,90,,6.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.99,63,,4.79,percent of total billed charges,63% of total billed charges,7.34,77.22,,5.87,percent of total billed charges,77.22% of total billed charges,6.28,66.1,,5.02,percent of total billed charges,66.1% of total billed charges,7.89,83,,6.31,percent of total billed charges,83% of total,9.03,95,,7.22,percent of total billed charges ,95% of total billed charges,7.6,80,,6.08,percent of total billed charges,78% of total billed charges,7.41,78,,5.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.99,63,,4.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,8.55,90,,6.84,percent of total billed charges,90% of total billed charges,7.6,80,,6.08,percent of total billed charges,80% of total billed charges,5.99,63,,4.79,percent of total billed charges,63% of total billed charges,8.08,85,,6.464,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.51,79,,6.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.99,450,
TIZANIDINE HCL 4MG TABLET,250017149,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
METRONIDAZOLE 0.75% 45 GM GEL,250017155,CDM,250,RC,A9270,HCPCS,outpatient,,,196,137.2,,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,151.35,77.22,,121.08,percent of total billed charges,77.22% of total billed charges,129.56,66.1,,103.65,percent of total billed charges,66.1% of total billed charges,162.68,83,,130.14,percent of total billed charges,83% of total,186.2,95,,148.96,percent of total billed charges ,95% of total billed charges,156.8,80,,125.44,percent of total billed charges,78% of total billed charges,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,123.48,450,
CALCIUM POLYCARBOPHIL 625MG TA,250017161,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
FLUORESCEIN SODIUM 1MG/STRIP,250017162,CDM,250,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EPINEPHRINE 11.25 MG NEB SOLN,250017164,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
NYSTATIN 15 GM OINT.GM,250017165,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
GUAIFENESIN 200MG/10 ML UD,250017166,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ZIDOVUDINE 200 MG/20ML VIAL,250017167,CDM,250,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
LOSARTAN POTASSIUM/HCTZ 1 TAB,250017168,CDM,250,RC,A9270,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
ACETYLCYSTEINE 10% 10 ML VIAL,250017169,CDM,250,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
MORPHINE SULF 20MG/ML ORAL SOL,250017170,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
FAMOTIDINE 10 MG/ML VIAL,250017171,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
VERAPAMIL HCL 180MG TAB.SA.OSM,250017173,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
QUINAPRIL HCL/MAG CARB 20MG TB,250017174,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
NADOLOL 20MG TAB,250017176,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
TAMSULOSIN HCL 0.4 MG CAP SR,250017177,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
TORSEMIDE 5MG TABLET,250017180,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FLUTICASONE PROPIONATE 13GM AE,250017181,CDM,250,RC,A9270,HCPCS,outpatient,,,438,306.6,,346.02,79,,276.82,percent of total billed charges,79% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.94,63,,220.75,percent of total billed charges,63% of total billed charges,338.22,77.22,,270.58,percent of total billed charges,77.22% of total billed charges,289.52,66.1,,231.62,percent of total billed charges,66.1% of total billed charges,363.54,83,,290.83,percent of total billed charges,83% of total,416.1,95,,332.88,percent of total billed charges ,95% of total billed charges,350.4,80,,280.32,percent of total billed charges,78% of total billed charges,341.64,78,,273.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,275.94,63,,220.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,275.94,63,,220.75,percent of total billed charges,63% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,346.02,79,,276.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,275.94,450,
KINEVAC FOR N M -5MCG VIAL,250017185,CDM,250,RC,,,outpatient,,,416,291.2,,328.64,79,,262.91,percent of total billed charges,79% of total billed charges,374.4,90,,299.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.08,63,,209.66,percent of total billed charges,63% of total billed charges,321.24,77.22,,256.99,percent of total billed charges,77.22% of total billed charges,274.98,66.1,,219.98,percent of total billed charges,66.1% of total billed charges,345.28,83,,276.22,percent of total billed charges,83% of total,395.2,95,,316.16,percent of total billed charges ,95% of total billed charges,332.8,80,,266.24,percent of total billed charges,78% of total billed charges,324.48,78,,259.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,262.08,63,,209.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,374.4,90,,299.52,percent of total billed charges,90% of total billed charges,332.8,80,,266.24,percent of total billed charges,80% of total billed charges,262.08,63,,209.66,percent of total billed charges,63% of total billed charges,353.6,85,,282.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,328.64,79,,262.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,262.08,450,
CEFDINIR 300MG CAPSULE,250017186,CDM,250,RC,A9270,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
HCTZ/BISOPROLOL FUMARATE 1 TAB,250017187,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MUPIROCIN CALCIUM 15GM CREAM,250017188,CDM,250,RC,A9270,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,84.61,66.1,,67.69,percent of total billed charges,66.1% of total billed charges,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.64,450,
CLINDAMYCIN PHOSPHATE 600MG,250017190,CDM,250,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
AMOXICILLIN TRIPHYDRATE 0250G,250017191,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
OSELTAMIVIR PHOSPHATE 75MG CAP,250017200,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
MINERAL OIL 133 ML ENEMA,250017202,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
POLYMYXIN B SULFATE/10ML DROPS,250017204,CDM,250,RC,A9270,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,58.17,66.1,,46.54,percent of total billed charges,66.1% of total billed charges,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.44,450,
CHOLESTYRAMINE/ASPARTAME 4G/PK,250017208,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ALUM/SAL ACID/MENTHOL/CAM 7.5G,250017213,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ENOXAPARIN SODIUM 100MG/ML SY,250017214,CDM,250,RC,,,outpatient,,,273,191.1,,215.67,79,,172.54,percent of total billed charges,79% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,210.81,77.22,,168.65,percent of total billed charges,77.22% of total billed charges,180.45,66.1,,144.36,percent of total billed charges,66.1% of total billed charges,226.59,83,,181.27,percent of total billed charges,83% of total,259.35,95,,207.48,percent of total billed charges ,95% of total billed charges,218.4,80,,174.72,percent of total billed charges,78% of total billed charges,212.94,78,,170.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,215.67,79,,172.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,171.99,450,
VALSARTAN/HCTZ 80/12.5MG TAB,250017217,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
MELATONIN 3 MG TABLET SA,250017218,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
CHLORDIAZEPOXIDE HCL 25MG CAP,250017219,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
ALPHAGAN 0.2% 5ML BTL,250017229,CDM,250,RC,A9270,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
MELATONIN 5 MG TABLET,250017230,CDM,250,RC,J3490,HCPCS,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
DILTIAZEM HCL 120MG CAPSULE.SA,250017232,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
HYDROXYUREA 300 MG CAPSULE,250017236,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
ZIAC 10/6.25 MG TAB,250017237,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
VALSARTAN/HCTZ 160/12.5MG TAB,250017240,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ISOSORBIDE MONONITRATE 30MG TA,250017242,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
DORZOLAMIDE HC.L/TIMOLOL 5ML D,250017243,CDM,250,RC,A9270,HCPCS,outpatient,,,194,135.8,,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,149.81,77.22,,119.85,percent of total billed charges,77.22% of total billed charges,128.23,66.1,,102.58,percent of total billed charges,66.1% of total billed charges,161.02,83,,128.82,percent of total billed charges,83% of total,184.3,95,,147.44,percent of total billed charges ,95% of total billed charges,155.2,80,,124.16,percent of total billed charges,78% of total billed charges,151.32,78,,121.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.22,450,
PIOGLITAZONE HCL 30MG TABLET,250017244,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
INSULIN NPL/INSULIN LISPRO 3ML,250017249,CDM,250,RC,A9270,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.05,450,
ACETAMINOPHEN/CAFFEINE/ 1 TAB,250017250,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ZIDOVUDINE/LAMIVUDINE 1 TAB,250017251,CDM,250,RC,,,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.29,450,
LAMOTRIGINE 25MG TAB DISPER,250017254,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
FEXOFENADINE HCL ER 180MG TAB,250017255,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
VENLAFAXINE HCL 75MG TABLET,250017256,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
AMPHOTERICIN B LIPID COMP 10MG,250017260,CDM,250,RC,J0287,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,11.13,100,,,Fee Schedule,100% of CMS OPPS rate,17.8,160,,,Fee Schedule,160% of CMS OPPS rate,14.46,130,,,Fee Schedule,130% of CMS OPPS rate,10.5,100,,,fee schedule,100% of GA fee schedule,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,11.03,105,,,fee schedule,105% of GA fee schedule,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,11.13,100,,,Fee Schedule,100% of CMS OPPS rate,10.5,100,,,fee schedule,100% of GA fee schedule,11.13,100,,,Fee Schedule,100% of CMS OPPS rate,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,10.5,100,,,fee schedule,100% of GA fee schedule,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.35,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,11.13,100,,,Fee Schedule,100% of CMS OPPS rate,11.13,100,,,Fee Schedule,100% of CMS OPPS rate,10.35,628.9,
ACETAZOLAMIDE SODIUM 500MG/VIA,250017264,CDM,250,RC,,,outpatient,,,137,95.9,,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,105.79,77.22,,84.63,percent of total billed charges,77.22% of total billed charges,90.56,66.1,,72.45,percent of total billed charges,66.1% of total billed charges,113.71,83,,90.97,percent of total billed charges,83% of total,130.15,95,,104.12,percent of total billed charges ,95% of total billed charges,109.6,80,,87.68,percent of total billed charges,78% of total billed charges,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.31,450,
CYANOCOBALAMIN 500MCG TABLET,250017270,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
AMMONIUM LACTATE 280 GM CREAM,250017271,CDM,250,RC,A9270,HCPCS,outpatient,,,154,107.8,,121.66,79,,97.33,percent of total billed charges,79% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.02,63,,77.62,percent of total billed charges,63% of total billed charges,118.92,77.22,,95.14,percent of total billed charges,77.22% of total billed charges,101.79,66.1,,81.43,percent of total billed charges,66.1% of total billed charges,127.82,83,,102.26,percent of total billed charges,83% of total,146.3,95,,117.04,percent of total billed charges ,95% of total billed charges,123.2,80,,98.56,percent of total billed charges,78% of total billed charges,120.12,78,,96.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,97.02,63,,77.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,97.02,63,,77.62,percent of total billed charges,63% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,121.66,79,,97.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.02,450,
TRANDOLAPRIL 4 MG TABLET,250017275,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
FELODIPINE 2.5 MG TAB SR 24H,250017276,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
ASPIRIN/DIPYRIDAMOLE 200MG CAP,250017277,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
NYSTATIN 15 GM POWDER,250017283,CDM,250,RC,A9270,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
PRIMAQUINE PHOS 26.3MG TABLET,250017284,CDM,250,RC,A9270,HCPCS,outpatient,,,6.4,4.48,,5.06,79,,4.05,percent of total billed charges,79% of total billed charges,5.76,90,,4.61,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.03,63,,3.22,percent of total billed charges,63% of total billed charges,4.94,77.22,,3.95,percent of total billed charges,77.22% of total billed charges,4.23,66.1,,3.38,percent of total billed charges,66.1% of total billed charges,5.31,83,,4.25,percent of total billed charges,83% of total,6.08,95,,4.86,percent of total billed charges ,95% of total billed charges,5.12,80,,4.1,percent of total billed charges,78% of total billed charges,4.99,78,,3.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.03,63,,3.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5.76,90,,4.61,percent of total billed charges,90% of total billed charges,5.12,80,,4.1,percent of total billed charges,80% of total billed charges,4.03,63,,3.22,percent of total billed charges,63% of total billed charges,5.44,85,,4.352,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.06,79,,4.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.03,450,
ANASTROZOLE 1 MG TABLET,250017286,CDM,250,RC,A9270,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
COLESTIPOL HCL 1 G  TABLET,250017289,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
EFAVIRENZ 200 MG CAPSULE,250017290,CDM,250,RC,A9270,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
NAPROXEN SODIUM 220 MG TAB,250017292,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
MENTHOL/CAMPHOR 222ML LOTION,250017297,CDM,250,RC,A9270,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
TERBINAFINE HCL 12GM CREAM GM,250017298,CDM,250,RC,A9270,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,44.29,66.1,,35.43,percent of total billed charges,66.1% of total billed charges,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.21,450,
CALCIUM CARBONATE 500MG/5ML,250017302,CDM,250,RC,A9270,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
LORAZEPAM ORAL CONC 2MG/ML,250017303,CDM,250,RC,A9270,HCPCS,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,113.69,66.1,,90.95,percent of total billed charges,66.1% of total billed charges,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.36,450,
OXYCODONE HCL 10 MG TAB.SR.12H,250017310,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
MEXILETINE HCL 150 MG CAPSULE,250017311,CDM,250,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
TOPICAL LIGHT MINERAL OIL STER,250017312,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TERAZOSIN HCL 2MG CAPSULE,250017313,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
TOBRADEX EYE OINTMENT 3.5 GM,250017317,CDM,250,RC,A9270,HCPCS,outpatient,,,264,184.8,,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,203.86,77.22,,163.09,percent of total billed charges,77.22% of total billed charges,174.5,66.1,,139.6,percent of total billed charges,66.1% of total billed charges,219.12,83,,175.3,percent of total billed charges,83% of total,250.8,95,,200.64,percent of total billed charges ,95% of total billed charges,211.2,80,,168.96,percent of total billed charges,78% of total billed charges,205.92,78,,164.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,166.32,450,
LANSOPRAZOLE 30MG CAPSULE.DR,250017323,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
MESALAMINE 400 MG TABLET,250017325,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
ZEBETA 5 MG TABLET,250017326,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
RIVASTIGMINE TARTRATE 1.5MG CA,250017327,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
NITROGLYCERIN 1 GR OINT.GM.,250017328,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
DOXEPIN HCL 10 MG CAPSULE,250017330,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
MINOCYCLINE HCL 100MG CAPSULE,250017331,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CHERRY FLAVOR 480ML SYRUP,250017332,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
METHOTREXATE 50MG/2ML VIAL,250017334,CDM,250,RC,J9250,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,41.64,66.1,,33.31,percent of total billed charges,66.1% of total billed charges,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.69,450,
METHYL SALICYLATE 37.5 GM,250017335,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
ACYCLOVIR 200 MG/5 ML ORAL,250017337,CDM,250,RC,,,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
CYPROHEPTADINE HCL 4MG TABLET,250017340,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
ZIAC 2.5/6.25 MG TAB,250017341,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
FLUOROMETHOLONE 5 ML DROPS SUS,250017343,CDM,250,RC,A9270,HCPCS,outpatient,,,93,65.1,,73.47,79,,58.78,percent of total billed charges,79% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.59,63,,46.87,percent of total billed charges,63% of total billed charges,71.81,77.22,,57.45,percent of total billed charges,77.22% of total billed charges,61.47,66.1,,49.18,percent of total billed charges,66.1% of total billed charges,77.19,83,,61.75,percent of total billed charges,83% of total,88.35,95,,70.68,percent of total billed charges ,95% of total billed charges,74.4,80,,59.52,percent of total billed charges,78% of total billed charges,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,58.59,63,,46.87,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,58.59,63,,46.87,percent of total billed charges,63% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,73.47,79,,58.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.59,450,
STADOL 1 MG/ML VIAL,250017344,CDM,250,RC,J0595,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.06,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,4.26,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.06,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,4.06,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.06,450,
TOPIRAMATE 100MG TABLET,250017345,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
ALENDRONATE SODIUM 70 MG TAB,250017349,CDM,250,RC,A9270,HCPCS,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
OXYIR 5 MG CAPSULE,250017351,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
QUETIAPINE FUMARATE 100MG TAB,250017352,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
MELOXICAM 15 MG TABLET,250017355,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
TELMISARTAN 40 MG TABLET,250017356,CDM,250,RC,A9270,HCPCS,outpatient,,,25.55,17.89,,20.18,79,,16.14,percent of total billed charges,79% of total billed charges,23,90,,18.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.1,63,,12.88,percent of total billed charges,63% of total billed charges,19.73,77.22,,15.78,percent of total billed charges,77.22% of total billed charges,16.89,66.1,,13.51,percent of total billed charges,66.1% of total billed charges,21.21,83,,16.97,percent of total billed charges,83% of total,24.27,95,,19.42,percent of total billed charges ,95% of total billed charges,20.44,80,,16.35,percent of total billed charges,78% of total billed charges,19.93,78,,15.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.1,63,,12.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,23,90,,18.4,percent of total billed charges,90% of total billed charges,20.44,80,,16.35,percent of total billed charges,80% of total billed charges,16.1,63,,12.88,percent of total billed charges,63% of total billed charges,21.72,85,,17.376,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.18,79,,16.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.1,450,
LIDOCAINE 2.5%/PRILOCAINE 2.5%,250017359,CDM,250,RC,,,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
BETA-CAROTENE(A) W-C & E/MIN,250017360,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
LITHIUM CARBONATE 150MG CAPSUL,250017361,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
CLOBETASOL PROPIONATE 15GR CRE,250017371,CDM,250,RC,A9270,HCPCS,outpatient,,,194,135.8,,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,149.81,77.22,,119.85,percent of total billed charges,77.22% of total billed charges,128.23,66.1,,102.58,percent of total billed charges,66.1% of total billed charges,161.02,83,,128.82,percent of total billed charges,83% of total,184.3,95,,147.44,percent of total billed charges ,95% of total billed charges,155.2,80,,124.16,percent of total billed charges,78% of total billed charges,151.32,78,,121.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.22,450,
DAPSONE 100MG TABLET,250017374,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
OFLOXACIN 5 ML DROPS,250017376,CDM,250,RC,A9270,HCPCS,outpatient,,,142,99.4,,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,109.65,77.22,,87.72,percent of total billed charges,77.22% of total billed charges,93.86,66.1,,75.09,percent of total billed charges,66.1% of total billed charges,117.86,83,,94.29,percent of total billed charges,83% of total,134.9,95,,107.92,percent of total billed charges ,95% of total billed charges,113.6,80,,90.88,percent of total billed charges,78% of total billed charges,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.46,450,
PHENOBARBITAL 20MG/5ML ML,250017380,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
LIDOCAINE HCL 1% 2ML VIAL,250017381,CDM,250,RC,J2001,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
VENLAFAXINE HCL 150MG CAP.SR,250017384,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
HUMIBID LA 600 MG TABLETS,250017386,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
MAGNESIUM SULFATE 2ML 4.06MEQ,250017388,CDM,250,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
MAGNESIUM SULFATE 10ML 4.06MEQ,250017389,CDM,250,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
SELENIUM 40 MCG/ML ML,250017390,CDM,250,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
GLIPIZIDE 2.5MG TAB.SA.OSM,250017391,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
TOLTERODINE TARTRATE LA 2MG CA,250017393,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
AZITHROMYCIN 200MG/5ML ML,250017395,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
VALPROATE SODIUM 100 MG/ML ML,250017396,CDM,250,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
NAFCILLIN SODIUM 2 G/VIAL,250017401,CDM,250,RC,,,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,40.32,66.1,,32.26,percent of total billed charges,66.1% of total billed charges,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.43,450,
ESOMEPRAZOLE MAG TRIHYDRATE 40,250017402,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
CLOTRIMAZOLE/BETAMET DIPROP 30,250017403,CDM,250,RC,A9270,HCPCS,outpatient,,,305,213.5,,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,235.52,77.22,,188.42,percent of total billed charges,77.22% of total billed charges,201.61,66.1,,161.29,percent of total billed charges,66.1% of total billed charges,253.15,83,,202.52,percent of total billed charges,83% of total,289.75,95,,231.8,percent of total billed charges ,95% of total billed charges,244,80,,195.2,percent of total billed charges,78% of total billed charges,237.9,78,,190.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,192.15,450,
VENLAFAXINE HCL 75MG CAP.SR.24,250017406,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
METOPROLOL SUCCINATE 25MG TAB,250017410,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
RISPERIDONE 0.25 MG TABLET,250017416,CDM,250,RC,A9270,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
URSODIOL 300 MG CAPSULE,250017417,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
KENALOG 40MG 1ML VIAL,250017422,CDM,250,RC,J3301,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,0.95,105,,,fee schedule,105% of GA fee schedule,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.9,100,,,fee schedule,100% of GA fee schedule,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.9,450,
PHENOBARBITAL SODIUM 130MG/ML,250017425,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
METFORMIN NCL XR 500MG TAB.SR.,250017426,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
CEFOTAXIME SODIUM 2 GRAMS VIAL,250017428,CDM,250,RC,J0698,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.8,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,10.29,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.8,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,9.8,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.8,450,
DIVALPROEX SODIUM 500MG TABLET,250017429,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
BUPROPION HCL 100 MG TABLET.SA,250017432,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CARVELILOL 12.5 MG TABLET,250017433,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
FENITUDUBE 10 MG TABLET,250017435,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
CALCIPOTRIENE 60 GM CREAM.GM,250017437,CDM,250,RC,A9270,HCPCS,outpatient,,,423,296.1,,334.17,79,,267.34,percent of total billed charges,79% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,326.64,77.22,,261.31,percent of total billed charges,77.22% of total billed charges,279.6,66.1,,223.68,percent of total billed charges,66.1% of total billed charges,351.09,83,,280.87,percent of total billed charges,83% of total,401.85,95,,321.48,percent of total billed charges ,95% of total billed charges,338.4,80,,270.72,percent of total billed charges,78% of total billed charges,329.94,78,,263.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,334.17,79,,267.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,266.49,450,
"INSULIN GLARGINE,HUM.REC.ANLOG",250017438,CDM,250,RC,A9270,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
VERAPAMIL HCL 300MG CAP 24H.PE,250017439,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
ATORVASTATIN CALCIUM 20MG TAB,250017444,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
XOPENEX .63,250017455,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
DROPERIDOL 5MG/2ML AMPUL,250017460,CDM,250,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
LAMOTRIGINE 100 MG TABLET,250017461,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
VERAPAMIL HCL 240MG TAB.SA.OSM,250017462,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
BENZTROPINE MESYLATE 0.5MG TAB,250017464,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
INSULIN NPL/INSUL LISPRO VIAL,250017467,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
POLYETHYLENE GLYCOL 3350 255GM,250017468,CDM,250,RC,A9270,HCPCS,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,53.54,66.1,,42.83,percent of total billed charges,66.1% of total billed charges,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.03,450,
LEVOTHYOXINE SODIUM 175 MCG,250017470,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
FLUTICASONE PROPIONATE 7.9 GR,250017472,CDM,250,RC,A9270,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,194.04,450,
DILTIAZEM HCL 360MG CAPSULE.SA,250017474,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
CEFDINIR SUSPENSION 125MG/5ML,250017475,CDM,250,RC,A9270,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
FENTANYL 50 MCG/HR 1 PATCH .72,250017476,CDM,250,RC,A9270,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,111.05,66.1,,88.84,percent of total billed charges,66.1% of total billed charges,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.84,450,
MODAFINIL 200MG TABLET,250017477,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
FENTANYL 100 MCG PATCH,250017478,CDM,250,RC,A9270,HCPCS,outpatient,,,328,229.6,,259.12,79,,207.3,percent of total billed charges,79% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,253.28,77.22,,202.62,percent of total billed charges,77.22% of total billed charges,216.81,66.1,,173.45,percent of total billed charges,66.1% of total billed charges,272.24,83,,217.79,percent of total billed charges,83% of total,311.6,95,,249.28,percent of total billed charges ,95% of total billed charges,262.4,80,,209.92,percent of total billed charges,78% of total billed charges,255.84,78,,204.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,259.12,79,,207.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.64,450,
ADVAIR 250 MCG/50 MCG 14 PUFFS,250017479,CDM,250,RC,A9270,HCPCS,outpatient,,,559,391.3,,441.61,79,,353.29,percent of total billed charges,79% of total billed charges,503.1,90,,402.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352.17,63,,281.74,percent of total billed charges,63% of total billed charges,431.66,77.22,,345.33,percent of total billed charges,77.22% of total billed charges,369.5,66.1,,295.6,percent of total billed charges,66.1% of total billed charges,463.97,83,,371.18,percent of total billed charges,83% of total,531.05,95,,424.84,percent of total billed charges ,95% of total billed charges,447.2,80,,357.76,percent of total billed charges,78% of total billed charges,436.02,78,,348.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,352.17,63,,281.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,352.17,63,,281.74,percent of total billed charges,63% of total billed charges,475.15,85,,380.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,441.61,79,,353.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,352.17,531.05,
ZOSYN VIAL 3.375 GM,250017481,CDM,250,RC,J2543,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.1,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,1.16,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.1,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.1,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.1,450,
MAG HYDROX/AL HYDROX/SIMETH 30,250017483,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
POTASSIUM CHLORIDE 40MEQ ORAL,250017484,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
DILTIAZEM HCL 240MG CAPSULE.SA,250017486,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MAGNESIUM HYDROXIDE 30ML,250017488,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
PANTOPRAZOLE SOD SESQUIHYDRATE,250017489,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
MYCOPHENOLATE MOFETIL 500MG T,250017494,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MOEXIPRIL HCL 15MG TABLET,250017497,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
QUETIAPINE FUMARATE 200MG TABL,250017498,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
ADVAIR 500 MCG/50 MCG 14 PUFFS,250017501,CDM,250,RC,A9270,HCPCS,outpatient,,,798,558.6,,630.42,79,,504.34,percent of total billed charges,79% of total billed charges,718.2,90,,574.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,616.22,77.22,,492.98,percent of total billed charges,77.22% of total billed charges,527.48,66.1,,421.98,percent of total billed charges,66.1% of total billed charges,662.34,83,,529.87,percent of total billed charges,83% of total,758.1,95,,606.48,percent of total billed charges ,95% of total billed charges,638.4,80,,510.72,percent of total billed charges,78% of total billed charges,622.44,78,,497.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,678.3,85,,542.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,630.42,79,,504.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,758.1,
GUAIFENESIN 100 MG/5ML SYRP,250017510,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
PSEUDOEPHEDRINE HCL 30MG TABL,250017511,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
ENOXAPARIN SODIUM 40MG/0.4 ML,250017512,CDM,250,RC,,,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
CARBIDOPA/LEVODOPA CR 25/100,250017516,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
ACETAMINOPHEN 650MG/20ML ORAL,250017517,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
MELOXICAM 7.5.MG TABLET,250017518,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
TRAMADOL HCL/ACETAMINOPHEN 1UD,250017527,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
SIMVASTATIN 40MG TABLET,250017528,CDM,250,RC,A9270,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
RAMIPRIL 1.25MG CAPSULE,250017533,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
AMOX TR/POTASS CLAV 50ML,250017537,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CALCIUM CARBONATE 600 MG TABLE,250017541,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SENNA/DOCUSATE SODIUM 1 TAB TA,250017542,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
ADENOSINE INJ 3MG/ML 2ML VIAL,250017554,CDM,250,RC,J0153,HCPCS,outpatient,,,408,285.6,,322.32,79,,257.86,percent of total billed charges,79% of total billed charges,367.2,90,,293.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,315.06,77.22,,252.05,percent of total billed charges,77.22% of total billed charges,0.42,105,,,fee schedule,105% of GA fee schedule,338.64,83,,270.91,percent of total billed charges,83% of total,387.6,95,,310.08,percent of total billed charges ,95% of total billed charges,326.4,80,,261.12,percent of total billed charges,78% of total billed charges,318.24,78,,254.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,367.2,90,,293.76,percent of total billed charges,90% of total billed charges,326.4,80,,261.12,percent of total billed charges,80% of total billed charges,0.4,100,,,fee schedule,100% of GA fee schedule,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,322.32,79,,257.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.4,450,
AMMONIA AROMATIC INHAL,250017556,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
ATIVAN 2MG AMP,250017559,CDM,250,RC,,,outpatient,,,79,55.3,,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,61,77.22,,48.8,percent of total billed charges,77.22% of total billed charges,52.22,66.1,,41.78,percent of total billed charges,66.1% of total billed charges,65.57,83,,52.46,percent of total billed charges,83% of total,75.05,95,,60.04,percent of total billed charges ,95% of total billed charges,63.2,80,,50.56,percent of total billed charges,78% of total billed charges,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.77,450,
POLYETHYLENE GLYCOL 3350 1 PKT,250017561,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
BUDESONIDE 32 MSG SRAY,250017565,CDM,250,RC,A9270,HCPCS,outpatient,,,359,251.3,,283.61,79,,226.89,percent of total billed charges,79% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,277.22,77.22,,221.78,percent of total billed charges,77.22% of total billed charges,237.3,66.1,,189.84,percent of total billed charges,66.1% of total billed charges,297.97,83,,238.38,percent of total billed charges,83% of total,341.05,95,,272.84,percent of total billed charges ,95% of total billed charges,287.2,80,,229.76,percent of total billed charges,78% of total billed charges,280.02,78,,224.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,283.61,79,,226.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,226.17,450,
BENZION TINCTUSE SPRAY DOSE,250017600,CDM,250,RC,A9270,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
BENZION CPD DOSE,250017606,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
AMPICILLIN 1GM VIAL,250017610,CDM,250,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
GARAMYCIN CREAM,250017611,CDM,250,RC,A9270,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
MOTRIN 800MG TABLET,250017620,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SILVER NITRATE STICK,250017629,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
SYNTHROID .25 MG TAB,250017632,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
IVP PREP KIT,250017851,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NUC MED MDP,250017858,CDM,250,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
PULMICORT .25MG,250017859,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
LIDOCAINE HCL/EPINEPHRINE 20ML,250019002,CDM,250,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
CEFOTAXIME SODIUM 500MG/VIAL,250019004,CDM,250,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
PERMETHRIN 60 GM CREAM,250019005,CDM,250,RC,A9270,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,85.27,66.1,,68.22,percent of total billed charges,66.1% of total billed charges,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.27,450,
MORPHINE SULFATE 0.5MG/ML AMPU,250019007,CDM,250,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
PYRIDOXINE HCL 100MG/ML VIAL,250019008,CDM,250,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
OXCARBAZEPINE 300MG TABLET,250019010,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
GUAIFENESIN/D-METHORPHAN HB 10,250019012,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
ZIPRASIDONE HCL 20MG CAPSULE,250019015,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
ROPINIROLE HCL 0.25MG TABLET,250019016,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
NIACIN 500 MG TABLET.SA,250019017,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
DIVALPROEX SODIUM 0250G TAB.SR,250019018,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
SORBITOL SOL 3% 3000ML IRRIG,250019021,CDM,250,RC,,,outpatient,,,143,100.1,,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,110.42,77.22,,88.34,percent of total billed charges,77.22% of total billed charges,94.52,66.1,,75.62,percent of total billed charges,66.1% of total billed charges,118.69,83,,94.95,percent of total billed charges,83% of total,135.85,95,,108.68,percent of total billed charges ,95% of total billed charges,114.4,80,,91.52,percent of total billed charges,78% of total billed charges,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.09,450,
DILTIAZEM HCL 25MG/5 ML VIAL,250019025,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
BUDESONIDE 3MG  CAP SR 24HR,250019026,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
MOEXIPRIL HCL/HCTZ 1 TAB TABLE,250019027,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
MAGNESIUM SULF 4G/WATER 50ML,250019029,CDM,250,RC,J3475,HCPCS,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.47,100,,,fee schedule,100% of GA fee schedule,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,0.49,105,,,fee schedule,105% of GA fee schedule,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.47,100,,,fee schedule,100% of GA fee schedule,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.47,450,
OXCARBAZEPINE 600MG TABLET,250019031,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
TERBINAFINE HCL 0250G TABLET,250019033,CDM,250,RC,A9270,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
ESCITALOPRAM OXALATE 10MG TABL,250019035,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
TRIHEXYPHENIDYL HCL 5MG TABLET,250019037,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
TERCONAZOLE 20GM CREAM.APPL,250019039,CDM,250,RC,A9270,HCPCS,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,160.62,66.1,,128.5,percent of total billed charges,66.1% of total billed charges,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.09,450,
IRBESARTAN HYDROCHLOROTHIAZIDE,250019040,CDM,250,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
LEVETIRACETAM 500 MG TABLET,250019041,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
GABAPENTIN 600MG TABLET,250019045,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ADVAIR 100 MCG/50 MCG 14 PUFFS,250019054,CDM,250,RC,A9270,HCPCS,outpatient,,,297,207.9,,234.63,79,,187.7,percent of total billed charges,79% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.11,63,,149.69,percent of total billed charges,63% of total billed charges,229.34,77.22,,183.47,percent of total billed charges,77.22% of total billed charges,196.32,66.1,,157.06,percent of total billed charges,66.1% of total billed charges,246.51,83,,197.21,percent of total billed charges,83% of total,282.15,95,,225.72,percent of total billed charges ,95% of total billed charges,237.6,80,,190.08,percent of total billed charges,78% of total billed charges,231.66,78,,185.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,187.11,63,,149.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,187.11,63,,149.69,percent of total billed charges,63% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,234.63,79,,187.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,187.11,450,
OLMESARTAN MEDOXOMIL 40MG TABL,250019055,CDM,250,RC,A9270,HCPCS,outpatient,,,39.75,27.83,,31.4,79,,25.12,percent of total billed charges,79% of total billed charges,35.78,90,,28.62,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.04,63,,20.03,percent of total billed charges,63% of total billed charges,30.69,77.22,,24.55,percent of total billed charges,77.22% of total billed charges,26.27,66.1,,21.02,percent of total billed charges,66.1% of total billed charges,32.99,83,,26.39,percent of total billed charges,83% of total,37.76,95,,30.21,percent of total billed charges ,95% of total billed charges,31.8,80,,25.44,percent of total billed charges,78% of total billed charges,31.01,78,,24.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.04,63,,20.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,35.78,90,,28.62,percent of total billed charges,90% of total billed charges,31.8,80,,25.44,percent of total billed charges,80% of total billed charges,25.04,63,,20.03,percent of total billed charges,63% of total billed charges,33.79,85,,27.032,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.4,79,,25.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.04,450,
MIRTAZAPINE 45 MG TABLET,250019056,CDM,250,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
OXYCODONE HCL/ACETAMINOPHEN,250019057,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ZINC SULFATE 1MG/ML VIAL,250019062,CDM,250,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
ARIPIPRAZOLE 10MG TABLET,250019067,CDM,250,RC,A9270,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
HYDROMORPHONE HCL 2 MG TABLET,250019068,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
METRONIDAZOLE 45 GM GEL,250019074,CDM,250,RC,A9270,HCPCS,outpatient,,,247,172.9,,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,190.73,77.22,,152.58,percent of total billed charges,77.22% of total billed charges,163.27,66.1,,130.62,percent of total billed charges,66.1% of total billed charges,205.01,83,,164.01,percent of total billed charges,83% of total,234.65,95,,187.72,percent of total billed charges ,95% of total billed charges,197.6,80,,158.08,percent of total billed charges,78% of total billed charges,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.61,450,
PILOCARPINE HCL 5 MG TABLET,250019078,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
COLESEVELAM HCL 625MG TABLET,250019079,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
OFLOXACIN 5ML DROPS,250019091,CDM,250,RC,A9270,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,183.76,66.1,,147.01,percent of total billed charges,66.1% of total billed charges,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,175.14,450,
NATEGLINIDE 120 MG TABLET,250019092,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
NEOMY SULF/BACITRA/POLYM B 30G,250019093,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
METHADONE HCL 10MG TABLET,250019094,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
CEFAZOLIN SODIUM/DEXTROSE 1G/5,250019095,CDM,250,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
P-EPHED SUL/LORATADINE 1 TAB,250019097,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
TOBRAMYCIN SULFATE 3.5 GM OINT,250019099,CDM,250,RC,A9270,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.05,450,
ENOXAPARIN SODIUM 120 MG/0.8ML,250019101,CDM,250,RC,,,outpatient,,,381,266.7,,300.99,79,,240.79,percent of total billed charges,79% of total billed charges,342.9,90,,274.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240.03,63,,192.02,percent of total billed charges,63% of total billed charges,294.21,77.22,,235.37,percent of total billed charges,77.22% of total billed charges,251.84,66.1,,201.47,percent of total billed charges,66.1% of total billed charges,316.23,83,,252.98,percent of total billed charges,83% of total,361.95,95,,289.56,percent of total billed charges ,95% of total billed charges,304.8,80,,243.84,percent of total billed charges,78% of total billed charges,297.18,78,,237.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,240.03,63,,192.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,240.03,63,,192.02,percent of total billed charges,63% of total billed charges,323.85,85,,259.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,300.99,79,,240.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,240.03,450,
OLMESARTAN MEDOXOMIL 20MG TAB,250019102,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
ERGOCALCIFEROL 400 UNIT TABLET,250019103,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
LEVETIRACETAM 0250G TABLET,250019104,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
CALCIUM/VIT D 500MG/600 IU TAB,250019105,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
ATORVASTATIN CALCIUM 40MG TABL,250019108,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
MONTELUKAST SODIUM 4MG TAB CHE,250019109,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
DESMOPRESSIN ACETATE 0.2MG TAB,250019114,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
CYANOCOBALAMIN 100 MCG TABLET,250019119,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
POLYSPORIN OINTMENT,250019120,CDM,250,RC,A9270,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
ALBUTEROL 2.5MG/0.5ML,250019121,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
BUDESONIDE 0.5MG/2ML AMPUL NEB,250019122,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
MEMANTINE HCL 5MG TABLET,250019126,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
INSULN ASP PRT/100U INSUL ASPA,250019127,CDM,250,RC,A9270,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
CORTENEMA RECTAL SUSPENSION,250019129,CDM,250,RC,A9270,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
ZOSYN VIAL 2.25 GM,250019130,CDM,250,RC,J2543,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.1,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,1.16,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.1,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.1,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.1,450,
EPINEPHrine 1 MG/ML AMPUL,250019135,CDM,250,RC,J0171,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,0.87,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.83,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.83,450,
LIDOCAINE HCL 4% 200MG/5ML AMP,250019136,CDM,250,RC,J2001,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
ACETYLCHOLINE CHLORID/2ML VIAL,250019138,CDM,250,RC,,,outpatient,,,142,99.4,,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,109.65,77.22,,87.72,percent of total billed charges,77.22% of total billed charges,93.86,66.1,,75.09,percent of total billed charges,66.1% of total billed charges,117.86,83,,94.29,percent of total billed charges,83% of total,134.9,95,,107.92,percent of total billed charges ,95% of total billed charges,113.6,80,,90.88,percent of total billed charges,78% of total billed charges,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.46,450,
IBUPROFEN 40MG/ML DROPS.SUSP,250019139,CDM,250,RC,A9270,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
FENTANYL CITRATE 0250CG/5ML AM,250019140,CDM,250,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
METOPROLOL TARTRATE 25MG TABLE,250019141,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
IBUPROFEN 100 MG/5 ML SYR,250019145,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TRAVATAN OPHTHALMIC DROPS 3.5M,250019147,CDM,250,RC,A9270,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
ROPINIROLE HCL 1 MG TABLET,250019152,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
SUCRALFATE 1 G/10 ML ORAL SUSP,250019154,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
LACTULOSE 20GRAMS/30ML SYRUP,250019155,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
DIPHENHYDRAMINE HCL 25MG/10ML,250019156,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
PREDNISOLONE 15MG/5ML SYRUP,250019158,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
SORBITOL SOLUTION 30ML SOLUTIO,250019159,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
NOVOLOG 100 UNITS/ML 1ML,250019161,CDM,250,RC,A9270,HCPCS,outpatient,,,453,317.1,,357.87,79,,286.3,percent of total billed charges,79% of total billed charges,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.39,63,,228.31,percent of total billed charges,63% of total billed charges,349.81,77.22,,279.85,percent of total billed charges,77.22% of total billed charges,299.43,66.1,,239.54,percent of total billed charges,66.1% of total billed charges,375.99,83,,300.79,percent of total billed charges,83% of total,430.35,95,,344.28,percent of total billed charges ,95% of total billed charges,362.4,80,,289.92,percent of total billed charges,78% of total billed charges,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,285.39,63,,228.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,285.39,63,,228.31,percent of total billed charges,63% of total billed charges,385.05,85,,308.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,357.87,79,,286.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,285.39,450,
BUPIVACAINE HCL 25MG/10ML VIAL,250019166,CDM,250,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
PSEUDOEPHEDRINE HCL 120MG TAB,250019168,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
BUPROPION HCL 150MG TAB SR 24H,250019174,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
LIDOCAINE/EPINEPHRINE 0.5%50ML,250019176,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
HYDROCHLOROTHIAZIDE 12.5MG CAP,250019177,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
METHYLPREDNISOLONE 4MG TABLET,250019179,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
LEFLUNOMIDE 20MG TABLET,250019180,CDM,250,RC,A9270,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
BETAMETHASONE DIP 45GM CREAM,250019181,CDM,250,RC,A9270,HCPCS,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
PSEUDOEPHEDRINE/CETIRIZINE TAB,250019184,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
CLONIDINE HCL 0.3 MG TABLET,250019187,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
CLONIDINE HCL 0.3MG/24HR PATCH,250019188,CDM,250,RC,A9270,HCPCS,outpatient,,,136,95.2,,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,105.02,77.22,,84.02,percent of total billed charges,77.22% of total billed charges,89.9,66.1,,71.92,percent of total billed charges,66.1% of total billed charges,112.88,83,,90.3,percent of total billed charges,83% of total,129.2,95,,103.36,percent of total billed charges ,95% of total billed charges,108.8,80,,87.04,percent of total billed charges,78% of total billed charges,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.68,450,
LINEZOLID 600MG TABLET,250019189,CDM,250,RC,A9270,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.02,450,
MICONAZOLE NITRATE 25GM CREAM,250019191,CDM,250,RC,A9270,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
PANTOPRAZOLE SOD 40MG/VIAL,250019192,CDM,250,RC,,,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
ZIPRASIDONE HCL 80MG CAPSULE,250019193,CDM,250,RC,A9270,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
TIOTROPIUM BIOMIDE 18MCG CAP W,250019197,CDM,250,RC,A9270,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
ROSUVASTATIN CALCIUM 10MG TAB,250019203,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
LORATADINE 5MG/5ML ML,250019205,CDM,250,RC,A9270,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
EZETIMIBE 10MG TABLET,250019212,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
METAXALONE 800MG TABLET,250019213,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
"FENOFIBRATE,MICRONIZED 145MG T",250019216,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
DULOXETINE HCL 30MG CAPSULE DR,250019217,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
"FENOFIBRATE,MICRONIZE 48MG TAB",250019220,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
FERROUS SULFATE 15MG/0.6 ML,250019227,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
DUTASTERIDE 0.5 MG CAPSULE,250019234,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
LITHIUM CARBONATE 450MG TABLET,250019246,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ACETAMINOPHEN/HYDROCODONE TAB,250019250,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
SOLIFENACIN SUCCINATE 5MG TAB,250019251,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
HCTZ/ENALAPRIL 1 TAB TABLET,250019254,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
PREGABALIN 50MG CAPSULE,250019255,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
CETRIAXONE/DEXTROSE 1G/50ML PI,250019256,CDM,250,RC,,,outpatient,,,142,99.4,,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,109.65,77.22,,87.72,percent of total billed charges,77.22% of total billed charges,93.86,66.1,,75.09,percent of total billed charges,66.1% of total billed charges,117.86,83,,94.29,percent of total billed charges,83% of total,134.9,95,,107.92,percent of total billed charges ,95% of total billed charges,113.6,80,,90.88,percent of total billed charges,78% of total billed charges,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.46,450,
ALBUTEROL 1.25 MG/3 ML,250019258,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
LEFLUNOMIDE 10MG TABLET,250019259,CDM,250,RC,A9270,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
BACITRACIN 3.5 GM OINT.GM,250019261,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
MELATONIN 1 MG TABLET,250019263,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ATROPINE SULFATE 3.5GM OINT,250019264,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
TEMAZEPAM 7.5MG CAPSULE,250019266,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
SOD FERRIC GLUC COMP/SUCR 62.5,250019269,CDM,250,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
NEOSPORIN/LOTRIMIN/ZINC/  60G,250019273,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
BISMUTH SUBSALICYLATE/30TAB BX,250019274,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PROBENECID/COLCHICINE 1 TAB TA,250019276,CDM,250,RC,A9270,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
FISH OIL 1 CAP CAPSULE,250019277,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
LEVETIRACETAM 100 MG/ML,250019278,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
CIPROFLOXACIN HCL/DEXAMETH 7.5,250019279,CDM,250,RC,A9270,HCPCS,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
SERTRALINE HCL 25MG TABLET,250019280,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
PERPHENAZINE 2MG TABLET,250019281,CDM,250,RC,A9270,HCPCS,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
HEPARIN LOCK FLUSH 5 ML SYR,250019284,CDM,250,RC,J1642,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.02,100,,,fee schedule,100% of GA fee schedule,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,0.02,105,,,fee schedule,105% of GA fee schedule,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.02,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.02,100,,,fee schedule,100% of GA fee schedule,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.02,450,
LEVALBUTEROL HCL 1.25 MG/0.5 M,250019285,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CALCIUM CARBONATE 500 MG TAB,250019286,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
WARFARIN SOD 6 MG TABLET,250019300,CDM,250,RC,A9270,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
MIRAPEX 0.25 MG TAB,250019301,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
CEFOXITIN/DEX PREMIX 2GR/50ML,250019302,CDM,250,RC,,,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
CEFOXITIN/DEX PREMIX 1GR/50ML,250019303,CDM,250,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
PREGABALIN 75MG CAP,250019304,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
HYDRALAZINE HCL 100MG TABLET,250019306,CDM,250,RC,A9270,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
HCTZ/LISINOPRIL 1 TAB TABLET,250019309,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
MEGESTROL ACETATE 400MG/10ML U,250019310,CDM,250,RC,A9270,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
MAGNESIUM SULF 2 GM/WATER 50ML,250019311,CDM,250,RC,J3475,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.47,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,0.49,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.47,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.47,450,
ABACAVIR/LAMIVUDINE 600MG/300M,250019313,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ATAZANAVIR SULFATE 200 MG,250019314,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
AZITHROMYCIN 600 MG TAB,250019315,CDM,250,RC,,,outpatient,,,334,233.8,,263.86,79,,211.09,percent of total billed charges,79% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.42,63,,168.34,percent of total billed charges,63% of total billed charges,257.91,77.22,,206.33,percent of total billed charges,77.22% of total billed charges,220.77,66.1,,176.62,percent of total billed charges,66.1% of total billed charges,277.22,83,,221.78,percent of total billed charges,83% of total,317.3,95,,253.84,percent of total billed charges ,95% of total billed charges,267.2,80,,213.76,percent of total billed charges,78% of total billed charges,260.52,78,,208.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,210.42,63,,168.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,210.42,63,,168.34,percent of total billed charges,63% of total billed charges,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,263.86,79,,211.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,210.42,450,
FLUVOXAMINE MALEATE 100MG TAB,250019316,CDM,250,RC,A9270,HCPCS,outpatient,,,65.8,46.06,,51.98,79,,41.58,percent of total billed charges,79% of total billed charges,59.22,90,,47.38,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.45,63,,33.16,percent of total billed charges,63% of total billed charges,50.81,77.22,,40.65,percent of total billed charges,77.22% of total billed charges,43.49,66.1,,34.79,percent of total billed charges,66.1% of total billed charges,54.61,83,,43.69,percent of total billed charges,83% of total,62.51,95,,50.01,percent of total billed charges ,95% of total billed charges,52.64,80,,42.11,percent of total billed charges,78% of total billed charges,51.32,78,,41.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.45,63,,33.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,59.22,90,,47.38,percent of total billed charges,90% of total billed charges,52.64,80,,42.11,percent of total billed charges,80% of total billed charges,41.45,63,,33.16,percent of total billed charges,63% of total billed charges,55.93,85,,44.744,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.98,79,,41.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.45,450,
SODIUM CHLORIDE INFANT NASAL,250019317,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SIMVASTATIN 10MG TABLET,250019319,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SPIRONOLACTONE 100 MG TAB,250019325,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
TRYPAN BLUE 0.5 ML DISP SYRING,250019326,CDM,250,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
TESTOSTERONE 200 MG/ML VIAL,250019332,CDM,250,RC,J1071,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,0.03,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.03,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,450,
DULOXETINE HCL 20MG CAPSULE,250019333,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
PANTOPRAZOLE SOD 20 MG TAB,250019334,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
PHENYTOIN ORAL SUSPENSION 125M,250019335,CDM,250,RC,A9270,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
CANCIDAS 70MG/VIAL VIAL,250019336,CDM,250,RC,J0637,HCPCS,outpatient,,,1292,904.4,,1020.68,79,,816.54,percent of total billed charges,79% of total billed charges,1162.8,90,,930.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,813.96,63,,651.17,percent of total billed charges,63% of total billed charges,997.68,77.22,,798.14,percent of total billed charges,77.22% of total billed charges,854.01,66.1,,683.21,percent of total billed charges,66.1% of total billed charges,1072.36,83,,857.89,percent of total billed charges,83% of total,1227.4,95,,981.92,percent of total billed charges ,95% of total billed charges,1033.6,80,,826.88,percent of total billed charges,78% of total billed charges,1007.76,78,,806.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,813.96,63,,651.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1162.8,90,,930.24,percent of total billed charges,90% of total billed charges,1033.6,80,,826.88,percent of total billed charges,80% of total billed charges,813.96,63,,651.17,percent of total billed charges,63% of total billed charges,1098.2,85,,878.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1020.68,79,,816.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1227.4,
ASCORBIC ACID 500 MG/ML VIAL,250019337,CDM,250,RC,,,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
CEFEPIME HCL 2 G/VIAL INJ,250019338,CDM,250,RC,,,outpatient,,,136,95.2,,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,105.02,77.22,,84.02,percent of total billed charges,77.22% of total billed charges,89.9,66.1,,71.92,percent of total billed charges,66.1% of total billed charges,112.88,83,,90.3,percent of total billed charges,83% of total,129.2,95,,103.36,percent of total billed charges ,95% of total billed charges,108.8,80,,87.04,percent of total billed charges,78% of total billed charges,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.68,450,
HYALURONIDASE 200 U/ML ML,250019339,CDM,250,RC,,,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,111.05,66.1,,88.84,percent of total billed charges,66.1% of total billed charges,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.84,450,
TRIAMCINOLONE ACETONIDE 80GM T,250019340,CDM,250,RC,A9270,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
CARBIDOP/LEVADOPA/ENTACA 1 TAB,250019342,CDM,250,RC,A9270,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
NULTIVITAMIN INJ W/O VIT K 10M,250019343,CDM,250,RC,,,outpatient,,,371,259.7,,293.09,79,,234.47,percent of total billed charges,79% of total billed charges,333.9,90,,267.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.73,63,,186.98,percent of total billed charges,63% of total billed charges,286.49,77.22,,229.19,percent of total billed charges,77.22% of total billed charges,245.23,66.1,,196.18,percent of total billed charges,66.1% of total billed charges,307.93,83,,246.34,percent of total billed charges,83% of total,352.45,95,,281.96,percent of total billed charges ,95% of total billed charges,296.8,80,,237.44,percent of total billed charges,78% of total billed charges,289.38,78,,231.504,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,233.73,63,,186.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,233.73,63,,186.98,percent of total billed charges,63% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,293.09,79,,234.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,233.73,450,
ACULAR LS 0.4% 5ML EYE DROPS,250019344,CDM,250,RC,A9270,HCPCS,outpatient,,,135.8,95.06,,107.28,79,,85.82,percent of total billed charges,79% of total billed charges,122.22,90,,97.78,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.55,63,,68.44,percent of total billed charges,63% of total billed charges,104.86,77.22,,83.89,percent of total billed charges,77.22% of total billed charges,89.76,66.1,,71.81,percent of total billed charges,66.1% of total billed charges,112.71,83,,90.17,percent of total billed charges,83% of total,129.01,95,,103.21,percent of total billed charges ,95% of total billed charges,108.64,80,,86.91,percent of total billed charges,78% of total billed charges,105.92,78,,84.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.55,63,,68.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,122.22,90,,97.78,percent of total billed charges,90% of total billed charges,108.64,80,,86.91,percent of total billed charges,80% of total billed charges,85.55,63,,68.44,percent of total billed charges,63% of total billed charges,115.43,85,,92.344,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,107.28,79,,85.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.55,450,
BUPIVACAINE HCL 0.5% 30ML VIAL,250019345,CDM,250,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
VALPROATE SODIUM 500MG/5ML VIA,250019346,CDM,250,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
ACETIC ACID 1000ML IRR,250019348,CDM,250,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
RANOLAZINE 500MG TABLET,250019350,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
LEVETIRACETAM 750MG TABLET,250019351,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
FLORASTOR 250 MG CAPSULE,250019354,CDM,250,RC,A9270,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
NITAZOXANIDE 100MG/5ML BOTTLE,250019356,CDM,250,RC,,,outpatient,,,427,298.9,,337.33,79,,269.86,percent of total billed charges,79% of total billed charges,384.3,90,,307.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.01,63,,215.21,percent of total billed charges,63% of total billed charges,329.73,77.22,,263.78,percent of total billed charges,77.22% of total billed charges,282.25,66.1,,225.8,percent of total billed charges,66.1% of total billed charges,354.41,83,,283.53,percent of total billed charges,83% of total,405.65,95,,324.52,percent of total billed charges ,95% of total billed charges,341.6,80,,273.28,percent of total billed charges,78% of total billed charges,333.06,78,,266.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,269.01,63,,215.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,269.01,63,,215.21,percent of total billed charges,63% of total billed charges,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,337.33,79,,269.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,269.01,450,
CHOLECALCIFEROL 400 UNIT TAB,250019357,CDM,250,RC,A9270,HCPCS,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
LUMIGAN OPHTHALMIC SOLU 2.5ML,250019360,CDM,250,RC,A9270,HCPCS,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,143.44,66.1,,114.75,percent of total billed charges,66.1% of total billed charges,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.71,450,
LUBIPROSTONE 24MCG CAPSULE,250019363,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TESTOSTERONE CYP 200MG/ML VIAL,250019365,CDM,250,RC,J1071,HCPCS,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,0.03,105,,,fee schedule,105% of GA fee schedule,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.03,100,,,fee schedule,100% of GA fee schedule,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,450,
BETHANECHOL CHL 10MG TABLET,250019368,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
CLINDAMYCIN PHOS 30 GM BOTTLE,250019369,CDM,250,RC,,,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.85,450,
RANITIDINE HCL 15MG/ML UDC,250019370,CDM,250,RC,A9270,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
MEGESTROL ACETATE 40MG/ML BLT,250019372,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
MEROPENEM 1 GRAM VIAL,250019374,CDM,250,RC,J2185,HCPCS,outpatient,,,242,169.4,,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.35,100,,,fee schedule,100% of GA fee schedule,186.87,77.22,,149.5,percent of total billed charges,77.22% of total billed charges,0.37,105,,,fee schedule,105% of GA fee schedule,200.86,83,,160.69,percent of total billed charges,83% of total,229.9,95,,183.92,percent of total billed charges ,95% of total billed charges,193.6,80,,154.88,percent of total billed charges,78% of total billed charges,188.76,78,,151.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.35,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.35,100,,,fee schedule,100% of GA fee schedule,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.35,450,
SITAGLIPTIN 100MG TABLET,250019381,CDM,250,RC,A9270,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
ZIPRASIDONE HCL 40MG CAPSULE,250019382,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
HYDROXYZINE HCL 50MG/ML VIAL,250019384,CDM,250,RC,J3410,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.41,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.03,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.41,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,12.41,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.41,450,
WARFARIN SOD 3 MG TABLET,250019386,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
GUAIFENESIN/PSEUDOEPHERDR 1TAB,250019387,CDM,250,RC,A9270,HCPCS,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
LIDOCAINE 5% PATCH,250019388,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
IRRIGATING SOLU 118ML IRRIG SO,250019389,CDM,250,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
BALANCED SALT SOLN 500ML IRRIG,250019390,CDM,250,RC,,,outpatient,,,79,55.3,,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,61,77.22,,48.8,percent of total billed charges,77.22% of total billed charges,52.22,66.1,,41.78,percent of total billed charges,66.1% of total billed charges,65.57,83,,52.46,percent of total billed charges,83% of total,75.05,95,,60.04,percent of total billed charges ,95% of total billed charges,63.2,80,,50.56,percent of total billed charges,78% of total billed charges,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.77,450,
HYDROXYZINE HCL 10MG/5ML UDC,250019392,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
DOES NOT APPLY PAD,250019393,CDM,250,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
FENTANYL 1 PATCH .72 H PATCH,250019395,CDM,250,RC,A9270,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
METOPROLOL SUCCINATE 100MG TAB,250019396,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
DOCUSATE SODIUM 60MG/15ML BTL,250019397,CDM,250,RC,A9270,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
THROMBIN/FIBRIN/APRO/CA 2MLKIT,250019398,CDM,250,RC,,,outpatient,,,328.45,229.92,,259.48,79,,207.58,percent of total billed charges,79% of total billed charges,295.61,90,,236.49,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.92,63,,165.54,percent of total billed charges,63% of total billed charges,253.63,77.22,,202.9,percent of total billed charges,77.22% of total billed charges,217.11,66.1,,173.69,percent of total billed charges,66.1% of total billed charges,272.61,83,,218.09,percent of total billed charges,83% of total,312.03,95,,249.62,percent of total billed charges ,95% of total billed charges,262.76,80,,210.21,percent of total billed charges,78% of total billed charges,256.19,78,,204.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.92,63,,165.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,295.61,90,,236.49,percent of total billed charges,90% of total billed charges,262.76,80,,210.21,percent of total billed charges,80% of total billed charges,206.92,63,,165.54,percent of total billed charges,63% of total billed charges,279.18,85,,223.344,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,259.48,79,,207.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.92,450,
LEVETIRACETAM 500 MG/5ML VIAL,250019399,CDM,250,RC,,,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,87.25,66.1,,69.8,percent of total billed charges,66.1% of total billed charges,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.16,450,
NORFLURANE TOPICAL ANES SPRAY,250019400,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DOCOSANOL 2 GM CREAM GM,250019401,CDM,250,RC,A9270,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
TRIMETHOPRIM/SULFAMETHOXA 800M,250019403,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
BUDESONIDE/FORMOTEROL FUM 6 GM,250019406,CDM,250,RC,A9270,HCPCS,outpatient,,,396,277.2,,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.48,63,,199.58,percent of total billed charges,63% of total billed charges,305.79,77.22,,244.63,percent of total billed charges,77.22% of total billed charges,261.76,66.1,,209.41,percent of total billed charges,66.1% of total billed charges,328.68,83,,262.94,percent of total billed charges,83% of total,376.2,95,,300.96,percent of total billed charges ,95% of total billed charges,316.8,80,,253.44,percent of total billed charges,78% of total billed charges,308.88,78,,247.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,249.48,63,,199.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,249.48,63,,199.58,percent of total billed charges,63% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,249.48,450,
MINOXIDIL 2.5 MG TABLET,250019407,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
SITAGLIPTIN 25 MG TABLET,250019410,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
"XYLOCAINE 1%-EPI 1:100,000",250019411,CDM,250,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MINERAL OIL/PETROLATUM 105GM,250019412,CDM,250,RC,A9270,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
NEBIVOLOL 5MG TABLET,250019415,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"XYLOCAINE 1%-EPI 1:200,000",250019417,CDM,250,RC,,,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
FLUVOXAMINE MALEATE 25 MG TAB,250019418,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SITAGLIPTIN 50 MG TAB,250019420,CDM,250,RC,A9270,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
SEVELAMER HCL 800 MG TABLET,250019422,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
CADEXOMER IODINE 40 GM GEL,250019423,CDM,250,RC,A9270,HCPCS,outpatient,,,511,357.7,,403.69,79,,322.95,percent of total billed charges,79% of total billed charges,459.9,90,,367.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,321.93,63,,257.54,percent of total billed charges,63% of total billed charges,394.59,77.22,,315.67,percent of total billed charges,77.22% of total billed charges,337.77,66.1,,270.22,percent of total billed charges,66.1% of total billed charges,424.13,83,,339.3,percent of total billed charges,83% of total,485.45,95,,388.36,percent of total billed charges ,95% of total billed charges,408.8,80,,327.04,percent of total billed charges,78% of total billed charges,398.58,78,,318.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,321.93,63,,257.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,459.9,90,,367.92,percent of total billed charges,90% of total billed charges,408.8,80,,327.04,percent of total billed charges,80% of total billed charges,321.93,63,,257.54,percent of total billed charges,63% of total billed charges,434.35,85,,347.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,403.69,79,,322.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,321.93,485.45,
DOXYCYCLINE HYCLATE 50 MG CAP,250019425,CDM,250,RC,A9270,HCPCS,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
"INJECTION,ENTAPENEM SODIUM IGM",250019426,CDM,250,RC,,,outpatient,,,201,140.7,,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,155.21,77.22,,124.17,percent of total billed charges,77.22% of total billed charges,132.86,66.1,,106.29,percent of total billed charges,66.1% of total billed charges,166.83,83,,133.46,percent of total billed charges,83% of total,190.95,95,,152.76,percent of total billed charges ,95% of total billed charges,160.8,80,,128.64,percent of total billed charges,78% of total billed charges,156.78,78,,125.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126.63,450,
THROMBIN/FIBRIN/APRO/CA 4ML KT,250019427,CDM,250,RC,,,outpatient,,,527.64,369.35,,416.84,79,,333.47,percent of total billed charges,79% of total billed charges,474.88,90,,379.9,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.41,63,,265.93,percent of total billed charges,63% of total billed charges,407.44,77.22,,325.95,percent of total billed charges,77.22% of total billed charges,348.77,66.1,,279.02,percent of total billed charges,66.1% of total billed charges,437.94,83,,350.35,percent of total billed charges,83% of total,501.26,95,,401.01,percent of total billed charges ,95% of total billed charges,422.11,80,,337.69,percent of total billed charges,78% of total billed charges,411.56,78,,329.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,332.41,63,,265.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,474.88,90,,379.9,percent of total billed charges,90% of total billed charges,422.11,80,,337.69,percent of total billed charges,80% of total billed charges,332.41,63,,265.93,percent of total billed charges,63% of total billed charges,448.49,85,,358.792,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,416.84,79,,333.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,332.41,501.26,
NEOSTIGMINE BROMIDE 15 MG TAB,250019430,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
COMPOUND DRUG,250019433,CDM,250,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
CHOLECALCIFEROL 1000 UNIT TAB,250019437,CDM,250,RC,A9270,HCPCS,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
KEFLEX 250 CAPSULE,250019438,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
MAGIC MOUTHWASH PED 90 ML SUS,250019440,CDM,250,RC,A9270,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
PPD RESULTS,250019441,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
KETAMINE HCL 25MG/0.25ML INJEC,250019447,CDM,250,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
ITRACONAZOLE 100 MG CAPSULE,250019448,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
POLYVINYL ALCOHOL/POVIDONE,250019449,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
LUBIPROSTONE 8 MCG CAPSULE,250019450,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MANNITOL 25% 50 ML VIAL,250019452,CDM,250,RC,J2150,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.61,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,2.74,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.61,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.61,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.61,450,
INSUL NPH HU REC/INS RG HU 100,250019455,CDM,250,RC,A9270,HCPCS,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
INSULIN HUMAN REGULAR 100U/ML,250019456,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INSULIN HUMAN NPH 100 UNITS/ML,250019457,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BUPIVACAINE/EPINEPHRINE 1.25%,250019460,CDM,250,RC,,,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
DICLOFENAC SODIUM 100GM TUBE,250019463,CDM,250,RC,A9270,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
PROPRANOLOL HCL 120MG CAP,250019467,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
DEXLANSOPRAZOLE 60 MG CAP,250019468,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
RIVASTIGMINE TARTRATE PATCH,250019469,CDM,250,RC,A9270,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
FENOFIBRIC ACID 135MG CAPSULE,250019475,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
"DEXLANSOPRAZOLE 30MG CAPSULE,D",250019476,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
"HEPARIN SODIUM,PORCINE 1 UNIT",250019482,CDM,250,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
COLCHICINE 0.6 MG TABLET,250019485,CDM,250,RC,A9270,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
RECLAST 5 MG/100 ML SOLUTION,250019486,CDM,250,RC,J3489,HCPCS,outpatient,,,2108,1475.6,,1665.32,79,,1332.26,percent of total billed charges,79% of total billed charges,1897.2,90,,1517.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.47,100,,,fee schedule,100% of GA fee schedule,1627.8,77.22,,1302.24,percent of total billed charges,77.22% of total billed charges,6.79,105,,,fee schedule,105% of GA fee schedule,1749.64,83,,1399.71,percent of total billed charges,83% of total,2002.6,95,,1602.08,percent of total billed charges ,95% of total billed charges,1686.4,80,,1349.12,percent of total billed charges,78% of total billed charges,1644.24,78,,1315.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1897.2,90,,1517.76,percent of total billed charges,90% of total billed charges,1686.4,80,,1349.12,percent of total billed charges,80% of total billed charges,6.47,100,,,fee schedule,100% of GA fee schedule,1791.8,85,,1433.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1665.32,79,,1332.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.47,2002.6,
SOD PHOS MONO/DIBAS/0250G POT,250019489,CDM,250,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
NICOTINE 7MG/24 HR PATCH,250019490,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
ONDANSETRON HCL 4MG ORAL DISIN,250019491,CDM,250,RC,A9270,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
LIDOCAINE HCL 1% 20ML BOTTLE,250019493,CDM,250,RC,J2001,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
BUPIVAC/EPT 0.5%/1:200.000 10M,250019494,CDM,250,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
LIDOCAINE HCL 5%/DEXTROSE 7.5%,250019496,CDM,250,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
ETOMIDATE 2 MG/1ML AMP,250019497,CDM,250,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
FENTANYL 12 MCG/HR PATCH,250019498,CDM,250,RC,A9270,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
LACASAMIDE 50MG TAB,250019499,CDM,250,RC,A9270,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
CLOTRIMAZOLE/BETAMET 15GM,250019501,CDM,250,RC,A9270,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
SODIUM PHOSPHATE 15MM/5ML VIAL,250019504,CDM,250,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
TAMIFLU 6 MG/ML 60ML,250019505,CDM,250,RC,A9270,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,183.76,66.1,,147.01,percent of total billed charges,66.1% of total billed charges,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,175.14,450,
MORPHINE SULF 50 MG/1 ML VIAL,250019506,CDM,250,RC,J2270,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,100,,,fee schedule,100% of GA fee schedule,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,5.08,105,,,fee schedule,105% of GA fee schedule,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.84,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,4.84,100,,,fee schedule,100% of GA fee schedule,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.84,450,
DABIGATRAN ETEXILATE MESYLATE,250019509,CDM,250,RC,A9270,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
CEFTRIAXONE SODIUM 2 GM VIAL,250019512,CDM,250,RC,J0696,HCPCS,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.44,100,,,fee schedule,100% of GA fee schedule,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
COMBIGAN EYE DROPS 5ML BTL,250019514,CDM,250,RC,A9270,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
PRAMIPEXOLE DI-HCL 0.5MG TAB,250019521,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
BUDESONIDE/FORMOTEROL FUM 10.2,250019522,CDM,250,RC,A9270,HCPCS,outpatient,,,524,366.8,,413.96,79,,331.17,percent of total billed charges,79% of total billed charges,471.6,90,,377.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.12,63,,264.1,percent of total billed charges,63% of total billed charges,404.63,77.22,,323.7,percent of total billed charges,77.22% of total billed charges,346.36,66.1,,277.09,percent of total billed charges,66.1% of total billed charges,434.92,83,,347.94,percent of total billed charges,83% of total,497.8,95,,398.24,percent of total billed charges ,95% of total billed charges,419.2,80,,335.36,percent of total billed charges,78% of total billed charges,408.72,78,,326.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.12,63,,264.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,330.12,63,,264.1,percent of total billed charges,63% of total billed charges,445.4,85,,356.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,413.96,79,,331.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.12,497.8,
ZOSYN VIAL 4.5 GM,250019534,CDM,250,RC,J2543,HCPCS,outpatient,,,58,40.6,,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.1,100,,,fee schedule,100% of GA fee schedule,44.79,77.22,,35.83,percent of total billed charges,77.22% of total billed charges,1.16,105,,,fee schedule,105% of GA fee schedule,48.14,83,,38.51,percent of total billed charges,83% of total,55.1,95,,44.08,percent of total billed charges ,95% of total billed charges,46.4,80,,37.12,percent of total billed charges,78% of total billed charges,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.1,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.1,100,,,fee schedule,100% of GA fee schedule,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.1,450,
ALBUTEROL SULFATE 0.63MG/3ML,250019535,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CINACALCET HCL 60MG TABLET,250019536,CDM,250,RC,A9270,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
GENTEAL EYE GEL,250019537,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SENSORCAINE 0.5% EPI1:200000 5,250019539,CDM,250,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
TIKOSYN 125 MG ORAL CAP,250019540,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
NICOTINE POLACRILEX 4MG GUM,250019543,CDM,250,RC,A9270,HCPCS,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
DRONEDARONE HYDROCHLOR 400MG T,250019544,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
NICOTINE POLACRILEX 2MG GUM,250019546,CDM,250,RC,A9270,HCPCS,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
"CYCLOSPORINE,MODIFIED 25MG CAP",250019550,CDM,250,RC,A9270,HCPCS,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
ENALAPRILAT DIHYDRATE 2.5MG V,250019551,CDM,250,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
MISOPROSTOL 25 MCG TABLET,250019552,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
ROPIVACAINE HCL 7.5MG/1ML VIAL,250019556,CDM,250,RC,,,outpatient,,,96,67.2,,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,74.13,77.22,,59.3,percent of total billed charges,77.22% of total billed charges,63.46,66.1,,50.77,percent of total billed charges,66.1% of total billed charges,79.68,83,,63.74,percent of total billed charges,83% of total,91.2,95,,72.96,percent of total billed charges ,95% of total billed charges,76.8,80,,61.44,percent of total billed charges,78% of total billed charges,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60.48,450,
NORTRIPTYLINE HCL 50MG CAPSULE,250019557,CDM,250,RC,A9270,HCPCS,outpatient,,,9.85,6.9,,7.78,79,,6.22,percent of total billed charges,79% of total billed charges,8.87,90,,7.1,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.21,63,,4.97,percent of total billed charges,63% of total billed charges,7.61,77.22,,6.09,percent of total billed charges,77.22% of total billed charges,6.51,66.1,,5.21,percent of total billed charges,66.1% of total billed charges,8.18,83,,6.54,percent of total billed charges,83% of total,9.36,95,,7.49,percent of total billed charges ,95% of total billed charges,7.88,80,,6.3,percent of total billed charges,78% of total billed charges,7.68,78,,6.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.21,63,,4.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,8.87,90,,7.1,percent of total billed charges,90% of total billed charges,7.88,80,,6.3,percent of total billed charges,80% of total billed charges,6.21,63,,4.97,percent of total billed charges,63% of total billed charges,8.37,85,,6.696,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.78,79,,6.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.21,450,
LVOTHYROXIN SODIUM 100MCG VIAL,250019558,CDM,250,RC,,,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
ARIPIPRAZOLE 2 MG TABLET,250019559,CDM,250,RC,A9270,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
INSULIN DETEMIR 100 UNITS/ML U,250019560,CDM,250,RC,A9270,HCPCS,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
NOVOLOG 100 UNITS/ML 0.01ML,250019562,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
INSULIN NPL/INSULIN LISPRO 100,250019563,CDM,250,RC,A9270,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
OMEGA-3 ACID ETHYL EST 1GM CAP,250019564,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
SAXAGLIPTIN HCL 5MG TAB,250019565,CDM,250,RC,A9270,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
LIDOCAINE HCL/PF 20MG/1ML AMP,250019568,CDM,250,RC,,,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
BUPIVACAINE HCL/PF 0.25% VIAL,250019570,CDM,250,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
NEVIRAPINE SUSPENSION 50MG/5ML,250019571,CDM,250,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
CEFEPIME HCL 1 GM VIAL,250019572,CDM,250,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
ONDANSETRON HCL 4MG/5ML UDC,250019573,CDM,250,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
SUPREP BOWEL PREP KIT 354 ML,250019574,CDM,250,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
BISOPROLOL FUMERATE 10MG TAB,250019575,CDM,250,RC,A9270,HCPCS,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
CLOTRIMAZOLE 30ML SOLUTION,250019576,CDM,250,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
RIFAMPIN 600MG VIAL INJECTION,250019577,CDM,250,RC,,,outpatient,,,360,252,,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,277.99,77.22,,222.39,percent of total billed charges,77.22% of total billed charges,237.96,66.1,,190.37,percent of total billed charges,66.1% of total billed charges,298.8,83,,239.04,percent of total billed charges,83% of total,342,95,,273.6,percent of total billed charges ,95% of total billed charges,288,80,,230.4,percent of total billed charges,78% of total billed charges,280.8,78,,224.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,226.8,450,
TRIAMCINOLONE ACETON 0.1% CREM,250019578,CDM,250,RC,A9270,HCPCS,outpatient,,,58,40.6,,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,44.79,77.22,,35.83,percent of total billed charges,77.22% of total billed charges,38.34,66.1,,30.67,percent of total billed charges,66.1% of total billed charges,48.14,83,,38.51,percent of total billed charges,83% of total,55.1,95,,44.08,percent of total billed charges ,95% of total billed charges,46.4,80,,37.12,percent of total billed charges,78% of total billed charges,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.54,450,
RIVAROXABAN 10MG TABLET,250019579,CDM,250,RC,A9270,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
FESOTERODINE FUMARATE 4MG TAB,250019580,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
FEBUXOSTAT 40 MG TABLET,250019582,CDM,250,RC,A9270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
ACETYLCYSTEINE 200MG/1ML VIAL,250019583,CDM,250,RC,,,outpatient,,,585,409.5,,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,451.74,77.22,,361.39,percent of total billed charges,77.22% of total billed charges,386.69,66.1,,309.35,percent of total billed charges,66.1% of total billed charges,485.55,83,,388.44,percent of total billed charges,83% of total,555.75,95,,444.6,percent of total billed charges ,95% of total billed charges,468,80,,374.4,percent of total billed charges,78% of total billed charges,456.3,78,,365.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,468,80,,374.4,percent of total billed charges,80% of total billed charges,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,497.25,85,,397.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,555.75,
LIDOCAINE 2%/EPINEPHRINE,250019586,CDM,250,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
EXENATIDE 10 MCG/O.04 ML INJ,250019587,CDM,250,RC,,,outpatient,,,891,623.7,,703.89,79,,563.11,percent of total billed charges,79% of total billed charges,801.9,90,,641.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,561.33,63,,449.06,percent of total billed charges,63% of total billed charges,688.03,77.22,,550.42,percent of total billed charges,77.22% of total billed charges,588.95,66.1,,471.16,percent of total billed charges,66.1% of total billed charges,739.53,83,,591.62,percent of total billed charges,83% of total,846.45,95,,677.16,percent of total billed charges ,95% of total billed charges,712.8,80,,570.24,percent of total billed charges,78% of total billed charges,694.98,78,,555.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,561.33,63,,449.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,561.33,63,,449.06,percent of total billed charges,63% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,703.89,79,,563.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,846.45,
TAMIFLU 6 MG/ML 1ML,250019591,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
INT FLUSH NORMAL SAL 10ML 1EA,250019592,CDM,250,RC,,,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
PHENYLE PHRINE 2.5% 3ML DROPS,250019593,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
CYCLOSPORINE 1 EA DROPERETTE,250019594,CDM,250,RC,A9270,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
MORPHINE SULFATE/PF 10MG/10ML,250019595,CDM,250,RC,,,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
MORPHINE SULFATE 10MG/ML SYRIN,250019597,CDM,250,RC,J2270,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,5.08,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.84,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,4.84,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.84,450,
ANCEF 2 GRAMS + D5W 50ML IVPB,250019598,CDM,250,RC,J0690,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.81,100,,,fee schedule,100% of GA fee schedule,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,0.85,105,,,fee schedule,105% of GA fee schedule,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.81,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.81,100,,,fee schedule,100% of GA fee schedule,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.81,450,
MICAFUNGIN SODIUM 100MG VIAL,250019600,CDM,250,RC,J2248,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.29,100,,,fee schedule,100% of GA fee schedule,447.1,77.22,,357.68,percent of total billed charges,77.22% of total billed charges,0.3,105,,,fee schedule,105% of GA fee schedule,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.29,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.29,100,,,fee schedule,100% of GA fee schedule,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.29,550.05,
LEVONORGESTREL 1.5 MG TABLET,250019603,CDM,250,RC,A9270,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
BUPIVACAINE HCL 0.25%/EPINEPHR,250019605,CDM,250,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
MITOMYCIN 0.2 MG KIT,250019608,CDM,250,RC,A9270,HCPCS,outpatient,,,805,563.5,,635.95,79,,508.76,percent of total billed charges,79% of total billed charges,724.5,90,,579.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,507.15,63,,405.72,percent of total billed charges,63% of total billed charges,621.62,77.22,,497.3,percent of total billed charges,77.22% of total billed charges,532.11,66.1,,425.69,percent of total billed charges,66.1% of total billed charges,668.15,83,,534.52,percent of total billed charges,83% of total,764.75,95,,611.8,percent of total billed charges ,95% of total billed charges,644,80,,515.2,percent of total billed charges,78% of total billed charges,627.9,78,,502.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,507.15,63,,405.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,724.5,90,,579.6,percent of total billed charges,90% of total billed charges,644,80,,515.2,percent of total billed charges,80% of total billed charges,507.15,63,,405.72,percent of total billed charges,63% of total billed charges,684.25,85,,547.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,635.95,79,,508.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,764.75,
EFAVIRENZ/EMTRICITAB 1 EA,250019609,CDM,250,RC,A9270,HCPCS,outpatient,,,179,125.3,,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.77,63,,90.22,percent of total billed charges,63% of total billed charges,138.22,77.22,,110.58,percent of total billed charges,77.22% of total billed charges,118.32,66.1,,94.66,percent of total billed charges,66.1% of total billed charges,148.57,83,,118.86,percent of total billed charges,83% of total,170.05,95,,136.04,percent of total billed charges ,95% of total billed charges,143.2,80,,114.56,percent of total billed charges,78% of total billed charges,139.62,78,,111.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,112.77,63,,90.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,112.77,63,,90.22,percent of total billed charges,63% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.77,450,
TIGECYCLINE 50MCG VIAL,250019613,CDM,250,RC,,,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,99.81,66.1,,79.85,percent of total billed charges,66.1% of total billed charges,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.13,450,
BUPIVACAINE LIPOSOME/PF 266MG,250019616,CDM,250,RC,,,outpatient,,,639,447.3,,504.81,79,,403.85,percent of total billed charges,79% of total billed charges,575.1,90,,460.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,402.57,63,,322.06,percent of total billed charges,63% of total billed charges,493.44,77.22,,394.75,percent of total billed charges,77.22% of total billed charges,422.38,66.1,,337.9,percent of total billed charges,66.1% of total billed charges,530.37,83,,424.3,percent of total billed charges,83% of total,607.05,95,,485.64,percent of total billed charges ,95% of total billed charges,511.2,80,,408.96,percent of total billed charges,78% of total billed charges,498.42,78,,398.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,402.57,63,,322.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,575.1,90,,460.08,percent of total billed charges,90% of total billed charges,511.2,80,,408.96,percent of total billed charges,80% of total billed charges,402.57,63,,322.06,percent of total billed charges,63% of total billed charges,543.15,85,,434.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,504.81,79,,403.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,402.57,607.05,
DIATRIZOATE MEGLUMINE 30%300ML,250019617,CDM,250,RC,,,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.34,450,
HYDROCODONE/ACETAMINOPHN 325MG,250019619,CDM,250,RC,A9270,HCPCS,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
HYDROCODONE BIT/ACETAMIN 7.5/3,250019620,CDM,250,RC,A9270,HCPCS,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
ZOLEDRONIC ACID 4 MG/100 ML,250019624,CDM,250,RC,J3489,HCPCS,outpatient,,,1469,1028.3,,1160.51,79,,928.41,percent of total billed charges,79% of total billed charges,1322.1,90,,1057.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.47,100,,,fee schedule,100% of GA fee schedule,1134.36,77.22,,907.49,percent of total billed charges,77.22% of total billed charges,6.79,105,,,fee schedule,105% of GA fee schedule,1219.27,83,,975.42,percent of total billed charges,83% of total,1395.55,95,,1116.44,percent of total billed charges ,95% of total billed charges,1175.2,80,,940.16,percent of total billed charges,78% of total billed charges,1145.82,78,,916.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1322.1,90,,1057.68,percent of total billed charges,90% of total billed charges,1175.2,80,,940.16,percent of total billed charges,80% of total billed charges,6.47,100,,,fee schedule,100% of GA fee schedule,1248.65,85,,998.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1160.51,79,,928.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.47,1395.55,
DOFETILIDE 250 MCG CAPSULE,250019625,CDM,250,RC,A9270,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
EMTRICITABINE/TENOFOVIR TABLET,250019627,CDM,250,RC,A9270,HCPCS,outpatient,,,2925,2047.5,,2310.75,79,,1848.6,percent of total billed charges,79% of total billed charges,2632.5,90,,2106,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1842.75,63,,1474.2,percent of total billed charges,63% of total billed charges,2258.69,77.22,,1806.95,percent of total billed charges,77.22% of total billed charges,1933.43,66.1,,1546.74,percent of total billed charges,66.1% of total billed charges,2427.75,83,,1942.2,percent of total billed charges,83% of total,2778.75,95,,2223,percent of total billed charges ,95% of total billed charges,2340,80,,1872,percent of total billed charges,78% of total billed charges,2281.5,78,,1825.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1842.75,63,,1474.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2632.5,90,,2106,percent of total billed charges,90% of total billed charges,2340,80,,1872,percent of total billed charges,80% of total billed charges,1842.75,63,,1474.2,percent of total billed charges,63% of total billed charges,2486.25,85,,1989,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2310.75,79,,1848.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2778.75,
RALTEGRAVIR POTASSIUM 400 MG T,250019628,CDM,250,RC,A9270,HCPCS,outpatient,,,4312,3018.4,,3406.48,79,,2725.18,percent of total billed charges,79% of total billed charges,3880.8,90,,3104.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2716.56,63,,2173.25,percent of total billed charges,63% of total billed charges,3329.73,77.22,,2663.78,percent of total billed charges,77.22% of total billed charges,2850.23,66.1,,2280.18,percent of total billed charges,66.1% of total billed charges,3578.96,83,,2863.17,percent of total billed charges,83% of total,4096.4,95,,3277.12,percent of total billed charges ,95% of total billed charges,3449.6,80,,2759.68,percent of total billed charges,78% of total billed charges,3363.36,78,,2690.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2716.56,63,,2173.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3880.8,90,,3104.64,percent of total billed charges,90% of total billed charges,3449.6,80,,2759.68,percent of total billed charges,80% of total billed charges,2716.56,63,,2173.25,percent of total billed charges,63% of total billed charges,3665.2,85,,2932.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3406.48,79,,2725.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4096.4,
ANUSOL-HC CREAM 2.5% 30GM TUBE,250019629,CDM,250,RC,A9270,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
"TRANEXAMIC ACID 1,000 MG/10 ML",250019630,CDM,250,RC,,,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
RIFAXIMIN 550MG TABLET,250019631,CDM,250,RC,A9270,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,58.17,66.1,,46.54,percent of total billed charges,66.1% of total billed charges,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.44,450,
PHARMACY CONSULT VANCOMYCIN,250019635,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PHARMACY CONSULT OTHER GENERAL,250019636,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHLORHEX GL/GLYCERIN/HE-CELL,250019638,CDM,250,RC,A9270,HCPCS,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
COENZYME Q10 100 MG CAPSULE,250019642,CDM,250,RC,A9270,HCPCS,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
QUETIAPINE FUMARATE 150 MG TAB,250019647,CDM,250,RC,A9270,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
DOES NOT APPLY PACK,250019648,CDM,250,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
TRACE ELEMENTS COMB NO.1 10 ML,250019652,CDM,250,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
LINACLOTIDE 290 MCG CAPSULE,250019654,CDM,250,RC,A9270,HCPCS,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
RIVASTIGMINE TARTRATE 3MG CAPS,250019655,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
GLUCOSAMINE/CHONDROITIN 1 EA C,250019656,CDM,250,RC,A9270,HCPCS,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
CEFPROZIL 0250G/5ML/100ML BOTT,250019657,CDM,250,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
L. RHAMNOSUS GG/INULIN 1 EA,250019658,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CALCIUM GLUCONATE 2.5%GEL 25GM,250019659,CDM,250,RC,A9270,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
NICOTINE LOZENGE 4MG,250019661,CDM,250,RC,A9270,HCPCS,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
LABETALOL INJECTION 20 MG DOSE,250019662,CDM,250,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
SOD LACTATE/AMM POT/LACT 140 G,250019664,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
IVERMECTIN 3 MG TABLET,250019666,CDM,250,RC,A9270,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OCTREOTIDE ACETATE 500 MCG/ML,250019667,CDM,250,RC,,,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,76.68,66.1,,61.34,percent of total billed charges,66.1% of total billed charges,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.08,450,
HYDROCODONE/ACETAMINOPHN 2.5,250019674,CDM,250,RC,A9270,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
LIDOCAINE 1%/EPINEPHRINE,250019676,CDM,250,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
MICAFUNGIN SODIUM 50MG VIAL,250019677,CDM,250,RC,J2248,HCPCS,outpatient,,,208,145.6,,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.29,100,,,fee schedule,100% of GA fee schedule,160.62,77.22,,128.5,percent of total billed charges,77.22% of total billed charges,0.3,105,,,fee schedule,105% of GA fee schedule,172.64,83,,138.11,percent of total billed charges,83% of total,197.6,95,,158.08,percent of total billed charges ,95% of total billed charges,166.4,80,,133.12,percent of total billed charges,78% of total billed charges,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.29,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.29,100,,,fee schedule,100% of GA fee schedule,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.29,450,
APIXABAN 2.5 MG TABLET,250019678,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
HEPARIN SOD PORCINE 100U 1ML,250019679,CDM,250,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
ZIPRASIDONE MESYLATE 20 MG/ML,250019684,CDM,250,RC,J3486,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.43,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,7.8,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.43,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,7.43,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.43,450,
CIPROFLOXACIN HCL 0.3%EYE DROP,250019685,CDM,250,RC,A9270,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
DECLOFENAC SODIUM 0.1%EYE DROP,250019686,CDM,250,RC,A9270,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
TETRACAINE HCL 0.5% EYE DROP,250019687,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
PHENYLEPHRINE HCL 2.5%EYE DROP,250019688,CDM,250,RC,A9270,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
CYCLOPENTOLATE HCL 1% EYE DROP,250019689,CDM,250,RC,A9270,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
IODINE/POTASSIUM IOD SOL 8,250019691,CDM,250,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
NEO/PLOYMYX B SULF DEXAMETH OP,250019692,CDM,250,RC,A9270,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
FOLIC ACID INJECTION 1MG,250019693,CDM,250,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
ALBUTEROL INHALER 90 MCG,250019694,CDM,250,RC,A9270,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.49,450,
DRONABINOL 5MG CAPSULE,250019695,CDM,250,RC,A9270,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,57.51,66.1,,46.01,percent of total billed charges,66.1% of total billed charges,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.81,450,
KETAMINE HCL 100MG/2 ML SYRING,250019696,CDM,250,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
SUGAMMADEX SODIUM 200MG VIAL,250019697,CDM,250,RC,,,outpatient,,,231,161.7,,182.49,79,,145.99,percent of total billed charges,79% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,178.38,77.22,,142.7,percent of total billed charges,77.22% of total billed charges,152.69,66.1,,122.15,percent of total billed charges,66.1% of total billed charges,191.73,83,,153.38,percent of total billed charges,83% of total,219.45,95,,175.56,percent of total billed charges ,95% of total billed charges,184.8,80,,147.84,percent of total billed charges,78% of total billed charges,180.18,78,,144.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,182.49,79,,145.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,145.53,450,
PHENAZOPYRIDINE HCL 95 MG TAB,250019698,CDM,250,RC,A9270,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
ORPHENADRINE CITRATE 30 MG/2ML,250019699,CDM,250,RC,A9270,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
DEPO-PROVERA 1MG/ML INJ. LARC,2500196LC,CDM,250,RC,J1050,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.54,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,0.57,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.54,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.54,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.54,450,
MEMANTINE HCL/DONEPEZIL 28/10,250019700,CDM,250,RC,A9270,HCPCS,outpatient,,,431,301.7,,340.49,79,,272.39,percent of total billed charges,79% of total billed charges,387.9,90,,310.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,332.82,77.22,,266.26,percent of total billed charges,77.22% of total billed charges,284.89,66.1,,227.91,percent of total billed charges,66.1% of total billed charges,357.73,83,,286.18,percent of total billed charges,83% of total,409.45,95,,327.56,percent of total billed charges ,95% of total billed charges,344.8,80,,275.84,percent of total billed charges,78% of total billed charges,336.18,78,,268.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,340.49,79,,272.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,271.53,450,
ASPIRIN 325 MG TAB,250019701,CDM,250,RC,A9270,HCPCS,outpatient,,,1,0.7,,0.79,79,,0.63,percent of total billed charges,79% of total billed charges,0.9,90,,0.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,0.77,77.22,,0.62,percent of total billed charges,77.22% of total billed charges,0.66,66.1,,0.53,percent of total billed charges,66.1% of total billed charges,0.83,83,,0.66,percent of total billed charges,83% of total,0.95,95,,0.76,percent of total billed charges ,95% of total billed charges,0.8,80,,0.64,percent of total billed charges,78% of total billed charges,0.78,78,,0.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,0.9,90,,0.72,percent of total billed charges,90% of total billed charges,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,0.79,79,,0.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.63,450,
MIRABEGRON 50 MG TB,250019704,CDM,250,RC,A9270,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
FELODIPINE 10 MG TAB SR 24H,250019709,CDM,250,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BOTOX ONABOTULINUTOXINA,250019710,CDM,250,RC,J0585,HCPCS,outpatient,,,1175,822.5,,928.25,79,,742.6,percent of total billed charges,79% of total billed charges,1057.5,90,,846,percent of total billed charges,90% of total billed charges,6.41,100,,,Fee Schedule,100% of CMS OPPS rate,10.25,160,,,Fee Schedule,160% of CMS OPPS rate,8.33,130,,,Fee Schedule,130% of CMS OPPS rate,6.41,100,,,fee schedule,100% of GA fee schedule,907.34,77.22,,725.87,percent of total billed charges,77.22% of total billed charges,6.73,105,,,fee schedule,105% of GA fee schedule,975.25,83,,780.2,percent of total billed charges,83% of total,1116.25,95,,893,percent of total billed charges ,95% of total billed charges,940,80,,752,percent of total billed charges,78% of total billed charges,916.5,78,,733.2,percent of total billed charges,78% of total billed charges,6.41,100,,,Fee Schedule,100% of CMS OPPS rate,6.41,100,,,fee schedule,100% of GA fee schedule,6.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,6.41,100,,,fee schedule,100% of GA fee schedule,998.75,85,,799,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.96,93,,,fee schedule,93% of CMS OPPS rate,928.25,79,,742.6,percent of total billed charges,79% of total billed charges,6.41,100,,,Fee Schedule,100% of CMS OPPS rate,6.41,100,,,Fee Schedule,100% of CMS OPPS rate,5.96,1116.25,
MAGNESIUM L-LACTATE 84 MG TAB,250019711,CDM,250,RC,A9270,HCPCS,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
COLISTIN 150 MG,250019712,CDM,250,RC,,,outpatient,,,124,86.8,,97.96,79,,78.37,percent of total billed charges,79% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.12,63,,62.5,percent of total billed charges,63% of total billed charges,95.75,77.22,,76.6,percent of total billed charges,77.22% of total billed charges,81.96,66.1,,65.57,percent of total billed charges,66.1% of total billed charges,102.92,83,,82.34,percent of total billed charges,83% of total,117.8,95,,94.24,percent of total billed charges ,95% of total billed charges,99.2,80,,79.36,percent of total billed charges,78% of total billed charges,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.12,63,,62.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.12,63,,62.5,percent of total billed charges,63% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.96,79,,78.37,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.12,450,
PHENYLEPHRINE HCL 1MG/10ML PRE,250019713,CDM,250,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
EPHEDRINE SULFATE 25MG/5ML PRE,250019714,CDM,250,RC,,,outpatient,,,102,71.4,,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,78.76,77.22,,63.01,percent of total billed charges,77.22% of total billed charges,67.42,66.1,,53.94,percent of total billed charges,66.1% of total billed charges,84.66,83,,67.73,percent of total billed charges,83% of total,96.9,95,,77.52,percent of total billed charges ,95% of total billed charges,81.6,80,,65.28,percent of total billed charges,78% of total billed charges,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.26,450,
SUCCINYLCHOLINE CHLOR 100MG/5M,250019715,CDM,250,RC,,,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
ROC BROMIDE 50MG/5ML PRE-F,250019716,CDM,250,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
NEOSTIGIMINE METHYLSULFATE 3MG,250019717,CDM,250,RC,,,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.7,450,
SELENIUM 200 MCG CAPSULE,250019719,CDM,250,RC,A9270,HCPCS,outpatient,,,1,0.7,,0.79,79,,0.63,percent of total billed charges,79% of total billed charges,0.9,90,,0.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,0.77,77.22,,0.62,percent of total billed charges,77.22% of total billed charges,0.66,66.1,,0.53,percent of total billed charges,66.1% of total billed charges,0.83,83,,0.66,percent of total billed charges,83% of total,0.95,95,,0.76,percent of total billed charges ,95% of total billed charges,0.8,80,,0.64,percent of total billed charges,78% of total billed charges,0.78,78,,0.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,0.9,90,,0.72,percent of total billed charges,90% of total billed charges,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,0.79,79,,0.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.63,450,
CINACALCET HCL 30 MG TABLET,250019720,CDM,250,RC,A9270,HCPCS,outpatient,,,486,340.2,,383.94,79,,307.15,percent of total billed charges,79% of total billed charges,437.4,90,,349.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306.18,63,,244.94,percent of total billed charges,63% of total billed charges,375.29,77.22,,300.23,percent of total billed charges,77.22% of total billed charges,321.25,66.1,,257,percent of total billed charges,66.1% of total billed charges,403.38,83,,322.7,percent of total billed charges,83% of total,461.7,95,,369.36,percent of total billed charges ,95% of total billed charges,388.8,80,,311.04,percent of total billed charges,78% of total billed charges,379.08,78,,303.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,306.18,63,,244.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,437.4,90,,349.92,percent of total billed charges,90% of total billed charges,388.8,80,,311.04,percent of total billed charges,80% of total billed charges,306.18,63,,244.94,percent of total billed charges,63% of total billed charges,413.1,85,,330.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,383.94,79,,307.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,306.18,461.7,
PREGABALIN 100 MG CAP,250019724,CDM,250,RC,A9270,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
TETRACAINE HCL/PF 4ML DROP,250019729,CDM,250,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
MODAFINIL 100 MG TABLET,250019733,CDM,250,RC,,,outpatient,,,213,149.1,,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,164.48,77.22,,131.58,percent of total billed charges,77.22% of total billed charges,140.79,66.1,,112.63,percent of total billed charges,66.1% of total billed charges,176.79,83,,141.43,percent of total billed charges,83% of total,202.35,95,,161.88,percent of total billed charges ,95% of total billed charges,170.4,80,,136.32,percent of total billed charges,78% of total billed charges,166.14,78,,132.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.19,450,
"WATER,STERILE IRRIG 50 ML V",250019736,CDM,250,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
KETAMINE HCL 20MG/2 ML PRE-FIL,250019737,CDM,250,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
LIDOCAINE HCL/PF 10MG AMP,250019739,CDM,250,RC,J2001,HCPCS,outpatient,,,1.5,1.05,,1.19,79,,0.95,percent of total billed charges,79% of total billed charges,1.35,90,,1.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,1.16,77.22,,0.93,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,1.25,83,,1,percent of total billed charges,83% of total,1.43,95,,1.14,percent of total billed charges ,95% of total billed charges,1.2,80,,0.96,percent of total billed charges,78% of total billed charges,1.17,78,,0.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1.35,90,,1.08,percent of total billed charges,90% of total billed charges,1.2,80,,0.96,percent of total billed charges,80% of total billed charges,0.04,100,,,fee schedule,100% of GA fee schedule,1.28,85,,1.024,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.19,79,,0.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
CANAGLIFLOZIN 300 MG TABLET,250019740,CDM,250,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
ALTEPLASE 2 MG VIAL,250019741,CDM,250,RC,J2997,HCPCS,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,146.35,160,,,Fee Schedule,160% of CMS OPPS rate,118.91,130,,,Fee Schedule,130% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.06,93,,,fee schedule,93% of CMS OPPS rate,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,85.06,450,
RING CUTTER,250019742,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
METHYLNATREXONE BROM 12MG/0.6,250019748,CDM,250,RC,J2212,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,0.94,100,,,Fee Schedule,100% of CMS OPPS rate,1.5,160,,,Fee Schedule,160% of CMS OPPS rate,1.22,130,,,Fee Schedule,130% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,0.94,100,,,Fee Schedule,100% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,0.94,100,,,Fee Schedule,100% of CMS OPPS rate,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,0.87,93,,,fee schedule,93% of CMS OPPS rate,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,0.94,100,,,Fee Schedule,100% of CMS OPPS rate,0.94,100,,,Fee Schedule,100% of CMS OPPS rate,0.87,450,
LIDOCAINE JELLY HCL 6ML,250019749,CDM,250,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ARFORMOTEROL TARTR 15MCG/2ML V,250019750,CDM,250,RC,J7605,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
SEVELAMER CARBONATE 2.4GM POWD,250019751,CDM,250,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
ABIRATERONE ACETATE 0250G TAB,250019752,CDM,250,RC,J9999,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,126.25,66.1,,101,percent of total billed charges,66.1% of total billed charges,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.33,450,
"WATER FOR INJECT,STERILE 20ML",250019753,CDM,250,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
CULTURELLE PROBIOT PROWELL CAP,250019756,CDM,250,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
MIRABEGRON 25 MG TABLET ER,250019757,CDM,250,RC,A9270,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
NITROFURANTOIN MACROCRYSTAL 50,250019758,CDM,250,RC,,,outpatient,,,237,165.9,,187.23,79,,149.78,percent of total billed charges,79% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.31,63,,119.45,percent of total billed charges,63% of total billed charges,183.01,77.22,,146.41,percent of total billed charges,77.22% of total billed charges,156.66,66.1,,125.33,percent of total billed charges,66.1% of total billed charges,196.71,83,,157.37,percent of total billed charges,83% of total,225.15,95,,180.12,percent of total billed charges ,95% of total billed charges,189.6,80,,151.68,percent of total billed charges,78% of total billed charges,184.86,78,,147.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,149.31,63,,119.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,149.31,63,,119.45,percent of total billed charges,63% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,187.23,79,,149.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,149.31,450,
LIDOCAINE HCL/EPINEPHRINE 30ML,250019762,CDM,250,RC,J2001,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
CLONIDINE HCL/PF 1000 MCG/10ML,250019766,CDM,250,RC,,,outpatient,,,111.6,78.12,,88.16,79,,70.53,percent of total billed charges,79% of total billed charges,100.44,90,,80.35,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.31,63,,56.25,percent of total billed charges,63% of total billed charges,86.18,77.22,,68.94,percent of total billed charges,77.22% of total billed charges,73.77,66.1,,59.02,percent of total billed charges,66.1% of total billed charges,92.63,83,,74.1,percent of total billed charges,83% of total,106.02,95,,84.82,percent of total billed charges ,95% of total billed charges,89.28,80,,71.42,percent of total billed charges,78% of total billed charges,87.05,78,,69.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,70.31,63,,56.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,100.44,90,,80.35,percent of total billed charges,90% of total billed charges,89.28,80,,71.42,percent of total billed charges,80% of total billed charges,70.31,63,,56.25,percent of total billed charges,63% of total billed charges,94.86,85,,75.888,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,88.16,79,,70.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.31,450,
ONDANESTRON HCL 2MG/ML VIAL,250019767,CDM,250,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
DILTIAZEM INJ 125 MG/25ML VIAL,250019768,CDM,250,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
AMIKACIN SULFATE 500MG/2ML VIA,250019770,CDM,250,RC,J0278,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.77,100,,,fee schedule,100% of GA fee schedule,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,0.81,105,,,fee schedule,105% of GA fee schedule,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.77,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.77,100,,,fee schedule,100% of GA fee schedule,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.77,450,
KETAMINE HCL 10 MG/ML VIAL,250019772,CDM,250,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
TETRACAINE HCL/PF 10MG/2ML,250019773,CDM,250,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
KETAMINE HCL 100 MG/ML VIAL 10,250019782,CDM,250,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
KETAMINE HCL 100MG/ML VIAL 5ML,250019783,CDM,250,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
CALCITONIN SALMON SYN 200 UNI,250019784,CDM,250,RC,J0630,HCPCS,outpatient,,,10000,7000,,7900,79,,6320,percent of total billed charges,79% of total billed charges,9000,90,,7200,percent of total billed charges,90% of total billed charges,1173.06,100,,,Fee Schedule,100% of CMS OPPS rate,1876.89,160,,,Fee Schedule,160% of CMS OPPS rate,1524.97,130,,,Fee Schedule,130% of CMS OPPS rate,1173.06,100,,,fee schedule,100% of GA fee schedule,7722,77.22,,6177.6,percent of total billed charges,77.22% of total billed charges,1231.71,105,,,fee schedule,105% of GA fee schedule,8300,83,,6640,percent of total billed charges,83% of total,9500,95,,7600,percent of total billed charges ,95% of total billed charges,8000,80,,6400,percent of total billed charges,78% of total billed charges,7800,78,,6240,percent of total billed charges,78% of total billed charges,1173.06,100,,,Fee Schedule,100% of CMS OPPS rate,1173.06,100,,,fee schedule,100% of GA fee schedule,1173.06,100,,,Fee Schedule,100% of CMS OPPS rate,9000,90,,7200,percent of total billed charges,90% of total billed charges,8000,80,,6400,percent of total billed charges,80% of total billed charges,1173.06,100,,,fee schedule,100% of GA fee schedule,8500,85,,6800,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1090.94,93,,,fee schedule,93% of CMS OPPS rate,7900,79,,6320,percent of total billed charges,79% of total billed charges,1173.06,100,,,Fee Schedule,100% of CMS OPPS rate,1173.06,100,,,Fee Schedule,100% of CMS OPPS rate,450,9500,
OLMESARTAN MEDOXOMIL 5MG TAB,250019785,CDM,250,RC,,,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
SODIUM HYPOCHLORITE 473ML 0.25,250019786,CDM,250,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
LINACLOTIDE 145 MCG CAPSULE,250019787,CDM,250,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
SIROLIMUS 1 MG TABLET,250019788,CDM,250,RC,J7520,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
BUPRENORPHINE HCL 2 MG TABLET,250019791,CDM,250,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
KETAMINE HCL 50MG/ML 10ML VIAL,250019794,CDM,250,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
MORPHINE SULFATE 0.9% NACL 1MG,250019795,CDM,250,RC,J2270,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,5.08,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.84,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,4.84,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.84,450,
TICAGRELOR 90 MG TABLET,250019798,CDM,250,RC,J8499,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
SACUBITRIL/VALSARTAN 49/51MG T,250019799,CDM,250,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
SACUBITRIL/VALSARTAN 24/26MG T,250019800,CDM,250,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
DEXTROSE GEL TUBE 15GM CARB,250019801,CDM,250,RC,,,outpatient,,,14.05,9.84,,11.1,79,,8.88,percent of total billed charges,79% of total billed charges,12.65,90,,10.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.85,63,,7.08,percent of total billed charges,63% of total billed charges,10.85,77.22,,8.68,percent of total billed charges,77.22% of total billed charges,9.29,66.1,,7.43,percent of total billed charges,66.1% of total billed charges,11.66,83,,9.33,percent of total billed charges,83% of total,13.35,95,,10.68,percent of total billed charges ,95% of total billed charges,11.24,80,,8.99,percent of total billed charges,78% of total billed charges,10.96,78,,8.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.85,63,,7.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,12.65,90,,10.12,percent of total billed charges,90% of total billed charges,11.24,80,,8.99,percent of total billed charges,80% of total billed charges,8.85,63,,7.08,percent of total billed charges,63% of total billed charges,11.94,85,,9.552,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.1,79,,8.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.85,450,
MISC HAZARDOUS DRUG,250019803,CDM,250,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
SODIUM HYPOCHLORITE 473ML .125,250019805,CDM,250,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
DRONABINOL 2.5 MG CAPSULE,250019807,CDM,250,RC,A9270,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,41.64,66.1,,33.31,percent of total billed charges,66.1% of total billed charges,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.69,450,
CLINDAMYCIN PHOS D5W PREMIX 30,250019808,CDM,250,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
ESTRADIOL 0.5 MG TABLET,250019810,CDM,250,RC,,,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
KETAMINE HCL 30MG/3ML SYRING,250019812,CDM,250,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
OSELTAMIVIR PHOSPHATE 30MG CAP,250019814,CDM,250,RC,A9270,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
PHENOL LIQUIFIED 89% SWABS,250019815,CDM,250,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
BUPROPION HCL 75 MG TABLET,250019816,CDM,250,RC,A9270,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
IPRATROPIUM/ALBUTEROL SULF 120,250019818,CDM,250,RC,A9270,HCPCS,outpatient,,,866,606.2,,684.14,79,,547.31,percent of total billed charges,79% of total billed charges,779.4,90,,623.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,545.58,63,,436.46,percent of total billed charges,63% of total billed charges,668.73,77.22,,534.98,percent of total billed charges,77.22% of total billed charges,572.43,66.1,,457.94,percent of total billed charges,66.1% of total billed charges,718.78,83,,575.02,percent of total billed charges,83% of total,822.7,95,,658.16,percent of total billed charges ,95% of total billed charges,692.8,80,,554.24,percent of total billed charges,78% of total billed charges,675.48,78,,540.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,545.58,63,,436.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,545.58,63,,436.46,percent of total billed charges,63% of total billed charges,736.1,85,,588.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,684.14,79,,547.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,822.7,
ALBUTEROL SULFATE 200P HFA 8.5,250019819,CDM,250,RC,,,outpatient,,,127,88.9,,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,98.07,77.22,,78.46,percent of total billed charges,77.22% of total billed charges,83.95,66.1,,67.16,percent of total billed charges,66.1% of total billed charges,105.41,83,,84.33,percent of total billed charges,83% of total,120.65,95,,96.52,percent of total billed charges ,95% of total billed charges,101.6,80,,81.28,percent of total billed charges,78% of total billed charges,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.01,450,
ZINC COP MANG CHROM SELEN 1 ML,250019820,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BUMETANIDE 0.25 MG/ML INJ 10,250019822,CDM,250,RC,,,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
VECURONIUM BROMIDE 10 MG VIAL,250019823,CDM,250,RC,,,outpatient,,,30.2,21.14,,23.86,79,,19.09,percent of total billed charges,79% of total billed charges,27.18,90,,21.74,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.03,63,,15.22,percent of total billed charges,63% of total billed charges,23.32,77.22,,18.66,percent of total billed charges,77.22% of total billed charges,19.96,66.1,,15.97,percent of total billed charges,66.1% of total billed charges,25.07,83,,20.06,percent of total billed charges,83% of total,28.69,95,,22.95,percent of total billed charges ,95% of total billed charges,24.16,80,,19.33,percent of total billed charges,78% of total billed charges,23.56,78,,18.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.03,63,,15.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,27.18,90,,21.74,percent of total billed charges,90% of total billed charges,24.16,80,,19.33,percent of total billed charges,80% of total billed charges,19.03,63,,15.22,percent of total billed charges,63% of total billed charges,25.67,85,,20.536,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.86,79,,19.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.03,450,
REMDESIVIR 100 MG VIAL,250019827,CDM,250,RC,,,outpatient,,,24.5,17.15,,19.36,79,,15.49,percent of total billed charges,79% of total billed charges,22.05,90,,17.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.44,63,,12.35,percent of total billed charges,63% of total billed charges,18.92,77.22,,15.14,percent of total billed charges,77.22% of total billed charges,16.19,66.1,,12.95,percent of total billed charges,66.1% of total billed charges,20.34,83,,16.27,percent of total billed charges,83% of total,23.28,95,,18.62,percent of total billed charges ,95% of total billed charges,19.6,80,,15.68,percent of total billed charges,78% of total billed charges,19.11,78,,15.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.44,63,,12.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,22.05,90,,17.64,percent of total billed charges,90% of total billed charges,19.6,80,,15.68,percent of total billed charges,80% of total billed charges,15.44,63,,12.35,percent of total billed charges,63% of total billed charges,20.83,85,,16.664,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.36,79,,15.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
BENZO/BUTAM/TETRAC TOP ANESTH,250019828,CDM,250,RC,,,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,84.61,66.1,,67.69,percent of total billed charges,66.1% of total billed charges,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.64,450,
CHLORHEXIDINE GLUCONATE 15 ML,250019831,CDM,250,RC,A9270,HCPCS,outpatient,,,16.2,11.34,,12.8,79,,10.24,percent of total billed charges,79% of total billed charges,14.58,90,,11.66,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.21,63,,8.17,percent of total billed charges,63% of total billed charges,12.51,77.22,,10.01,percent of total billed charges,77.22% of total billed charges,10.71,66.1,,8.57,percent of total billed charges,66.1% of total billed charges,13.45,83,,10.76,percent of total billed charges,83% of total,15.39,95,,12.31,percent of total billed charges ,95% of total billed charges,12.96,80,,10.37,percent of total billed charges,78% of total billed charges,12.64,78,,10.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.21,63,,8.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,14.58,90,,11.66,percent of total billed charges,90% of total billed charges,12.96,80,,10.37,percent of total billed charges,80% of total billed charges,10.21,63,,8.17,percent of total billed charges,63% of total billed charges,13.77,85,,11.016,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.8,79,,10.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.21,450,
LIDOCAINE 1%/EPI 100MG/10ML VI,250019834,CDM,250,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
IRON SUCROSE CMPLX 200MG/10 ML,250019836,CDM,250,RC,J1756,HCPCS,outpatient,,,532.8,372.96,,420.91,79,,336.73,percent of total billed charges,79% of total billed charges,479.52,90,,383.62,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.23,100,,,fee schedule,100% of GA fee schedule,411.43,77.22,,329.14,percent of total billed charges,77.22% of total billed charges,0.24,105,,,fee schedule,105% of GA fee schedule,442.22,83,,353.78,percent of total billed charges,83% of total,506.16,95,,404.93,percent of total billed charges ,95% of total billed charges,426.24,80,,340.99,percent of total billed charges,78% of total billed charges,415.58,78,,332.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.23,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,479.52,90,,383.62,percent of total billed charges,90% of total billed charges,426.24,80,,340.99,percent of total billed charges,80% of total billed charges,0.23,100,,,fee schedule,100% of GA fee schedule,452.88,85,,362.304,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,420.91,79,,336.73,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.23,506.16,
LIDOCAINE 1%/EPI 500MG/50ML VI,250019844,CDM,250,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
AZATHIOPRINE 50 MG TABLET,250019848,CDM,250,RC,J7500,HCPCS,outpatient,,,3.05,2.14,,2.41,79,,1.93,percent of total billed charges,79% of total billed charges,2.75,90,,2.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,63,,1.54,percent of total billed charges,63% of total billed charges,2.36,77.22,,1.89,percent of total billed charges,77.22% of total billed charges,2.02,66.1,,1.62,percent of total billed charges,66.1% of total billed charges,2.53,83,,2.02,percent of total billed charges,83% of total,2.9,95,,2.32,percent of total billed charges ,95% of total billed charges,2.44,80,,1.95,percent of total billed charges,78% of total billed charges,2.38,78,,1.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.92,63,,1.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2.75,90,,2.2,percent of total billed charges,90% of total billed charges,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.92,63,,1.54,percent of total billed charges,63% of total billed charges,2.59,85,,2.072,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.41,79,,1.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.92,450,
LIDOCAINE HCL 2% 20MG/2ML VIAL,250019849,CDM,250,RC,J2001,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,0.04,105,,,fee schedule,105% of GA fee schedule,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.04,100,,,fee schedule,100% of GA fee schedule,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.04,450,
LIDOCAINE HCL/EPINEPHRINE150MC,250019853,CDM,250,RC,,,outpatient,,,45.95,32.17,,36.3,79,,29.04,percent of total billed charges,79% of total billed charges,41.36,90,,33.09,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.95,63,,23.16,percent of total billed charges,63% of total billed charges,35.48,77.22,,28.38,percent of total billed charges,77.22% of total billed charges,30.37,66.1,,24.3,percent of total billed charges,66.1% of total billed charges,38.14,83,,30.51,percent of total billed charges,83% of total,43.65,95,,34.92,percent of total billed charges ,95% of total billed charges,36.76,80,,29.41,percent of total billed charges,78% of total billed charges,35.84,78,,28.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.95,63,,23.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,41.36,90,,33.09,percent of total billed charges,90% of total billed charges,36.76,80,,29.41,percent of total billed charges,80% of total billed charges,28.95,63,,23.16,percent of total billed charges,63% of total billed charges,39.06,85,,31.248,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.3,79,,29.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.95,450,
CARBACHOL INTRAOCULAR SOL 0.01,250019854,CDM,250,RC,,,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,450,
APIXABAN 5 MG TABLET,250019856,CDM,250,RC,A9270,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SODIUM CHLORIDE 0.9% 20ML VIAL,250019863,CDM,250,RC,,,outpatient,,,5.4,3.78,,4.27,79,,3.42,percent of total billed charges,79% of total billed charges,4.86,90,,3.89,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.4,63,,2.72,percent of total billed charges,63% of total billed charges,4.17,77.22,,3.34,percent of total billed charges,77.22% of total billed charges,3.57,66.1,,2.86,percent of total billed charges,66.1% of total billed charges,4.48,83,,3.58,percent of total billed charges,83% of total,5.13,95,,4.1,percent of total billed charges ,95% of total billed charges,4.32,80,,3.46,percent of total billed charges,78% of total billed charges,4.21,78,,3.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.4,63,,2.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4.86,90,,3.89,percent of total billed charges,90% of total billed charges,4.32,80,,3.46,percent of total billed charges,80% of total billed charges,3.4,63,,2.72,percent of total billed charges,63% of total billed charges,4.59,85,,3.672,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.27,79,,3.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.4,450,
BUPIVACAINE HCL 0.5%/EPINEPHR,250019864,CDM,250,RC,,,outpatient,,,20.6,14.42,,16.27,79,,13.02,percent of total billed charges,79% of total billed charges,18.54,90,,14.83,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.98,63,,10.38,percent of total billed charges,63% of total billed charges,15.91,77.22,,12.73,percent of total billed charges,77.22% of total billed charges,13.62,66.1,,10.9,percent of total billed charges,66.1% of total billed charges,17.1,83,,13.68,percent of total billed charges,83% of total,19.57,95,,15.66,percent of total billed charges ,95% of total billed charges,16.48,80,,13.18,percent of total billed charges,78% of total billed charges,16.07,78,,12.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.98,63,,10.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,18.54,90,,14.83,percent of total billed charges,90% of total billed charges,16.48,80,,13.18,percent of total billed charges,80% of total billed charges,12.98,63,,10.38,percent of total billed charges,63% of total billed charges,17.51,85,,14.008,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.27,79,,13.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.98,450,
BUPIVACAINE HCL0.25%/30MLEPINE,250019865,CDM,250,RC,,,outpatient,,,40.45,28.32,,31.96,79,,25.57,percent of total billed charges,79% of total billed charges,36.41,90,,29.13,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.48,63,,20.38,percent of total billed charges,63% of total billed charges,31.24,77.22,,24.99,percent of total billed charges,77.22% of total billed charges,26.74,66.1,,21.39,percent of total billed charges,66.1% of total billed charges,33.57,83,,26.86,percent of total billed charges,83% of total,38.43,95,,30.74,percent of total billed charges ,95% of total billed charges,32.36,80,,25.89,percent of total billed charges,78% of total billed charges,31.55,78,,25.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.48,63,,20.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,36.41,90,,29.13,percent of total billed charges,90% of total billed charges,32.36,80,,25.89,percent of total billed charges,80% of total billed charges,25.48,63,,20.38,percent of total billed charges,63% of total billed charges,34.38,85,,27.504,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.96,79,,25.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.48,450,
MEROPENEM 1 GRAM 0.9% SODIUM C,250019869,CDM,250,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
LIDOCAINE HCL 3% CREAM 28.3 GR,250019873,CDM,250,RC,,,outpatient,,,104.75,73.33,,82.75,79,,66.2,percent of total billed charges,79% of total billed charges,94.28,90,,75.42,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.99,63,,52.79,percent of total billed charges,63% of total billed charges,80.89,77.22,,64.71,percent of total billed charges,77.22% of total billed charges,69.24,66.1,,55.39,percent of total billed charges,66.1% of total billed charges,86.94,83,,69.55,percent of total billed charges,83% of total,99.51,95,,79.61,percent of total billed charges ,95% of total billed charges,83.8,80,,67.04,percent of total billed charges,78% of total billed charges,81.71,78,,65.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,65.99,63,,52.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,94.28,90,,75.42,percent of total billed charges,90% of total billed charges,83.8,80,,67.04,percent of total billed charges,80% of total billed charges,65.99,63,,52.79,percent of total billed charges,63% of total billed charges,89.04,85,,71.232,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.75,79,,66.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.99,450,
SOTROVIMAB 500MG/8ML VIAL,250019875,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DIATRIZOATE MEGLUMINE 37%300ML,250019884,CDM,250,RC,Q9958,HCPCS,outpatient,,,141.35,98.95,,111.67,79,,89.34,percent of total billed charges,79% of total billed charges,127.22,90,,101.78,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.05,63,,71.24,percent of total billed charges,63% of total billed charges,109.15,77.22,,87.32,percent of total billed charges,77.22% of total billed charges,93.43,66.1,,74.74,percent of total billed charges,66.1% of total billed charges,117.32,83,,93.86,percent of total billed charges,83% of total,134.28,95,,107.42,percent of total billed charges ,95% of total billed charges,113.08,80,,90.46,percent of total billed charges,78% of total billed charges,110.25,78,,88.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,89.05,63,,71.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,127.22,90,,101.78,percent of total billed charges,90% of total billed charges,113.08,80,,90.46,percent of total billed charges,80% of total billed charges,89.05,63,,71.24,percent of total billed charges,63% of total billed charges,120.15,85,,96.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,111.67,79,,89.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.05,450,
FIDAXOMICIN 200 MG TAB,250019885,CDM,250,RC,,,outpatient,,,939.8,657.86,,742.44,79,,593.95,percent of total billed charges,79% of total billed charges,845.82,90,,676.66,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,592.07,63,,473.66,percent of total billed charges,63% of total billed charges,725.71,77.22,,580.57,percent of total billed charges,77.22% of total billed charges,621.21,66.1,,496.97,percent of total billed charges,66.1% of total billed charges,780.03,83,,624.02,percent of total billed charges,83% of total,892.81,95,,714.25,percent of total billed charges ,95% of total billed charges,751.84,80,,601.47,percent of total billed charges,78% of total billed charges,733.04,78,,586.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,592.07,63,,473.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,845.82,90,,676.66,percent of total billed charges,90% of total billed charges,751.84,80,,601.47,percent of total billed charges,80% of total billed charges,592.07,63,,473.66,percent of total billed charges,63% of total billed charges,798.83,85,,639.064,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,742.44,79,,593.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,892.81,
OXYCODONE HCL/ACETAMIN 5/325M,250019886,CDM,250,RC,A9270,HCPCS,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
ONDANSETRON ODT 4MG TO-GO PACK,250019887,CDM,250,RC,A9270,HCPCS,outpatient,,,25.4,17.78,,20.07,79,,16.06,percent of total billed charges,79% of total billed charges,22.86,90,,18.29,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,63,,12.8,percent of total billed charges,63% of total billed charges,19.61,77.22,,15.69,percent of total billed charges,77.22% of total billed charges,16.79,66.1,,13.43,percent of total billed charges,66.1% of total billed charges,21.08,83,,16.86,percent of total billed charges,83% of total,24.13,95,,19.3,percent of total billed charges ,95% of total billed charges,20.32,80,,16.26,percent of total billed charges,78% of total billed charges,19.81,78,,15.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16,63,,12.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,22.86,90,,18.29,percent of total billed charges,90% of total billed charges,20.32,80,,16.26,percent of total billed charges,80% of total billed charges,16,63,,12.8,percent of total billed charges,63% of total billed charges,21.59,85,,17.272,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.07,79,,16.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16,450,
ACETYLCYSTEINE 100MG/4ML VIAL,250019892,CDM,250,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
NEOSTIGIMINE METHYLSULFATE 1MG,250019893,CDM,250,RC,,,outpatient,,,63.35,44.35,,50.05,79,,40.04,percent of total billed charges,79% of total billed charges,57.02,90,,45.62,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.91,63,,31.93,percent of total billed charges,63% of total billed charges,48.92,77.22,,39.14,percent of total billed charges,77.22% of total billed charges,41.87,66.1,,33.5,percent of total billed charges,66.1% of total billed charges,52.58,83,,42.06,percent of total billed charges,83% of total,60.18,95,,48.14,percent of total billed charges ,95% of total billed charges,50.68,80,,40.54,percent of total billed charges,78% of total billed charges,49.41,78,,39.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.91,63,,31.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,57.02,90,,45.62,percent of total billed charges,90% of total billed charges,50.68,80,,40.54,percent of total billed charges,80% of total billed charges,39.91,63,,31.93,percent of total billed charges,63% of total billed charges,53.85,85,,43.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,50.05,79,,40.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.91,450,
LABETALOL HCL 5MG/ML 40ML MDV,250019894,CDM,250,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
KETAMINE HCL NACL 50MG/5ML SYR,250019903,CDM,250,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
ETOMIDATE 2 MG/ML 10ML VIAL,250019904,CDM,250,RC,,,outpatient,,,20.5,14.35,,16.2,79,,12.96,percent of total billed charges,79% of total billed charges,18.45,90,,14.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.92,63,,10.34,percent of total billed charges,63% of total billed charges,15.83,77.22,,12.66,percent of total billed charges,77.22% of total billed charges,13.55,66.1,,10.84,percent of total billed charges,66.1% of total billed charges,17.02,83,,13.62,percent of total billed charges,83% of total,19.48,95,,15.58,percent of total billed charges ,95% of total billed charges,16.4,80,,13.12,percent of total billed charges,78% of total billed charges,15.99,78,,12.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.92,63,,10.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,18.45,90,,14.76,percent of total billed charges,90% of total billed charges,16.4,80,,13.12,percent of total billed charges,80% of total billed charges,12.92,63,,10.34,percent of total billed charges,63% of total billed charges,17.43,85,,13.944,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.2,79,,12.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.92,450,
ANCEF 2GM VIAL,250019905,CDM,250,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
LIDOCAINE 2%/EPI 0.2 MG/20ML,250019906,CDM,250,RC,,,outpatient,,,13.55,9.49,,10.7,79,,8.56,percent of total billed charges,79% of total billed charges,12.2,90,,9.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.54,63,,6.83,percent of total billed charges,63% of total billed charges,10.46,77.22,,8.37,percent of total billed charges,77.22% of total billed charges,8.96,66.1,,7.17,percent of total billed charges,66.1% of total billed charges,11.25,83,,9,percent of total billed charges,83% of total,12.87,95,,10.3,percent of total billed charges ,95% of total billed charges,10.84,80,,8.67,percent of total billed charges,78% of total billed charges,10.57,78,,8.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.54,63,,6.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,12.2,90,,9.76,percent of total billed charges,90% of total billed charges,10.84,80,,8.67,percent of total billed charges,80% of total billed charges,8.54,63,,6.83,percent of total billed charges,63% of total billed charges,11.52,85,,9.216,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.7,79,,8.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.54,450,
UROGESIC BLUE TABLET,250019908,CDM,250,RC,A9270,HCPCS,outpatient,,,18.9,13.23,,14.93,79,,11.94,percent of total billed charges,79% of total billed charges,17.01,90,,13.61,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.91,63,,9.53,percent of total billed charges,63% of total billed charges,14.59,77.22,,11.67,percent of total billed charges,77.22% of total billed charges,12.49,66.1,,9.99,percent of total billed charges,66.1% of total billed charges,15.69,83,,12.55,percent of total billed charges,83% of total,17.96,95,,14.37,percent of total billed charges ,95% of total billed charges,15.12,80,,12.1,percent of total billed charges,78% of total billed charges,14.74,78,,11.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.91,63,,9.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,17.01,90,,13.61,percent of total billed charges,90% of total billed charges,15.12,80,,12.1,percent of total billed charges,80% of total billed charges,11.91,63,,9.53,percent of total billed charges,63% of total billed charges,16.07,85,,12.856,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.93,79,,11.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.91,450,
PRADAXA 150MG,250019912,CDM,250,RC,,,outpatient,,,16.8,11.76,,13.27,79,,10.62,percent of total billed charges,79% of total billed charges,15.12,90,,12.1,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.58,63,,8.46,percent of total billed charges,63% of total billed charges,12.97,77.22,,10.38,percent of total billed charges,77.22% of total billed charges,11.1,66.1,,8.88,percent of total billed charges,66.1% of total billed charges,13.94,83,,11.15,percent of total billed charges,83% of total,15.96,95,,12.77,percent of total billed charges ,95% of total billed charges,13.44,80,,10.75,percent of total billed charges,78% of total billed charges,13.1,78,,10.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.58,63,,8.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,15.12,90,,12.1,percent of total billed charges,90% of total billed charges,13.44,80,,10.75,percent of total billed charges,80% of total billed charges,10.58,63,,8.46,percent of total billed charges,63% of total billed charges,14.28,85,,11.424,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.27,79,,10.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.58,450,
CLOTRIMAZOLE/BETAMET 30GM,250019913,CDM,250,RC,A9270,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.47,450,
ZINC OXIDE OINT TUBE BALSAM,250019914,CDM,250,RC,A9270,HCPCS,outpatient,,,20.3,14.21,,16.04,79,,12.83,percent of total billed charges,79% of total billed charges,18.27,90,,14.62,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.79,63,,10.23,percent of total billed charges,63% of total billed charges,15.68,77.22,,12.54,percent of total billed charges,77.22% of total billed charges,13.42,66.1,,10.74,percent of total billed charges,66.1% of total billed charges,16.85,83,,13.48,percent of total billed charges,83% of total,19.29,95,,15.43,percent of total billed charges ,95% of total billed charges,16.24,80,,12.99,percent of total billed charges,78% of total billed charges,15.83,78,,12.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.79,63,,10.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,18.27,90,,14.62,percent of total billed charges,90% of total billed charges,16.24,80,,12.99,percent of total billed charges,80% of total billed charges,12.79,63,,10.23,percent of total billed charges,63% of total billed charges,17.26,85,,13.808,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.04,79,,12.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.79,450,
FERRIC SUBSULFATE 8ML SOLN MON,250019919,CDM,250,RC,A9270,HCPCS,outpatient,,,37.9,26.53,,29.94,79,,23.95,percent of total billed charges,79% of total billed charges,34.11,90,,27.29,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.88,63,,19.1,percent of total billed charges,63% of total billed charges,29.27,77.22,,23.42,percent of total billed charges,77.22% of total billed charges,25.05,66.1,,20.04,percent of total billed charges,66.1% of total billed charges,31.46,83,,25.17,percent of total billed charges,83% of total,36.01,95,,28.81,percent of total billed charges ,95% of total billed charges,30.32,80,,24.26,percent of total billed charges,78% of total billed charges,29.56,78,,23.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.88,63,,19.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,34.11,90,,27.29,percent of total billed charges,90% of total billed charges,30.32,80,,24.26,percent of total billed charges,80% of total billed charges,23.88,63,,19.1,percent of total billed charges,63% of total billed charges,32.22,85,,25.776,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.94,79,,23.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.88,450,
CYCLOPENTOLATE HCL 2% EYE DROP,250019921,CDM,250,RC,A9270,HCPCS,outpatient,,,4.5,3.15,,3.56,79,,2.85,percent of total billed charges,79% of total billed charges,4.05,90,,3.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.84,63,,2.27,percent of total billed charges,63% of total billed charges,3.47,77.22,,2.78,percent of total billed charges,77.22% of total billed charges,2.97,66.1,,2.38,percent of total billed charges,66.1% of total billed charges,3.74,83,,2.99,percent of total billed charges,83% of total,4.28,95,,3.42,percent of total billed charges ,95% of total billed charges,3.6,80,,2.88,percent of total billed charges,78% of total billed charges,3.51,78,,2.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.84,63,,2.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4.05,90,,3.24,percent of total billed charges,90% of total billed charges,3.6,80,,2.88,percent of total billed charges,80% of total billed charges,2.84,63,,2.27,percent of total billed charges,63% of total billed charges,3.83,85,,3.064,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.56,79,,2.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.84,450,
HEP B PEDS 10MCG/0.5ML VL ST,250019929,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SODIUM CHLORIDE 3% NEB SOL 4ML,250019930,CDM,250,RC,J7620,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
"DEXTROSE 10% 1,000 ML BAG",258016194,CDM,250,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
CIPROFLOXACIN/D5W 400MG 200ML,258016338,CDM,250,RC,,,outpatient,,,163,114.1,,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,125.87,77.22,,100.7,percent of total billed charges,77.22% of total billed charges,107.74,66.1,,86.19,percent of total billed charges,66.1% of total billed charges,135.29,83,,108.23,percent of total billed charges,83% of total,154.85,95,,123.88,percent of total billed charges ,95% of total billed charges,130.4,80,,104.32,percent of total billed charges,78% of total billed charges,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.69,450,
CIPROFLOXACIN/D5W 200MG/100ML,258016419,CDM,250,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
HEPARIN SODIUM PORCINE/D5W,258016474,CDM,250,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
"WATER,STERILE IRRIG 3000ML BTL",258016801,CDM,250,RC,,,outpatient,,,51.9,36.33,,41,79,,32.8,percent of total billed charges,79% of total billed charges,46.71,90,,37.37,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.7,63,,26.16,percent of total billed charges,63% of total billed charges,40.08,77.22,,32.06,percent of total billed charges,77.22% of total billed charges,34.31,66.1,,27.45,percent of total billed charges,66.1% of total billed charges,43.08,83,,34.46,percent of total billed charges,83% of total,49.31,95,,39.45,percent of total billed charges ,95% of total billed charges,41.52,80,,33.22,percent of total billed charges,78% of total billed charges,40.48,78,,32.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.7,63,,26.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,46.71,90,,37.37,percent of total billed charges,90% of total billed charges,41.52,80,,33.22,percent of total billed charges,80% of total billed charges,32.7,63,,26.16,percent of total billed charges,63% of total billed charges,44.12,85,,35.296,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41,79,,32.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.7,450,
"IRRIG, WATER U/BAG 1000ML",258016802,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FENTANYL/BUPIVACAINE/NS 200MCG,258016978,CDM,250,RC,,,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.47,450,
ST WATER IRR 1500 ML BOTTLE,258017038,CDM,250,RC,,,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,40.32,66.1,,32.26,percent of total billed charges,66.1% of total billed charges,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.43,450,
SODIUM CLORIDE 0.9% IRR 0250L,258017039,CDM,250,RC,,,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,40.32,66.1,,32.26,percent of total billed charges,66.1% of total billed charges,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.43,450,
ST WATER IRR 0250L BOTTLE,258017043,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ST WATER IRR 1000ML BOTTLE,258017045,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SODIUM CLORIDE 0.9% 25ML BAG,258017055,CDM,250,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
D5W 100CC BAG,258017059,CDM,250,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
SODIUM CLORIDE 0.9% IRR 3000ML,258017061,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
"WATER FOR IRRIGATION,STRL 0250",258017141,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LEVOFLOXACIN 500 MG IV SOLN.,258017192,CDM,250,RC,,,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,138.15,66.1,,110.52,percent of total billed charges,66.1% of total billed charges,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,131.67,450,
LEVAQUIN (LEVOFLOXAXIN)0250G P,258017441,CDM,250,RC,,,outpatient,,,471,329.7,,372.09,79,,297.67,percent of total billed charges,79% of total billed charges,423.9,90,,339.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,296.73,63,,237.38,percent of total billed charges,63% of total billed charges,363.71,77.22,,290.97,percent of total billed charges,77.22% of total billed charges,311.33,66.1,,249.06,percent of total billed charges,66.1% of total billed charges,390.93,83,,312.74,percent of total billed charges,83% of total,447.45,95,,357.96,percent of total billed charges ,95% of total billed charges,376.8,80,,301.44,percent of total billed charges,78% of total billed charges,367.38,78,,293.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,296.73,63,,237.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,296.73,63,,237.38,percent of total billed charges,63% of total billed charges,400.35,85,,320.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,372.09,79,,297.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,296.73,450,
MAGNESIUM SULF 20G/WATER 500ML,258019030,CDM,250,RC,J3475,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.47,100,,,fee schedule,100% of GA fee schedule,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,0.49,105,,,fee schedule,105% of GA fee schedule,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.47,100,,,fee schedule,100% of GA fee schedule,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.47,450,
POTASSIUM CHL.40MEQ/0.9%NS,258019132,CDM,250,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
POTASSIUM CHL.20MEQ/D5NS 1000M,258019133,CDM,250,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
POTASSIUM CHLORIDE/STER H20 10,258019150,CDM,250,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
POTASSIUM CHLR/D5NS 40MEQ/1000,258019151,CDM,250,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
LINEZOLID IV PREMIX 600 MG/300,258019364,CDM,250,RC,J2020,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.08,100,,,fee schedule,100% of GA fee schedule,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,3.23,105,,,fee schedule,105% of GA fee schedule,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.08,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,3.08,100,,,fee schedule,100% of GA fee schedule,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.08,450,
LEVOFLOXACIN 750 MG IV SOL,258019383,CDM,250,RC,,,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.85,450,
NICARDIPINE HCL 20MG/200ML PIG,258019405,CDM,250,RC,,,outpatient,,,445,311.5,,351.55,79,,281.24,percent of total billed charges,79% of total billed charges,400.5,90,,320.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280.35,63,,224.28,percent of total billed charges,63% of total billed charges,343.63,77.22,,274.9,percent of total billed charges,77.22% of total billed charges,294.15,66.1,,235.32,percent of total billed charges,66.1% of total billed charges,369.35,83,,295.48,percent of total billed charges,83% of total,422.75,95,,338.2,percent of total billed charges ,95% of total billed charges,356,80,,284.8,percent of total billed charges,78% of total billed charges,347.1,78,,277.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,280.35,63,,224.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,280.35,63,,224.28,percent of total billed charges,63% of total billed charges,378.25,85,,302.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,351.55,79,,281.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,280.35,450,
FLUCONAZOLE IV PREMIX 400 MG,258019471,CDM,250,RC,J1450,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.61,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,2.74,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.61,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.61,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.61,450,
AMIODRON N/DEXTROS ISO-OSM 360,258019547,CDM,250,RC,,,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.47,450,
AMIODARN N/DEXTRSE ISO-OSM 150,258019548,CDM,250,RC,,,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.47,450,
ACETAMINOPHEN 1000 MG/100 ML,258019614,CDM,250,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
TPN CENTRAL-AMINO ACIDS 5% DEX,258019640,CDM,250,RC,,,outpatient,,,411,287.7,,324.69,79,,259.75,percent of total billed charges,79% of total billed charges,369.9,90,,295.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.93,63,,207.14,percent of total billed charges,63% of total billed charges,317.37,77.22,,253.9,percent of total billed charges,77.22% of total billed charges,271.67,66.1,,217.34,percent of total billed charges,66.1% of total billed charges,341.13,83,,272.9,percent of total billed charges,83% of total,390.45,95,,312.36,percent of total billed charges ,95% of total billed charges,328.8,80,,263.04,percent of total billed charges,78% of total billed charges,320.58,78,,256.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,258.93,63,,207.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,258.93,63,,207.14,percent of total billed charges,63% of total billed charges,349.35,85,,279.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,324.69,79,,259.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.93,450,
TPN PERIPHRAL AMINO ACID 4.25%,258019641,CDM,250,RC,,,outpatient,,,391,273.7,,308.89,79,,247.11,percent of total billed charges,79% of total billed charges,351.9,90,,281.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.33,63,,197.06,percent of total billed charges,63% of total billed charges,301.93,77.22,,241.54,percent of total billed charges,77.22% of total billed charges,258.45,66.1,,206.76,percent of total billed charges,66.1% of total billed charges,324.53,83,,259.62,percent of total billed charges,83% of total,371.45,95,,297.16,percent of total billed charges ,95% of total billed charges,312.8,80,,250.24,percent of total billed charges,78% of total billed charges,304.98,78,,243.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,246.33,63,,197.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,246.33,63,,197.06,percent of total billed charges,63% of total billed charges,332.35,85,,265.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,308.89,79,,247.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,246.33,450,
AMINOACIDS 4.25% DEXTROSE 5%,258019771,CDM,250,RC,,,outpatient,,,123.02,86.11,,97.19,79,,77.75,percent of total billed charges,79% of total billed charges,110.72,90,,88.58,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.5,63,,62,percent of total billed charges,63% of total billed charges,95,77.22,,76,percent of total billed charges,77.22% of total billed charges,81.32,66.1,,65.06,percent of total billed charges,66.1% of total billed charges,102.11,83,,81.69,percent of total billed charges,83% of total,116.87,95,,93.5,percent of total billed charges ,95% of total billed charges,98.42,80,,78.74,percent of total billed charges,78% of total billed charges,95.96,78,,76.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.5,63,,62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,110.72,90,,88.58,percent of total billed charges,90% of total billed charges,98.42,80,,78.74,percent of total billed charges,80% of total billed charges,77.5,63,,62,percent of total billed charges,63% of total billed charges,104.57,85,,83.656,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.19,79,,77.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.5,450,
SODIUM CLORIDE 0.9% IRR 2000ML,258019897,CDM,250,RC,,,outpatient,,,32.2,22.54,,25.44,79,,20.35,percent of total billed charges,79% of total billed charges,28.98,90,,23.18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.29,63,,16.23,percent of total billed charges,63% of total billed charges,24.86,77.22,,19.89,percent of total billed charges,77.22% of total billed charges,21.28,66.1,,17.02,percent of total billed charges,66.1% of total billed charges,26.73,83,,21.38,percent of total billed charges,83% of total,30.59,95,,24.47,percent of total billed charges ,95% of total billed charges,25.76,80,,20.61,percent of total billed charges,78% of total billed charges,25.12,78,,20.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.29,63,,16.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,28.98,90,,23.18,percent of total billed charges,90% of total billed charges,25.76,80,,20.61,percent of total billed charges,80% of total billed charges,20.29,63,,16.23,percent of total billed charges,63% of total billed charges,27.37,85,,21.896,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.44,79,,20.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.29,450,
NON-BILL PHARMACY CHARGE,270000555,CDM,250,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
AMNIOFILL AF2000 2000MG MIMEDX,278228412,CDM,250,RC,,,outpatient,,,8000,5600,,6320,79,,5056,percent of total billed charges,79% of total billed charges,7200,90,,5760,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5040,63,,4032,percent of total billed charges,63% of total billed charges,6177.6,77.22,,4942.08,percent of total billed charges,77.22% of total billed charges,5288,66.1,,4230.4,percent of total billed charges,66.1% of total billed charges,6640,83,,5312,percent of total billed charges,83% of total,7600,95,,6080,percent of total billed charges ,95% of total billed charges,6400,80,,5120,percent of total billed charges,78% of total billed charges,6240,78,,4992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5040,63,,4032,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7200,90,,5760,percent of total billed charges,90% of total billed charges,6400,80,,5120,percent of total billed charges,80% of total billed charges,5040,63,,4032,percent of total billed charges,63% of total billed charges,6800,85,,5440,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6320,79,,5056,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7600,
AMNIOFILL AF1000 1000MG MIMEDX,278228460,CDM,250,RC,,,outpatient,,,4000,2800,,3160,79,,2528,percent of total billed charges,79% of total billed charges,3600,90,,2880,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2520,63,,2016,percent of total billed charges,63% of total billed charges,3088.8,77.22,,2471.04,percent of total billed charges,77.22% of total billed charges,2644,66.1,,2115.2,percent of total billed charges,66.1% of total billed charges,3320,83,,2656,percent of total billed charges,83% of total,3800,95,,3040,percent of total billed charges ,95% of total billed charges,3200,80,,2560,percent of total billed charges,78% of total billed charges,3120,78,,2496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2520,63,,2016,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3600,90,,2880,percent of total billed charges,90% of total billed charges,3200,80,,2560,percent of total billed charges,80% of total billed charges,2520,63,,2016,percent of total billed charges,63% of total billed charges,3400,85,,2720,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3160,79,,2528,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3800,
INJ RHO(D) IMMUNE GLOB 300 MCG,390000025,CDM,250,RC,J2790,HCPCS,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.14,100,,,fee schedule,100% of GA fee schedule,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,84.15,105,,,fee schedule,105% of GA fee schedule,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.14,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,80.14,100,,,fee schedule,100% of GA fee schedule,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.14,450,
"DICYCLOMINE HCL INJ, 20 MG",4930J0500,CDM,250,RC,J0500,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.87,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,16.66,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.87,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,15.87,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.87,450,
ROCEPHIN 1GM,4930J0694,CDM,250,RC,J0694,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.51,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,4.74,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,4.51,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.51,450,
ROCEPHIN 250 MG,4930J0696,CDM,250,RC,J0696,HCPCS,outpatient,,,2.63,1.84,,2.08,79,,1.66,percent of total billed charges,79% of total billed charges,2.37,90,,1.9,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,2.03,77.22,,1.62,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,2.18,83,,1.74,percent of total billed charges,83% of total,2.5,95,,2,percent of total billed charges ,95% of total billed charges,2.1,80,,1.68,percent of total billed charges,78% of total billed charges,2.05,78,,1.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,2.37,90,,1.9,percent of total billed charges,90% of total billed charges,2.1,80,,1.68,percent of total billed charges,80% of total billed charges,0.44,100,,,fee schedule,100% of GA fee schedule,2.24,85,,1.792,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.08,79,,1.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
CELESTONE (BETAMETHASONE),4930J0702,CDM,250,RC,J0702,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.4,100,,,fee schedule,100% of GA fee schedule,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,7.77,105,,,fee schedule,105% of GA fee schedule,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,7.4,100,,,fee schedule,100% of GA fee schedule,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.4,450,
DEPO-MEDROL 40 MG INJ,4930J1030,CDM,250,RC,J1030,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
DEPRO-MEDROL 80 MG INJ,4930J1040,CDM,250,RC,J1040,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
MEDROXPROGESTRONE ACETATE,4930J1050,CDM,250,RC,J1050,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.54,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,0.57,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.54,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.54,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.54,450,
DECADRON 10MG,4930J1094,CDM,250,RC,J1094,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
DEXAMETHASONE IM,4930J1100,CDM,250,RC,J1100,HCPCS,outpatient,,,6.25,4.38,,4.94,79,,3.95,percent of total billed charges,79% of total billed charges,5.63,90,,4.5,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,4.83,77.22,,3.86,percent of total billed charges,77.22% of total billed charges,0.12,105,,,fee schedule,105% of GA fee schedule,5.19,83,,4.15,percent of total billed charges,83% of total,5.94,95,,4.75,percent of total billed charges ,95% of total billed charges,5,80,,4,percent of total billed charges,78% of total billed charges,4.88,78,,3.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,5.63,90,,4.5,percent of total billed charges,90% of total billed charges,5,80,,4,percent of total billed charges,80% of total billed charges,0.11,100,,,fee schedule,100% of GA fee schedule,5.31,85,,4.248,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.94,79,,3.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.11,450,
BENADRYL UP TO 50MG,4930J1200,CDM,250,RC,J1200,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.75,100,,,fee schedule,100% of GA fee schedule,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,0.79,105,,,fee schedule,105% of GA fee schedule,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.75,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.75,100,,,fee schedule,100% of GA fee schedule,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.75,450,
TORADOL 15 MG INJ,4930J1885,CDM,250,RC,J1885,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,0.71,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.68,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.68,450,
LASIX 20 MG INJ,4930J1940,CDM,250,RC,J1940,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,0.42,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.4,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.4,450,
ZOFRAN INJ,4930J2405,CDM,250,RC,J2405,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.09,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,0.09,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.09,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.09,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.09,450,
PHENERGAN UP TO 50 MG,4930J2550,CDM,250,RC,J2550,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.31,100,,,fee schedule,100% of GA fee schedule,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.48,105,,,fee schedule,105% of GA fee schedule,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.31,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,3.31,100,,,fee schedule,100% of GA fee schedule,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.31,450,
SOLU-MED UP TO 40 MG,4930J2920,CDM,250,RC,J2920,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
SOLUMEDROL 125 MG,4930J2930,CDM,250,RC,J2930,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
B-12 UP TO 1000 MCG,4930J3420,CDM,250,RC,J3420,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.15,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,1.21,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.15,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.15,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.15,450,
"TR RH IG,FULL-DOSE,IM",761090384,CDM,250,RC,90384,HCPCS,outpatient,,,459,321.3,,362.61,79,,290.09,percent of total billed charges,79% of total billed charges,413.1,90,,330.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.17,63,,231.34,percent of total billed charges,63% of total billed charges,354.44,77.22,,283.55,percent of total billed charges,77.22% of total billed charges,303.4,66.1,,242.72,percent of total billed charges,66.1% of total billed charges,380.97,83,,304.78,percent of total billed charges,83% of total,436.05,95,,348.84,percent of total billed charges ,95% of total billed charges,367.2,80,,293.76,percent of total billed charges,78% of total billed charges,358.02,78,,286.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,289.17,63,,231.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,289.17,63,,231.34,percent of total billed charges,63% of total billed charges,390.15,85,,312.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,362.61,79,,290.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,289.17,450,
"DICYCLOMINE HCL INJ, 20 MG",J0500,CDM,250,RC,J0500,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.87,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,16.66,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.87,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,15.87,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.87,450,
CEFOXITIN 1GM,J0694,CDM,250,RC,J0694,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.51,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,4.74,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,4.51,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.51,450,
ROCEPHIN 250MG,J0696-1,CDM,250,RC,J0696,HCPCS,outpatient,,,2.63,1.84,,2.08,79,,1.66,percent of total billed charges,79% of total billed charges,2.37,90,,1.9,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,2.03,77.22,,1.62,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,2.18,83,,1.74,percent of total billed charges,83% of total,2.5,95,,2,percent of total billed charges ,95% of total billed charges,2.1,80,,1.68,percent of total billed charges,78% of total billed charges,2.05,78,,1.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,2.37,90,,1.9,percent of total billed charges,90% of total billed charges,2.1,80,,1.68,percent of total billed charges,80% of total billed charges,0.44,100,,,fee schedule,100% of GA fee schedule,2.24,85,,1.792,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.08,79,,1.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
ROCEPHIN 500MG,J0696-2,CDM,250,RC,J0696,HCPCS,outpatient,,,10.52,7.36,,8.31,79,,6.65,percent of total billed charges,79% of total billed charges,9.47,90,,7.58,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,8.12,77.22,,6.5,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,8.73,83,,6.98,percent of total billed charges,83% of total,9.99,95,,7.99,percent of total billed charges ,95% of total billed charges,8.42,80,,6.74,percent of total billed charges,78% of total billed charges,8.21,78,,6.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,9.47,90,,7.58,percent of total billed charges,90% of total billed charges,8.42,80,,6.74,percent of total billed charges,80% of total billed charges,0.44,100,,,fee schedule,100% of GA fee schedule,8.94,85,,7.152,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.31,79,,6.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
ROCEPHIN 1 GRAM,J0696-3,CDM,250,RC,J0696,HCPCS,outpatient,,,10.52,7.36,,8.31,79,,6.65,percent of total billed charges,79% of total billed charges,9.47,90,,7.58,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,8.12,77.22,,6.5,percent of total billed charges,77.22% of total billed charges,0.46,105,,,fee schedule,105% of GA fee schedule,8.73,83,,6.98,percent of total billed charges,83% of total,9.99,95,,7.99,percent of total billed charges ,95% of total billed charges,8.42,80,,6.74,percent of total billed charges,78% of total billed charges,8.21,78,,6.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.44,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,9.47,90,,7.58,percent of total billed charges,90% of total billed charges,8.42,80,,6.74,percent of total billed charges,80% of total billed charges,0.44,100,,,fee schedule,100% of GA fee schedule,8.94,85,,7.152,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.31,79,,6.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.44,450,
CELESTONE (BETAMETHASONE),J0702,CDM,250,RC,J0702,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.4,100,,,fee schedule,100% of GA fee schedule,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,7.77,105,,,fee schedule,105% of GA fee schedule,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,7.4,100,,,fee schedule,100% of GA fee schedule,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.4,450,
DEPO-MEDROL 20 MG,J1020,CDM,250,RC,J1020,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
DEPO-MEDROL 40MG,J1030,CDM,250,RC,J1030,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
DEPO-MEDROL 80MG,J1040,CDM,250,RC,J1040,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
MEDROXPROGESTRONE ACETATE 1MG,J1050,CDM,250,RC,J1050,HCPCS,outpatient,,,1.32,0.92,,1.04,79,,0.83,percent of total billed charges,79% of total billed charges,1.19,90,,0.95,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.54,100,,,fee schedule,100% of GA fee schedule,1.02,77.22,,0.82,percent of total billed charges,77.22% of total billed charges,0.57,105,,,fee schedule,105% of GA fee schedule,1.1,83,,0.88,percent of total billed charges,83% of total,1.25,95,,1,percent of total billed charges ,95% of total billed charges,1.06,80,,0.85,percent of total billed charges,78% of total billed charges,1.03,78,,0.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.54,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1.19,90,,0.95,percent of total billed charges,90% of total billed charges,1.06,80,,0.85,percent of total billed charges,80% of total billed charges,0.54,100,,,fee schedule,100% of GA fee schedule,1.12,85,,0.896,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.04,79,,0.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.54,450,
"DEXAMETHASONE, 4MG",J1100-1,CDM,250,RC,J1100,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,0.12,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.11,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.11,450,
"DEXAMETHASONE, 10MG",J1100-2,CDM,250,RC,J1100,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,0.12,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.11,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.11,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.11,450,
BENADRYL UP TO 50MG,J1200,CDM,250,RC,J1200,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.75,100,,,fee schedule,100% of GA fee schedule,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,0.79,105,,,fee schedule,105% of GA fee schedule,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.75,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.75,100,,,fee schedule,100% of GA fee schedule,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.75,450,
TORADOL 60 MG INJ,J1885-1,CDM,250,RC,J1885,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,0.71,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.68,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.68,450,
TORADOL 30 MG INJ,J1885-2,CDM,250,RC,J1885,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,0.71,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.68,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.68,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.68,450,
LASIX 20 MG INJ,J1940,CDM,250,RC,J1940,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,0.42,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.4,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.4,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.4,450,
ZOFRAN INJ 1MG,J2405,CDM,250,RC,J2405,HCPCS,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.09,100,,,fee schedule,100% of GA fee schedule,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,0.09,105,,,fee schedule,105% of GA fee schedule,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.09,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.09,100,,,fee schedule,100% of GA fee schedule,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.09,450,
PHENERGAN UP TO 50 MG,J2550,CDM,250,RC,J2550,HCPCS,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.31,100,,,fee schedule,100% of GA fee schedule,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.48,105,,,fee schedule,105% of GA fee schedule,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.31,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,3.31,100,,,fee schedule,100% of GA fee schedule,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.31,450,
SOLU-MED UP TO 40 MG,J2920,CDM,250,RC,J2920,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
SOLUMEDROL UP TO 125 MG,J2930,CDM,250,RC,J2930,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
KENALOG 40MG,J3301-1,CDM,250,RC,J3301,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,0.95,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.9,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.9,450,
KENALOG 80MG,J3301-2,CDM,250,RC,J3301,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,0.95,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.9,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.9,450,
B-12 UP TO 1000MCG,J3420,CDM,250,RC,J3420,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.15,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,1.21,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.15,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.15,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.15,450,
CLINDAMYCIN 300MG,S0077,CDM,250,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
NUC MED MAA,250017854,CDM,255,RC,,,outpatient,,,287,200.9,,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.81,63,,144.65,percent of total billed charges,63% of total billed charges,221.62,77.22,,177.3,percent of total billed charges,77.22% of total billed charges,189.71,66.1,,151.77,percent of total billed charges,66.1% of total billed charges,238.21,83,,190.57,percent of total billed charges,83% of total,272.65,95,,218.12,percent of total billed charges ,95% of total billed charges,229.6,80,,183.68,percent of total billed charges,78% of total billed charges,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,180.81,63,,144.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,180.81,63,,144.65,percent of total billed charges,63% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.81,450,
PRFLUTREN LIPID MICROSPHERES,250019046,CDM,255,RC,Q9957,HCPCS,outpatient,,,447,312.9,,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,345.17,77.22,,276.14,percent of total billed charges,77.22% of total billed charges,295.47,66.1,,236.38,percent of total billed charges,66.1% of total billed charges,371.01,83,,296.81,percent of total billed charges,83% of total,424.65,95,,339.72,percent of total billed charges ,95% of total billed charges,357.6,80,,286.08,percent of total billed charges,78% of total billed charges,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,281.61,450,
ORA-SWEET FLAVORED SYRUP 480 M,250019488,CDM,255,RC,,,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,58.17,66.1,,46.54,percent of total billed charges,66.1% of total billed charges,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.44,450,
OMNISCAN 287 MG.ML 10ML VIAL,250019515,CDM,255,RC,,,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.18,450,
OMNISCAN 287 MG/ML 15ML VIAL,250019516,CDM,255,RC,A9576,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.18,450,
OMNISCAN 287 MG/ML 20 ML VIAL,250019517,CDM,255,RC,,,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.18,450,
OMNIPAQUE 350 MG/ML 100ML,250019520,CDM,255,RC,Q9967,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,58.17,66.1,,46.54,percent of total billed charges,66.1% of total billed charges,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.44,450,
IOPAMIDOL 370 MG/ML 100ML VIAL,250019847,CDM,255,RC,Q9967,HCPCS,outpatient,,,198.5,138.95,,156.82,79,,125.46,percent of total billed charges,79% of total billed charges,178.65,90,,142.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.06,63,,100.05,percent of total billed charges,63% of total billed charges,153.28,77.22,,122.62,percent of total billed charges,77.22% of total billed charges,131.21,66.1,,104.97,percent of total billed charges,66.1% of total billed charges,164.76,83,,131.81,percent of total billed charges,83% of total,188.58,95,,150.86,percent of total billed charges ,95% of total billed charges,158.8,80,,127.04,percent of total billed charges,78% of total billed charges,154.83,78,,123.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,125.06,63,,100.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,178.65,90,,142.92,percent of total billed charges,90% of total billed charges,158.8,80,,127.04,percent of total billed charges,80% of total billed charges,125.06,63,,100.05,percent of total billed charges,63% of total billed charges,168.73,85,,134.984,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,156.82,79,,125.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.06,450,
GADODIAMIDE 2.5MMIL/5ML VIAL,250019852,CDM,255,RC,A9579,HCPCS,outpatient,,,60.25,42.18,,47.6,79,,38.08,percent of total billed charges,79% of total billed charges,54.23,90,,43.38,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.96,63,,30.37,percent of total billed charges,63% of total billed charges,46.53,77.22,,37.22,percent of total billed charges,77.22% of total billed charges,39.83,66.1,,31.86,percent of total billed charges,66.1% of total billed charges,50.01,83,,40.01,percent of total billed charges,83% of total,57.24,95,,45.79,percent of total billed charges ,95% of total billed charges,48.2,80,,38.56,percent of total billed charges,78% of total billed charges,47,78,,37.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.96,63,,30.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,54.23,90,,43.38,percent of total billed charges,90% of total billed charges,48.2,80,,38.56,percent of total billed charges,80% of total billed charges,37.96,63,,30.37,percent of total billed charges,63% of total billed charges,51.21,85,,40.968,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.6,79,,38.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.96,450,
IOHEXOL 300MG/ML 100ML,250019860,CDM,255,RC,Q9967,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,111.05,66.1,,88.84,percent of total billed charges,66.1% of total billed charges,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.84,450,
GADODIAMIDE 5MMOL/10ML VIAL,250019876,CDM,255,RC,,,outpatient,,,101.5,71.05,,80.19,79,,64.15,percent of total billed charges,79% of total billed charges,91.35,90,,73.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.95,63,,51.16,percent of total billed charges,63% of total billed charges,78.38,77.22,,62.7,percent of total billed charges,77.22% of total billed charges,67.09,66.1,,53.67,percent of total billed charges,66.1% of total billed charges,84.25,83,,67.4,percent of total billed charges,83% of total,96.43,95,,77.14,percent of total billed charges ,95% of total billed charges,81.2,80,,64.96,percent of total billed charges,78% of total billed charges,79.17,78,,63.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.95,63,,51.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,91.35,90,,73.08,percent of total billed charges,90% of total billed charges,81.2,80,,64.96,percent of total billed charges,80% of total billed charges,63.95,63,,51.16,percent of total billed charges,63% of total billed charges,86.28,85,,69.024,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,80.19,79,,64.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.95,450,
GADODIAMIDE 10MMOL/20ML VIAL,250019877,CDM,255,RC,,,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.89,450,
IOHEXOL 350MG/ML 125ML,250019882,CDM,255,RC,Q9967,HCPCS,outpatient,,,282.1,197.47,,222.86,79,,178.29,percent of total billed charges,79% of total billed charges,253.89,90,,203.11,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.72,63,,142.18,percent of total billed charges,63% of total billed charges,217.84,77.22,,174.27,percent of total billed charges,77.22% of total billed charges,186.47,66.1,,149.18,percent of total billed charges,66.1% of total billed charges,234.14,83,,187.31,percent of total billed charges,83% of total,268,95,,214.4,percent of total billed charges ,95% of total billed charges,225.68,80,,180.54,percent of total billed charges,78% of total billed charges,220.04,78,,176.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,177.72,63,,142.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,253.89,90,,203.11,percent of total billed charges,90% of total billed charges,225.68,80,,180.54,percent of total billed charges,80% of total billed charges,177.72,63,,142.18,percent of total billed charges,63% of total billed charges,239.79,85,,191.832,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,222.86,79,,178.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,177.72,450,
IODIXANOL 270 MG/ML 100 ML,250019883,CDM,255,RC,Q9966,HCPCS,outpatient,,,251.3,175.91,,198.53,79,,158.82,percent of total billed charges,79% of total billed charges,226.17,90,,180.94,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.32,63,,126.66,percent of total billed charges,63% of total billed charges,194.05,77.22,,155.24,percent of total billed charges,77.22% of total billed charges,166.11,66.1,,132.89,percent of total billed charges,66.1% of total billed charges,208.58,83,,166.86,percent of total billed charges,83% of total,238.74,95,,190.99,percent of total billed charges ,95% of total billed charges,201.04,80,,160.83,percent of total billed charges,78% of total billed charges,196.01,78,,156.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,158.32,63,,126.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,226.17,90,,180.94,percent of total billed charges,90% of total billed charges,201.04,80,,160.83,percent of total billed charges,80% of total billed charges,158.32,63,,126.66,percent of total billed charges,63% of total billed charges,213.61,85,,170.888,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,198.53,79,,158.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.32,450,
NUC MED DTPA,255017856,CDM,255,RC,,,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.44,63,,94.75,percent of total billed charges,63% of total billed charges,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,124.27,66.1,,99.42,percent of total billed charges,66.1% of total billed charges,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,118.44,63,,94.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,118.44,63,,94.75,percent of total billed charges,63% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,118.44,450,
LACTATED RINGERS IRRIG 3000ML,250017144,CDM,258,RC,J7120,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.42,100,,,fee schedule,100% of GA fee schedule,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,2.54,105,,,fee schedule,105% of GA fee schedule,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.42,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.42,100,,,fee schedule,100% of GA fee schedule,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.42,450,
MIDAZOLAM HCL 5 MG/ML VIAL,250019857,CDM,258,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
OXYTOCIN 10 UNITS/ML VIAL,250019867,CDM,258,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
DEXMEDETOMIDINE 0.9% HCL 200,250019901,CDM,258,RC,,,outpatient,,,20.2,14.14,,15.96,79,,12.77,percent of total billed charges,79% of total billed charges,18.18,90,,14.54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.73,63,,10.18,percent of total billed charges,63% of total billed charges,15.6,77.22,,12.48,percent of total billed charges,77.22% of total billed charges,13.35,66.1,,10.68,percent of total billed charges,66.1% of total billed charges,16.77,83,,13.42,percent of total billed charges,83% of total,19.19,95,,15.35,percent of total billed charges ,95% of total billed charges,16.16,80,,12.93,percent of total billed charges,78% of total billed charges,15.76,78,,12.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.73,63,,10.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,18.18,90,,14.54,percent of total billed charges,90% of total billed charges,16.16,80,,12.93,percent of total billed charges,80% of total billed charges,12.73,63,,10.18,percent of total billed charges,63% of total billed charges,17.17,85,,13.736,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.96,79,,12.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.73,450,
OCELIZUMAB 300MG/10ML VIAL,250019910,CDM,258,RC,J2350,HCPCS,outpatient,,,41681.83,29177.28,,32928.65,79,,26342.92,percent of total billed charges,79% of total billed charges,37513.65,90,,30010.92,percent of total billed charges,90% of total billed charges,3633.79,100,,,Fee Schedule,100% of CMS OPPS rate,3638.28,160,,,Fee Schedule,160% of CMS OPPS rate,3636.03,130,,,Fee Schedule,130% of CMS OPPS rate,59.8,100,,,fee schedule,100% of GA fee schedule,32186.71,77.22,,25749.37,percent of total billed charges,77.22% of total billed charges,62.79,105,,,fee schedule,105% of GA fee schedule,34595.92,83,,27676.74,percent of total billed charges,83% of total,39597.74,95,,31678.19,percent of total billed charges ,95% of total billed charges,33345.46,80,,26676.37,percent of total billed charges,78% of total billed charges,32511.83,78,,26009.464,percent of total billed charges,78% of total billed charges,3633.79,100,,,Fee Schedule,100% of CMS OPPS rate,59.8,100,,,fee schedule,100% of GA fee schedule,3633.79,100,,,Fee Schedule,100% of CMS OPPS rate,37513.65,90,,30010.92,percent of total billed charges,90% of total billed charges,33345.46,80,,26676.37,percent of total billed charges,80% of total billed charges,59.8,100,,,fee schedule,100% of GA fee schedule,35429.56,85,,28343.648,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3633.27,93,,,fee schedule,93% of CMS OPPS rate,32928.65,79,,26342.92,percent of total billed charges,79% of total billed charges,3633.79,100,,,Fee Schedule,100% of CMS OPPS rate,3633.79,100,,,Fee Schedule,100% of CMS OPPS rate,59.8,39597.74,
SODIUM CHLORIDE IRRIG SO 500ML,250019911,CDM,258,RC,J7040,HCPCS,outpatient,,,12.15,8.51,,9.6,79,,7.68,percent of total billed charges,79% of total billed charges,10.94,90,,8.75,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,100,,,fee schedule,100% of GA fee schedule,9.38,77.22,,7.5,percent of total billed charges,77.22% of total billed charges,1.34,105,,,fee schedule,105% of GA fee schedule,10.08,83,,8.06,percent of total billed charges,83% of total,11.54,95,,9.23,percent of total billed charges ,95% of total billed charges,9.72,80,,7.78,percent of total billed charges,78% of total billed charges,9.48,78,,7.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.28,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,10.94,90,,8.75,percent of total billed charges,90% of total billed charges,9.72,80,,7.78,percent of total billed charges,80% of total billed charges,1.28,100,,,fee schedule,100% of GA fee schedule,10.33,85,,8.264,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.6,79,,7.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.28,450,
KCL 0.15%/DEX/NACL 0.2% 500ML,258016174,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
D5.45NS 500ML @ KCL 10 MEQ,258016182,CDM,258,RC,,,outpatient,,,121,84.7,,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.23,63,,60.98,percent of total billed charges,63% of total billed charges,93.44,77.22,,74.75,percent of total billed charges,77.22% of total billed charges,79.98,66.1,,63.98,percent of total billed charges,66.1% of total billed charges,100.43,83,,80.34,percent of total billed charges,83% of total,114.95,95,,91.96,percent of total billed charges ,95% of total billed charges,96.8,80,,77.44,percent of total billed charges,78% of total billed charges,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,76.23,63,,60.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,76.23,63,,60.98,percent of total billed charges,63% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.23,450,
NITROGLYCERIN/D5W 100 MCG/ML,258016473,CDM,258,RC,,,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,98.75,79,,79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.75,450,
KCL 20MEG .9 SOD CHL 1000 MLBG,258016746,CDM,258,RC,,,outpatient,,,136,95.2,,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,105.02,77.22,,84.02,percent of total billed charges,77.22% of total billed charges,89.9,66.1,,71.92,percent of total billed charges,66.1% of total billed charges,112.88,83,,90.3,percent of total billed charges,83% of total,129.2,95,,103.36,percent of total billed charges ,95% of total billed charges,108.8,80,,87.04,percent of total billed charges,78% of total billed charges,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.68,450,
DEXTROSE 10% 500 ML BAG,258017003,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEXTROSE 5% 0250L BAG,258017004,CDM,258,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
DEXTROSE 5% 500ML BAG,258017005,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEXTROSE 5% 1000ML BAG,258017006,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEX 5%/NACL 0.9% 500ML BAG,258017007,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEX 5%/NACL 0.9% 1000ML BAG,258017008,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEX 5%/LACTATED RINGERS 500ML,258017009,CDM,258,RC,J7121,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEX 5%/LACTATED RINGERS 1000ML,258017010,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEXTROSE 5%/.45% SOD CHL 500ML,258017011,CDM,258,RC,J7042,HCPCS,outpatient,,,121,84.7,,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.14,100,,,fee schedule,100% of GA fee schedule,93.44,77.22,,74.75,percent of total billed charges,77.22% of total billed charges,1.2,105,,,fee schedule,105% of GA fee schedule,100.43,83,,80.34,percent of total billed charges,83% of total,114.95,95,,91.96,percent of total billed charges ,95% of total billed charges,96.8,80,,77.44,percent of total billed charges,78% of total billed charges,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.14,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.14,100,,,fee schedule,100% of GA fee schedule,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.14,450,
DEX 5%/NACL 0.45% 1000ML BAG,258017012,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEX 5%/NACL 0.225% 500ML BAG,258017013,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DEX 5%/NACL 0.225% 1000ML BAG,258017014,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
LACTATED RINGERS 500ML BAG,258017015,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
LACTATED RINGERS 1000ML BAG,258017016,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
SODIUM CHLORIDE 0.9% INJ 0250L,258017017,CDM,258,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
SODIUM CHLORIDE 0.9% INJ 500ML,258017018,CDM,258,RC,J7040,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,100,,,fee schedule,100% of GA fee schedule,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,1.34,105,,,fee schedule,105% of GA fee schedule,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.28,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.28,100,,,fee schedule,100% of GA fee schedule,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.28,450,
DEX 5%/NACL 0.225% 0250L BAG,258017020,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
SODIUM CHLORID .45% INJ 1000ML,258017021,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
SODIUM CHLORIDE .45% INJ 500ML,258017022,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
N S IRRIGATION 1000CC,258017023,CDM,258,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
SODIUM CHLORIDE 0.9% INJ 50ML,258017024,CDM,258,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
SODIUM CHLORIDE 0.9% INJ 100MG,258017025,CDM,258,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
LIDOCAINE DRIP 500CC,258017030,CDM,258,RC,,,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
SODIUM CLORIDE 3% 500ML BAG,258017036,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
ST WATER 1000ML BAG,258017040,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
INTRALIPIDS 20 500CC,258017041,CDM,258,RC,,,outpatient,,,194,135.8,,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,149.81,77.22,,119.85,percent of total billed charges,77.22% of total billed charges,128.23,66.1,,102.58,percent of total billed charges,66.1% of total billed charges,161.02,83,,128.82,percent of total billed charges,83% of total,184.3,95,,147.44,percent of total billed charges ,95% of total billed charges,155.2,80,,124.16,percent of total billed charges,78% of total billed charges,151.32,78,,121.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.22,450,
FLAGYL 500MG RTU BAG,258017049,CDM,258,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
MANNITOL 20% 500ML BAG,258017051,CDM,258,RC,,,outpatient,,,435,304.5,,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.05,63,,219.24,percent of total billed charges,63% of total billed charges,335.91,77.22,,268.73,percent of total billed charges,77.22% of total billed charges,287.54,66.1,,230.03,percent of total billed charges,66.1% of total billed charges,361.05,83,,288.84,percent of total billed charges,83% of total,413.25,95,,330.6,percent of total billed charges ,95% of total billed charges,348,80,,278.4,percent of total billed charges,78% of total billed charges,339.3,78,,271.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,274.05,63,,219.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,348,80,,278.4,percent of total billed charges,80% of total billed charges,274.05,63,,219.24,percent of total billed charges,63% of total billed charges,369.75,85,,295.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,274.05,450,
D5.45NS 1000CC KCL 20MEQ,258017054,CDM,258,RC,,,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
DEXTROSE 5% VIAFLEX 250 ML BTL,258017056,CDM,258,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
D5.45NS 1000CC KCL 30MEQ,258017057,CDM,258,RC,,,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
KCL 0.3%/DEX/NACL 0.45% 1000ML,258017058,CDM,258,RC,,,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
DEXTROSE 5% VIAFLEX 50 ML BAG,258017064,CDM,258,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
PROPOFOL 50 ML BOTTLE,258017193,CDM,258,RC,,,outpatient,,,323,226.1,,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,249.42,77.22,,199.54,percent of total billed charges,77.22% of total billed charges,213.5,66.1,,170.8,percent of total billed charges,66.1% of total billed charges,268.09,83,,214.47,percent of total billed charges,83% of total,306.85,95,,245.48,percent of total billed charges ,95% of total billed charges,258.4,80,,206.72,percent of total billed charges,78% of total billed charges,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,203.49,450,
PROPOFOL 100 ML BOTTLE,258017194,CDM,258,RC,,,outpatient,,,578,404.6,,456.62,79,,365.3,percent of total billed charges,79% of total billed charges,520.2,90,,416.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364.14,63,,291.31,percent of total billed charges,63% of total billed charges,446.33,77.22,,357.06,percent of total billed charges,77.22% of total billed charges,382.06,66.1,,305.65,percent of total billed charges,66.1% of total billed charges,479.74,83,,383.79,percent of total billed charges,83% of total,549.1,95,,439.28,percent of total billed charges ,95% of total billed charges,462.4,80,,369.92,percent of total billed charges,78% of total billed charges,450.84,78,,360.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,364.14,63,,291.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,520.2,90,,416.16,percent of total billed charges,90% of total billed charges,462.4,80,,369.92,percent of total billed charges,80% of total billed charges,364.14,63,,291.31,percent of total billed charges,63% of total billed charges,491.3,85,,393.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,456.62,79,,365.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,364.14,549.1,
SODIUM CHLORIDE 0.9% INJ 1000,258017246,CDM,258,RC,,,outpatient,,,143,100.1,,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,110.42,77.22,,88.34,percent of total billed charges,77.22% of total billed charges,94.52,66.1,,75.62,percent of total billed charges,66.1% of total billed charges,118.69,83,,94.95,percent of total billed charges,83% of total,135.85,95,,108.68,percent of total billed charges ,95% of total billed charges,114.4,80,,91.52,percent of total billed charges,78% of total billed charges,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.09,450,
POTASSIUM CHL 20 MEQ/0.45% NS,258019131,CDM,258,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
ESMOLOL HCL 2500MG/NS 0250LBAG,258019149,CDM,258,RC,,,outpatient,,,435,304.5,,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.05,63,,219.24,percent of total billed charges,63% of total billed charges,335.91,77.22,,268.73,percent of total billed charges,77.22% of total billed charges,287.54,66.1,,230.03,percent of total billed charges,66.1% of total billed charges,361.05,83,,288.84,percent of total billed charges,83% of total,413.25,95,,330.6,percent of total billed charges ,95% of total billed charges,348,80,,278.4,percent of total billed charges,78% of total billed charges,339.3,78,,271.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,274.05,63,,219.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,348,80,,278.4,percent of total billed charges,80% of total billed charges,274.05,63,,219.24,percent of total billed charges,63% of total billed charges,369.75,85,,295.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,274.05,450,
DEXTROSE/WATER 500 ML IV SOL,258019380,CDM,258,RC,J7060,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.82,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,1.91,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.82,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.82,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.82,450,
PROPOFOL 50ML 10MG/1 ML EMULSI,258019481,CDM,258,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
OXYTOCIN 20 UNITS/NS 1000ML BG,258019553,CDM,258,RC,,,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.47,450,
LEVETIRACETAM IN 0.82% NALC500,258019646,CDM,258,RC,J1953,HCPCS,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
KCL 20MEQ D5 0.2 NACL 1000MLGB,258019668,CDM,258,RC,,,outpatient,,,58,40.6,,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,44.79,77.22,,35.83,percent of total billed charges,77.22% of total billed charges,38.34,66.1,,30.67,percent of total billed charges,66.1% of total billed charges,48.14,83,,38.51,percent of total billed charges,83% of total,55.1,95,,44.08,percent of total billed charges ,95% of total billed charges,46.4,80,,37.12,percent of total billed charges,78% of total billed charges,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.54,450,
CLINDAMYCIN PHOSPHATE 900 MG,258019735,CDM,258,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
LEVETIRACETAM IVP 1000MG/100MG,258019755,CDM,258,RC,J1953,HCPCS,outpatient,,,121,84.7,,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.23,63,,60.98,percent of total billed charges,63% of total billed charges,93.44,77.22,,74.75,percent of total billed charges,77.22% of total billed charges,79.98,66.1,,63.98,percent of total billed charges,66.1% of total billed charges,100.43,83,,80.34,percent of total billed charges,83% of total,114.95,95,,91.96,percent of total billed charges ,95% of total billed charges,96.8,80,,77.44,percent of total billed charges,78% of total billed charges,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,76.23,63,,60.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,76.23,63,,60.98,percent of total billed charges,63% of total billed charges,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.23,450,
NITROPRUSSIDE IN 0.9% NACL 50M,258019792,CDM,258,RC,,,outpatient,,,112,78.4,,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,86.49,77.22,,69.19,percent of total billed charges,77.22% of total billed charges,74.03,66.1,,59.22,percent of total billed charges,66.1% of total billed charges,92.96,83,,74.37,percent of total billed charges,83% of total,106.4,95,,85.12,percent of total billed charges ,95% of total billed charges,89.6,80,,71.68,percent of total billed charges,78% of total billed charges,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.56,450,
OXYTOCIN/0.9% SODIUMCHLOR 30U,258019796,CDM,258,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
0.9% SOD CHL 100ML MINI SIN PK,258019825,CDM,258,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
INSULIN REG IN 0.9 NACL 100 U,258019830,CDM,258,RC,A9270,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
DEXMEDETOMIDINE IN 0.9% NACL,258019838,CDM,258,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
MIDAZOLAM HCL IN 0.9% NACL/PF,258019845,CDM,258,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
NOREPINEPHRINE BIT/0.9%/16MG,258019878,CDM,258,RC,J0171,HCPCS,outpatient,,,145,101.5,,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,111.97,77.22,,89.58,percent of total billed charges,77.22% of total billed charges,0.87,105,,,fee schedule,105% of GA fee schedule,120.35,83,,96.28,percent of total billed charges,83% of total,137.75,95,,110.2,percent of total billed charges ,95% of total billed charges,116,80,,92.8,percent of total billed charges,78% of total billed charges,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.83,100,,,fee schedule,100% of GA fee schedule,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.83,450,
NOREPINEPHRINE BIT/0.9%/4MG,258019880,CDM,258,RC,J0171,HCPCS,outpatient,,,56.05,39.24,,44.28,79,,35.42,percent of total billed charges,79% of total billed charges,50.45,90,,40.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,43.28,77.22,,34.62,percent of total billed charges,77.22% of total billed charges,0.87,105,,,fee schedule,105% of GA fee schedule,46.52,83,,37.22,percent of total billed charges,83% of total,53.25,95,,42.6,percent of total billed charges ,95% of total billed charges,44.84,80,,35.87,percent of total billed charges,78% of total billed charges,43.72,78,,34.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,50.45,90,,40.36,percent of total billed charges,90% of total billed charges,44.84,80,,35.87,percent of total billed charges,80% of total billed charges,0.83,100,,,fee schedule,100% of GA fee schedule,47.64,85,,38.112,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.28,79,,35.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.83,450,
SOD CHLOR REGIN  0.9% INJ 50ML,258117024,CDM,258,RC,,,outpatient,,,24.4,17.08,,19.28,79,,15.42,percent of total billed charges,79% of total billed charges,21.96,90,,17.57,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.37,63,,12.3,percent of total billed charges,63% of total billed charges,18.84,77.22,,15.07,percent of total billed charges,77.22% of total billed charges,16.13,66.1,,12.9,percent of total billed charges,66.1% of total billed charges,20.25,83,,16.2,percent of total billed charges,83% of total,23.18,95,,18.54,percent of total billed charges ,95% of total billed charges,19.52,80,,15.62,percent of total billed charges,78% of total billed charges,19.03,78,,15.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.37,63,,12.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,21.96,90,,17.57,percent of total billed charges,90% of total billed charges,19.52,80,,15.62,percent of total billed charges,80% of total billed charges,15.37,63,,12.3,percent of total billed charges,63% of total billed charges,20.74,85,,16.592,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.28,79,,15.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.37,450,
IV FLUIDS NS 1000 CC,4930J7030,CDM,258,RC,J7030,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,2.7,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.57,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.57,450,
IV FLUIDS/ NS 1000CC,J7030,CDM,258,RC,J7030,HCPCS,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.57,100,,,fee schedule,100% of GA fee schedule,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,2.7,105,,,fee schedule,105% of GA fee schedule,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.57,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,2.57,100,,,fee schedule,100% of GA fee schedule,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.57,450,
IV INFUSION BAMLANIVIMAB,260000239,CDM,260,RC,M0239,HCPCS,outpatient,,,695,486.5,,549.05,79,,439.24,percent of total billed charges,79% of total billed charges,625.5,90,,500.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437.85,63,,350.28,percent of total billed charges,63% of total billed charges,536.68,77.22,,429.34,percent of total billed charges,77.22% of total billed charges,459.4,66.1,,367.52,percent of total billed charges,66.1% of total billed charges,576.85,83,,461.48,percent of total billed charges,83% of total,660.25,95,,528.2,percent of total billed charges ,95% of total billed charges,556,80,,444.8,percent of total billed charges,78% of total billed charges,542.1,78,,433.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,437.85,63,,350.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,625.5,90,,500.4,percent of total billed charges,90% of total billed charges,556,80,,444.8,percent of total billed charges,80% of total billed charges,437.85,63,,350.28,percent of total billed charges,63% of total billed charges,590.75,85,,472.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,549.05,79,,439.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,437.85,660.25,
IV INFUSION INITIAL 31MIN-1HR,260096360,CDM,260,RC,96360,HCPCS,outpatient,,,477,333.9,,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,368.34,77.22,,294.67,percent of total billed charges,77.22% of total billed charges,315.3,66.1,,252.24,percent of total billed charges,66.1% of total billed charges,395.91,83,,316.73,percent of total billed charges,83% of total,453.15,95,,362.52,percent of total billed charges ,95% of total billed charges,381.6,80,,305.28,percent of total billed charges,78% of total billed charges,372.06,78,,297.648,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,453.15,
IV INFUSION ADDL HR,260096361,CDM,260,RC,96361,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
INTRAVENOUS INFUSION,260096365,CDM,260,RC,96365,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,628.9,
INTRAV INFUSION EA ADDL HR,260096366,CDM,260,RC,96366,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
IV INF SEQUENTIAL UP TO 1 HR,260096367,CDM,260,RC,96367,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.56,130,,,Fee Schedule,130% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,103.78,66.1,,83.02,percent of total billed charges,66.1% of total billed charges,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
IM OR SUBCUTANEOUS INJECT,260096372,CDM,260,RC,96372,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
IV INJECTION SINGLE OR INITIAL,260096374,CDM,260,RC,96374,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,450,
IV INJECTION SUBSEQUENT,260096375,CDM,260,RC,96375,HCPCS,outpatient,,,279,195.3,,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,215.44,77.22,,172.35,percent of total billed charges,77.22% of total billed charges,184.42,66.1,,147.54,percent of total billed charges,66.1% of total billed charges,231.57,83,,185.26,percent of total billed charges,83% of total,265.05,95,,212.04,percent of total billed charges ,95% of total billed charges,223.2,80,,178.56,percent of total billed charges,78% of total billed charges,217.62,78,,174.096,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
CHEMO HORMON ANTINEOPL SQ/IM,260096402,CDM,260,RC,96402,HCPCS,outpatient,,,224,156.8,,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,172.97,77.22,,138.38,percent of total billed charges,77.22% of total billed charges,148.06,66.1,,118.45,percent of total billed charges,66.1% of total billed charges,185.92,83,,148.74,percent of total billed charges,83% of total,212.8,95,,170.24,percent of total billed charges ,95% of total billed charges,179.2,80,,143.36,percent of total billed charges,78% of total billed charges,174.72,78,,139.776,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
"NEWBORN IV INFUSION,UP TO 1 HR",260296365,CDM,260,RC,96365,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,628.9,
OB IM OR SUBCUTANEOUS INJ LARC,2609637LC,CDM,260,RC,96372,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS 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,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
OB IV HYDRA INFUSION EA ADD HR,260996361,CDM,260,RC,96361,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
OB.OP IV INJ SINGLE OR INITIAL,260996374,CDM,260,RC,96374,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,450,
THERA PROPHYLACTIC OR DIAG INJ,324096372,CDM,260,RC,96372,HCPCS,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
"IV HYDRATION, EA ADDL HR",450096361,CDM,260,RC,96361,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
IV INFUSION INITIAL 30-60 MIN,450096365,CDM,260,RC,96365,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,628.9,
"IV INF THERAPY, EA ADDL HR",450096366,CDM,260,RC,96366,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
IV INFUSN SEQ NEW DRG 30-60MIN,450096367,CDM,260,RC,96367,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.56,130,,,Fee Schedule,130% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,103.78,66.1,,83.02,percent of total billed charges,66.1% of total billed charges,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
IV INFUSN CONCURRENT NEW DRUG,450096368,CDM,260,RC,96368,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
IV PUSH INTIAL,450096374,CDM,260,RC,96374,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,450,
IV PUSH NEW DRUG EA ADDL,450096375,CDM,260,RC,96375,HCPCS,outpatient,,,280,196,,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,216.22,77.22,,172.98,percent of total billed charges,77.22% of total billed charges,185.08,66.1,,148.06,percent of total billed charges,66.1% of total billed charges,232.4,83,,185.92,percent of total billed charges,83% of total,266,95,,212.8,percent of total billed charges ,95% of total billed charges,224,80,,179.2,percent of total billed charges,78% of total billed charges,218.4,78,,174.72,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
"IV PUSH SAME DRUG, EA ADDL",450096376,CDM,260,RC,96376,HCPCS,outpatient,,,274,191.8,,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,211.58,77.22,,169.26,percent of total billed charges,77.22% of total billed charges,181.11,66.1,,144.89,percent of total billed charges,66.1% of total billed charges,227.42,83,,181.94,percent of total billed charges,83% of total,260.3,95,,208.24,percent of total billed charges ,95% of total billed charges,219.2,80,,175.36,percent of total billed charges,78% of total billed charges,213.72,78,,170.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,172.62,450,
"TR IV INFUSION,HYDRATIN < 1HR",761090760,CDM,260,RC,96360,HCPCS,outpatient,,,477,333.9,,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,368.34,77.22,,294.67,percent of total billed charges,77.22% of total billed charges,315.3,66.1,,252.24,percent of total billed charges,66.1% of total billed charges,395.91,83,,316.73,percent of total billed charges,83% of total,453.15,95,,362.52,percent of total billed charges ,95% of total billed charges,381.6,80,,305.28,percent of total billed charges,78% of total billed charges,372.06,78,,297.648,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,453.15,
TR IV INF THERAPY UP TO 1HR,761090765,CDM,260,RC,96365,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,628.9,
TR IV INF THERAPY ADD HRS TO 8,761090766,CDM,260,RC,96366,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
TR IV INF SEQUENTIAL UP TO 1HR,761090767,CDM,260,RC,96367,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.56,130,,,Fee Schedule,130% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,103.78,66.1,,83.02,percent of total billed charges,66.1% of total billed charges,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
IV INFUSION INITIAL 31MIN-1 HR,761096360,CDM,260,RC,96360,HCPCS,outpatient,,,477,333.9,,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,368.34,77.22,,294.67,percent of total billed charges,77.22% of total billed charges,315.3,66.1,,252.24,percent of total billed charges,66.1% of total billed charges,395.91,83,,316.73,percent of total billed charges,83% of total,453.15,95,,362.52,percent of total billed charges ,95% of total billed charges,381.6,80,,305.28,percent of total billed charges,78% of total billed charges,372.06,78,,297.648,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,453.15,
TR IV INFUSION ADDL  HR,761096361,CDM,260,RC,96361,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
TR IV INFUSION UP TO 1 HR,761096365,CDM,260,RC,96365,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,628.9,
TR IV INF THERAPY EA ADDL HR,761096366,CDM,260,RC,96366,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
TR IV INF SEQUENTIL UP TO 1HR,761096367,CDM,260,RC,96367,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.56,130,,,Fee Schedule,130% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,103.78,66.1,,83.02,percent of total billed charges,66.1% of total billed charges,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
TR IV PUSH SINGLE OR INTIAL,761096374,CDM,260,RC,96374,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,450,
TR IV PUSH ADD SEQ NEW DRU-SUB,761096375,CDM,260,RC,96375,HCPCS,outpatient,,,279,195.3,,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,215.44,77.22,,172.35,percent of total billed charges,77.22% of total billed charges,184.42,66.1,,147.54,percent of total billed charges,66.1% of total billed charges,231.57,83,,185.26,percent of total billed charges,83% of total,265.05,95,,212.04,percent of total billed charges ,95% of total billed charges,223.2,80,,178.56,percent of total billed charges,78% of total billed charges,217.62,78,,174.096,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
INTRAV PUSH SUBSEQU SAME DRUG,761096376,CDM,260,RC,96376,HCPCS,outpatient,,,274,191.8,,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,211.58,77.22,,169.26,percent of total billed charges,77.22% of total billed charges,181.11,66.1,,144.89,percent of total billed charges,66.1% of total billed charges,227.42,83,,181.94,percent of total billed charges,83% of total,260.3,95,,208.24,percent of total billed charges ,95% of total billed charges,219.2,80,,175.36,percent of total billed charges,78% of total billed charges,213.72,78,,170.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,172.62,450,
OB IV INF INITIAL 31MIN-1HR,761996360,CDM,260,RC,96360,HCPCS,outpatient,,,477,333.9,,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,368.34,77.22,,294.67,percent of total billed charges,77.22% of total billed charges,315.3,66.1,,252.24,percent of total billed charges,66.1% of total billed charges,395.91,83,,316.73,percent of total billed charges,83% of total,453.15,95,,362.52,percent of total billed charges ,95% of total billed charges,381.6,80,,305.28,percent of total billed charges,78% of total billed charges,372.06,78,,297.648,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,453.15,
OB IV INFUSION EA ADDL HR,761996361,CDM,260,RC,96361,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
OB IV INFUSION UP TO 1 HR,761996365,CDM,260,RC,96365,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,628.9,
OB IV INF THERAPY ADD HR TO 8,761996366,CDM,260,RC,96366,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
OB OBS IV INF SEQU UP TO 1 HR,761996367,CDM,260,RC,96367,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.56,130,,,Fee Schedule,130% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,103.78,66.1,,83.02,percent of total billed charges,66.1% of total billed charges,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
OB IM OR SUBCUTANEOUS INJ,761996372,CDM,260,RC,96372,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
"OB IV PUSH,SINGLE OR INITIAL",761996374,CDM,260,RC,96374,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,450,
OB IV PUSH ADD SEQ NEW DRU-SUB,761996375,CDM,260,RC,96375,HCPCS,outpatient,,,280,196,,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,216.22,77.22,,172.98,percent of total billed charges,77.22% of total billed charges,185.08,66.1,,148.06,percent of total billed charges,66.1% of total billed charges,232.4,83,,185.92,percent of total billed charges,83% of total,266,95,,212.8,percent of total billed charges ,95% of total billed charges,224,80,,179.2,percent of total billed charges,78% of total billed charges,218.4,78,,174.72,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
INTRAV PUSH SUBSEQU SAME DRUG,761996376,CDM,260,RC,96376,HCPCS,outpatient,,,274,191.8,,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,211.58,77.22,,169.26,percent of total billed charges,77.22% of total billed charges,181.11,66.1,,144.89,percent of total billed charges,66.1% of total billed charges,227.42,83,,181.94,percent of total billed charges,83% of total,260.3,95,,208.24,percent of total billed charges ,95% of total billed charges,219.2,80,,175.36,percent of total billed charges,78% of total billed charges,213.72,78,,170.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,172.62,450,
IV INFUSION INITIAL 31MIN-1 HR,762096360,CDM,260,RC,96360,HCPCS,outpatient,,,477,333.9,,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,368.34,77.22,,294.67,percent of total billed charges,77.22% of total billed charges,315.3,66.1,,252.24,percent of total billed charges,66.1% of total billed charges,395.91,83,,316.73,percent of total billed charges,83% of total,453.15,95,,362.52,percent of total billed charges ,95% of total billed charges,381.6,80,,305.28,percent of total billed charges,78% of total billed charges,372.06,78,,297.648,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,453.15,
OBS IV INFUSION EA ADD HOUR,762096361,CDM,260,RC,96361,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
OBS IV INFUSION UP TO 1 HR,762096365,CDM,260,RC,96365,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,628.9,
OBS IV INF THERAPY EA ADD HR,762096366,CDM,260,RC,96366,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
OBS IV INF SEQUENTIL UP TO 1HR,762096367,CDM,260,RC,96367,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.56,130,,,Fee Schedule,130% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,103.78,66.1,,83.02,percent of total billed charges,66.1% of total billed charges,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
OBS IV INF SUBQUENTIAL CONCURR,762096368,CDM,260,RC,96368,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
OBS IM OR SUBCUTANEOUS INJECT,762096372,CDM,260,RC,96372,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
"IV PUSH, SINGLE OR INTIAL",762096374,CDM,260,RC,96374,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,450,
OBS IV PUSH ADD SEQ NEW DRU/SU,762096375,CDM,260,RC,96375,HCPCS,outpatient,,,279,195.3,,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,215.44,77.22,,172.35,percent of total billed charges,77.22% of total billed charges,184.42,66.1,,147.54,percent of total billed charges,66.1% of total billed charges,231.57,83,,185.26,percent of total billed charges,83% of total,265.05,95,,212.04,percent of total billed charges ,95% of total billed charges,223.2,80,,178.56,percent of total billed charges,78% of total billed charges,217.62,78,,174.096,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
OBS IV INJ SUBSQ SA DRUG ADON,762096376,CDM,260,RC,96376,HCPCS,outpatient,,,274,191.8,,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,211.58,77.22,,169.26,percent of total billed charges,77.22% of total billed charges,181.11,66.1,,144.89,percent of total billed charges,66.1% of total billed charges,227.42,83,,181.94,percent of total billed charges,83% of total,260.3,95,,208.24,percent of total billed charges ,95% of total billed charges,219.2,80,,175.36,percent of total billed charges,78% of total billed charges,213.72,78,,170.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,172.62,450,
OBS INSULIN TREATMENT,7620G9147,CDM,260,RC,G9147,HCPCS,outpatient,,,662,463.4,,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,595.8,90,,476.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,511.2,77.22,,408.96,percent of total billed charges,77.22% of total billed charges,437.58,66.1,,350.06,percent of total billed charges,66.1% of total billed charges,549.46,83,,439.57,percent of total billed charges,83% of total,628.9,95,,503.12,percent of total billed charges ,95% of total billed charges,529.6,80,,423.68,percent of total billed charges,78% of total billed charges,516.36,78,,413.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,417.06,63,,333.65,percent of total billed charges,63% of total billed charges,562.7,85,,450.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,522.98,79,,418.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,417.06,628.9,
IV FLUIDS,96360,CDM,260,RC,96360,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,450,
HYDRATE IV INFUSION ADD-ON,96361,CDM,260,RC,96361,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,36.93,450,
INTRAVENOUS INFUSION,96365,CDM,260,RC,96365,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,450,
IM INJECTION THERAPEUTIC DIAG,96372,CDM,260,RC,96372,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,35.91,450,
DUBIN DEVICE DISPOSABLE,250050049,CDM,270,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
MALE WITH DRAINAGE ADAPTER,270000027,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
GPS USER KIT,270000079,CDM,270,RC,,,outpatient,,,900,630,,711,79,,568.8,percent of total billed charges,79% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,694.98,77.22,,555.98,percent of total billed charges,77.22% of total billed charges,594.9,66.1,,475.92,percent of total billed charges,66.1% of total billed charges,747,83,,597.6,percent of total billed charges,83% of total,855,95,,684,percent of total billed charges ,95% of total billed charges,720,80,,576,percent of total billed charges,78% of total billed charges,702,78,,561.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,567,63,,453.6,percent of total billed charges,63% of total billed charges,765,85,,612,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,711,79,,568.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,855,
AGT ORAL PERFORMED 4.5MM,270000300,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"ANKLE DETRACTOR, FOOT STRAP",270000341,CDM,270,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
GIA 80 STAPLER,270000387,CDM,270,RC,,,outpatient,,,753,527.1,,594.87,79,,475.9,percent of total billed charges,79% of total billed charges,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,474.39,63,,379.51,percent of total billed charges,63% of total billed charges,581.47,77.22,,465.18,percent of total billed charges,77.22% of total billed charges,497.73,66.1,,398.18,percent of total billed charges,66.1% of total billed charges,624.99,83,,499.99,percent of total billed charges,83% of total,715.35,95,,572.28,percent of total billed charges ,95% of total billed charges,602.4,80,,481.92,percent of total billed charges,78% of total billed charges,587.34,78,,469.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,474.39,63,,379.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,474.39,63,,379.51,percent of total billed charges,63% of total billed charges,640.05,85,,512.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,594.87,79,,475.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,715.35,
CARBIDE 1.5MM ROUND,270000531,CDM,270,RC,,,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,44.29,66.1,,35.43,percent of total billed charges,66.1% of total billed charges,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.21,450,
O2 HOURS,270000600,CDM,270,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
SAFETY DRAIN W/TUBING,270000684,CDM,270,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
905H SUTURE,270000815,CDM,270,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
GROSHONG 8FR CATH,270000866,CDM,270,RC,,,outpatient,,,914,639.8,,722.06,79,,577.65,percent of total billed charges,79% of total billed charges,822.6,90,,658.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,575.82,63,,460.66,percent of total billed charges,63% of total billed charges,705.79,77.22,,564.63,percent of total billed charges,77.22% of total billed charges,604.15,66.1,,483.32,percent of total billed charges,66.1% of total billed charges,758.62,83,,606.9,percent of total billed charges,83% of total,868.3,95,,694.64,percent of total billed charges ,95% of total billed charges,731.2,80,,584.96,percent of total billed charges,78% of total billed charges,712.92,78,,570.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,575.82,63,,460.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,822.6,90,,658.08,percent of total billed charges,90% of total billed charges,731.2,80,,584.96,percent of total billed charges,80% of total billed charges,575.82,63,,460.66,percent of total billed charges,63% of total billed charges,776.9,85,,621.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,722.06,79,,577.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,868.3,
MULTIFIRE GIA 80  3.8 REFILL,270000874,CDM,270,RC,,,outpatient,,,458,320.6,,361.82,79,,289.46,percent of total billed charges,79% of total billed charges,412.2,90,,329.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,353.67,77.22,,282.94,percent of total billed charges,77.22% of total billed charges,302.74,66.1,,242.19,percent of total billed charges,66.1% of total billed charges,380.14,83,,304.11,percent of total billed charges,83% of total,435.1,95,,348.08,percent of total billed charges ,95% of total billed charges,366.4,80,,293.12,percent of total billed charges,78% of total billed charges,357.24,78,,285.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,361.82,79,,289.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,288.54,450,
ALP GARMENT REG THIGH-DISPOSAB,270000908,CDM,270,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
SUCTION COAG 1 TIME DISP,270000914,CDM,270,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
CONTROL A FLOW SET,270000938,CDM,270,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
ADAPTER AIRLIFE T VALVE,270000955,CDM,270,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
"7MM FLAT SILICON DRAIN, FULL",270000971,CDM,270,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
10MM FLAT SILICON DRAIN,270000972,CDM,270,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
"ULTRA SLING, LARGE",270001139,CDM,270,RC,,,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,56.19,66.1,,44.95,percent of total billed charges,66.1% of total billed charges,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.55,450,
DISPOSABLE HEAD STRAP,270001170,CDM,270,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
BALLARD FLEX,270001188,CDM,270,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
TRACHEOSTOMY ADULT,270001233,CDM,270,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
ESMARK BANDAGE 4x12,270001282,CDM,270,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
BIOPSY KIT,270001903,CDM,270,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
ADAPTIC 3X3,270002000,CDM,270,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ADAPTIC 3X8,270002001,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
BANDAID SURGICAL 8X6,270002007,CDM,270,RC,,,outpatient,,,1,0.7,,0.79,79,,0.63,percent of total billed charges,79% of total billed charges,0.9,90,,0.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,0.77,77.22,,0.62,percent of total billed charges,77.22% of total billed charges,0.66,66.1,,0.53,percent of total billed charges,66.1% of total billed charges,0.83,83,,0.66,percent of total billed charges,83% of total,0.95,95,,0.76,percent of total billed charges ,95% of total billed charges,0.8,80,,0.64,percent of total billed charges,78% of total billed charges,0.78,78,,0.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,0.9,90,,0.72,percent of total billed charges,90% of total billed charges,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.63,63,,0.5,percent of total billed charges,63% of total billed charges,0.85,85,,0.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,0.79,79,,0.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.63,450,
BANDAID SURGICAL 4X6,270002008,CDM,270,RC,,,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
"DRAPE, IOBAN",270002010,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
"DRESSING, UNIFLEX SMALL",270002014,CDM,270,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
KERLIX ROLL,270002021,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
"KLING, 2""""",270002025,CDM,270,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"KLING, 3""""",270002026,CDM,270,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"KLING, 4""""",270002027,CDM,270,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
"KLING, 6""""",270002028,CDM,270,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
NU GAUZE 1 1/4 IN,270002029,CDM,270,RC,,,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.76,450,
NU GAUZE 1 1/2 IN,270002030,CDM,270,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
NU GAUZE 1 1 IN,270002031,CDM,270,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
NU GAUZE P 1/4 IN,270002032,CDM,270,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
STERI STRIP 1/4X3,270002038,CDM,270,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
STERI STRIP 1/4X4,270002039,CDM,270,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
ABD PAD,270002040,CDM,270,RC,,,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
"COBAN WRAP 2""""",270002070,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"COBAN WRAP 3""""",270002072,CDM,270,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
"PILLOW, LEG ABDUCTION SMALL",270002101,CDM,270,RC,,,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,207.72,77.22,,166.18,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,169.47,450,
"PILLOW, LEG ABDUCTION LARGE",270002103,CDM,270,RC,,,outpatient,,,245,171.5,,193.55,79,,154.84,percent of total billed charges,79% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.35,63,,123.48,percent of total billed charges,63% of total billed charges,189.19,77.22,,151.35,percent of total billed charges,77.22% of total billed charges,161.95,66.1,,129.56,percent of total billed charges,66.1% of total billed charges,203.35,83,,162.68,percent of total billed charges,83% of total,232.75,95,,186.2,percent of total billed charges ,95% of total billed charges,196,80,,156.8,percent of total billed charges,78% of total billed charges,191.1,78,,152.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,154.35,63,,123.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,154.35,63,,123.48,percent of total billed charges,63% of total billed charges,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,193.55,79,,154.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,154.35,450,
"PLASTER BANDAGE 3""""",270002111,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"PLASTER BANDAGE 4""""",270002112,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"PLASTER BANDAGE 6""""",270002113,CDM,270,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
"CAST PADDING 2""""",270002140,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"CAST PADDING 3""""",270002141,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"CAST PADDING 4""""",270002142,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"CAST PADDING 6""""",270002143,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"CAST TAPE 3""""",270002153,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"CAST TAPE 4""""",270002154,CDM,270,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
"CAST TAPE 5""""",270002155,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"COLLAR, PHILADELPHIA PEDIATRIC",270002164,CDM,270,RC,L0172,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
"SHOE, POST OP MALE SMALL",270002193,CDM,270,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
"SHOE, POST OP MALE MEDIUM",270002194,CDM,270,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
"SHOE, POST OP MALE LARGE",270002195,CDM,270,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
"SHOE, POST OP FEMALE SMALL",270002197,CDM,270,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
"SHOE, POST OP FEMALE MEDIUM",270002198,CDM,270,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
"SHOE, POST OP FEMALE LARGE",270002199,CDM,270,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"SLING, ARM MEDIUM",270002210,CDM,270,RC,A4565,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.36,450,
"SKIN TRAC, SMALL",270002216,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"SKIN TRAC, LARGE",270002218,CDM,270,RC,,,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
"STOCKINETTE, SYNTHETIC 3""""",270002234,CDM,270,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
"RESTRAINT, WRIST/ANKLE",270002245,CDM,270,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
"ELASTIC BANDAGE 2""""",270002260,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
"ELASTIC BANDAGE 3""""",270002261,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
"ELASTIC BANDAGE 4""""",270002262,CDM,270,RC,,,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,25.78,66.1,,20.62,percent of total billed charges,66.1% of total billed charges,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.57,450,
"ELASTIC BANDAGE 6""""",270002263,CDM,270,RC,,,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,25.78,66.1,,20.62,percent of total billed charges,66.1% of total billed charges,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.57,450,
BINDER ABDOMINAL UNIVERSAL,270002287,CDM,270,RC,,,outpatient,,,161,112.7,,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,124.32,77.22,,99.46,percent of total billed charges,77.22% of total billed charges,106.42,66.1,,85.14,percent of total billed charges,66.1% of total billed charges,133.63,83,,106.9,percent of total billed charges,83% of total,152.95,95,,122.36,percent of total billed charges ,95% of total billed charges,128.8,80,,103.04,percent of total billed charges,78% of total billed charges,125.58,78,,100.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.43,450,
SPLINT TIBIA/FIBULA 12IN,270002290,CDM,270,RC,L2999,HCPCS,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,166.57,66.1,,133.26,percent of total billed charges,66.1% of total billed charges,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.76,450,
"TIBIA/FIBULA SPLINT, 14""""",270002291,CDM,270,RC,,,outpatient,,,299,209.3,,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,230.89,77.22,,184.71,percent of total billed charges,77.22% of total billed charges,197.64,66.1,,158.11,percent of total billed charges,66.1% of total billed charges,248.17,83,,198.54,percent of total billed charges,83% of total,284.05,95,,227.24,percent of total billed charges ,95% of total billed charges,239.2,80,,191.36,percent of total billed charges,78% of total billed charges,233.22,78,,186.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,188.37,450,
"TIBIA/FIBULA SPLINT 16""""",270002292,CDM,270,RC,,,outpatient,,,231,161.7,,182.49,79,,145.99,percent of total billed charges,79% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,178.38,77.22,,142.7,percent of total billed charges,77.22% of total billed charges,152.69,66.1,,122.15,percent of total billed charges,66.1% of total billed charges,191.73,83,,153.38,percent of total billed charges,83% of total,219.45,95,,175.56,percent of total billed charges ,95% of total billed charges,184.8,80,,147.84,percent of total billed charges,78% of total billed charges,180.18,78,,144.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,182.49,79,,145.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,145.53,450,
"CATHETER, FOLEY 22FR 30CC CONT",270002313,CDM,270,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
"CATHETER, ROBINSON 8FR",270002319,CDM,270,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"CATHETER, ROBINSON 18FR",270002322,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"CATHETER, THORACIC 20GA",270002335,CDM,270,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
"THORACIC CATHETER, 24 FR",270002339,CDM,270,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
"THORACIC CATHETER, 16 FR",270002341,CDM,270,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
CATHETER ADAPTOR,270002448,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
"ADAPTOR, MALE PLUG",270002450,CDM,270,RC,,,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
"CONNECTOR,5 IN 1",270002463,CDM,270,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
"SUPPORT, IV ANTECUBITAL",270002468,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
"SUPPORT, IV INFANT/CHILD",270002470,CDM,270,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
"SUPPORT, IV NEONATAL",270002472,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"SUPPORT,WRIST HAND-AIDM ADULT",270002474,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
"SUPPORT, WRIST HAND-AID, PED",270002476,CDM,270,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
"IMPERVIOUS STOCKINETTE, MEDIUM",270002504,CDM,270,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
"IMPERVIOUS STOCKINETTE, LARGE",270002505,CDM,270,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
HALF SHEET,270002508,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
PEDIATRIC T SHEET,270002509,CDM,270,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
BACK TABLECOVER,270002510,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
VERTICAL ISOLATION DRAPE,270002512,CDM,270,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
"PACK, ORTHO/MINOR",270002518,CDM,270,RC,,,outpatient,,,247,172.9,,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,190.73,77.22,,152.58,percent of total billed charges,77.22% of total billed charges,163.27,66.1,,130.62,percent of total billed charges,66.1% of total billed charges,205.01,83,,164.01,percent of total billed charges,83% of total,234.65,95,,187.72,percent of total billed charges ,95% of total billed charges,197.6,80,,158.08,percent of total billed charges,78% of total billed charges,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.61,450,
"PACK, LAPAROSCOPY II",270002519,CDM,270,RC,,,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,104.44,66.1,,83.55,percent of total billed charges,66.1% of total billed charges,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.54,450,
"PACK, MAJOR BASIN SET",270002525,CDM,270,RC,,,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,166.57,66.1,,133.26,percent of total billed charges,66.1% of total billed charges,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.76,450,
"KIT, VACUUM DELIVERY",270002526,CDM,270,RC,,,outpatient,,,221,154.7,,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,170.66,77.22,,136.53,percent of total billed charges,77.22% of total billed charges,146.08,66.1,,116.86,percent of total billed charges,66.1% of total billed charges,183.43,83,,146.74,percent of total billed charges,83% of total,209.95,95,,167.96,percent of total billed charges ,95% of total billed charges,176.8,80,,141.44,percent of total billed charges,78% of total billed charges,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.23,450,
"PACK, ORTHO SHOULDER",270002527,CDM,270,RC,,,outpatient,,,672,470.4,,530.88,79,,424.7,percent of total billed charges,79% of total billed charges,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,518.92,77.22,,415.14,percent of total billed charges,77.22% of total billed charges,444.19,66.1,,355.35,percent of total billed charges,66.1% of total billed charges,557.76,83,,446.21,percent of total billed charges,83% of total,638.4,95,,510.72,percent of total billed charges ,95% of total billed charges,537.6,80,,430.08,percent of total billed charges,78% of total billed charges,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,530.88,79,,424.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,423.36,638.4,
SKIN STAPLE REMOVER,270002532,CDM,270,RC,,,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,65.44,66.1,,52.35,percent of total billed charges,66.1% of total billed charges,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.37,450,
"SKIN STAPLER, 35W",270002535,CDM,270,RC,,,outpatient,,,490,343,,387.1,79,,309.68,percent of total billed charges,79% of total billed charges,441,90,,352.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.7,63,,246.96,percent of total billed charges,63% of total billed charges,378.38,77.22,,302.7,percent of total billed charges,77.22% of total billed charges,323.89,66.1,,259.11,percent of total billed charges,66.1% of total billed charges,406.7,83,,325.36,percent of total billed charges,83% of total,465.5,95,,372.4,percent of total billed charges ,95% of total billed charges,392,80,,313.6,percent of total billed charges,78% of total billed charges,382.2,78,,305.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,308.7,63,,246.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,308.7,63,,246.96,percent of total billed charges,63% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,387.1,79,,309.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,308.7,465.5,
"ELECTRODE PAD, PEDIATRIC",270002545,CDM,270,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
"ELECTRODE PAD, ADULT",270002546,CDM,270,RC,,,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
HANDSWITCHING PENCIL,270002547,CDM,270,RC,,,outpatient,,,213,149.1,,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,164.48,77.22,,131.58,percent of total billed charges,77.22% of total billed charges,140.79,66.1,,112.63,percent of total billed charges,66.1% of total billed charges,176.79,83,,141.43,percent of total billed charges,83% of total,202.35,95,,161.88,percent of total billed charges ,95% of total billed charges,170.4,80,,136.32,percent of total billed charges,78% of total billed charges,166.14,78,,132.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.19,450,
"ELECTRODE, DISPOSABLE EXTENDED",270002548,CDM,270,RC,,,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,74.69,66.1,,59.75,percent of total billed charges,66.1% of total billed charges,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.19,450,
INSTRA-MAG DRAPE,270002561,CDM,270,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
BREATHING CIRCUIT,270002595,CDM,270,RC,,,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,68.74,66.1,,54.99,percent of total billed charges,66.1% of total billed charges,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.52,450,
"MASK, SMALL ADULT DISP",270002596,CDM,270,RC,,,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
"MASK, LARGE ADULT DISP",270002597,CDM,270,RC,,,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.71,450,
LAP SPONGE 17X26,270002600,CDM,270,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
INFANT PREMIUM MASK DISP,270002601,CDM,270,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
LAP SPONGE 4X18,270002602,CDM,270,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
"SCRUB TRAY, WET SKIN",270002605,CDM,270,RC,,,outpatient,,,144,100.8,,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,111.2,77.22,,88.96,percent of total billed charges,77.22% of total billed charges,95.18,66.1,,76.14,percent of total billed charges,66.1% of total billed charges,119.52,83,,95.62,percent of total billed charges,83% of total,136.8,95,,109.44,percent of total billed charges ,95% of total billed charges,115.2,80,,92.16,percent of total billed charges,78% of total billed charges,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.72,450,
BURN DRESSING,270002612,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
TIP POLISHER,270002616,CDM,270,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
MAYO STAND COVER,270002618,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
VIAL DECANTER,270002620,CDM,270,RC,,,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
PEANUT SPONGE,270002621,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
SKIN MARKER,270002624,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
BULB SYRINGE,270002628,CDM,270,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
SUCTION CANNISTER,270002665,CDM,270,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
UVAC SWIVEL HANDLEW/TUBING,270002670,CDM,270,RC,,,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,166.57,66.1,,133.26,percent of total billed charges,66.1% of total billed charges,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.76,450,
PRESSURE DRESSING,270002681,CDM,270,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
SECONDRY TROCAR SLEEVE,270002687,CDM,270,RC,,,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,48.91,66.1,,39.13,percent of total billed charges,66.1% of total billed charges,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.62,450,
"SUPPLEMENT, ADULT (ENSURE CHOC",270002702,CDM,270,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
BREAST PUMP DISPOSABLE,270002918,CDM,270,RC,,,outpatient,,,249,174.3,,196.71,79,,157.37,percent of total billed charges,79% of total billed charges,224.1,90,,179.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.87,63,,125.5,percent of total billed charges,63% of total billed charges,192.28,77.22,,153.82,percent of total billed charges,77.22% of total billed charges,164.59,66.1,,131.67,percent of total billed charges,66.1% of total billed charges,206.67,83,,165.34,percent of total billed charges,83% of total,236.55,95,,189.24,percent of total billed charges ,95% of total billed charges,199.2,80,,159.36,percent of total billed charges,78% of total billed charges,194.22,78,,155.376,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,156.87,63,,125.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,224.1,90,,179.28,percent of total billed charges,90% of total billed charges,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,156.87,63,,125.5,percent of total billed charges,63% of total billed charges,211.65,85,,169.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,196.71,79,,157.37,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,156.87,450,
SITZ BATH,270002920,CDM,270,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
CORD CLAMP,270002975,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"SUCTION TIP, YANKAUER",270003038,CDM,270,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
SUCTION TUBING,270003040,CDM,270,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
"TUBE, FEEDING 8FR",270003094,CDM,270,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
EAR SYRINGE,270003116,CDM,270,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
ENEMA KIT,270003126,CDM,270,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
MUCOUS TRAP,270003130,CDM,270,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
FLATUS BAG,270003132,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"SUSPENSORY, MEDIUM",270003136,CDM,270,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
"SUSPENSORY, X-LARGE",270003138,CDM,270,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
"ELECTRODE, RED DOT DISP",270003145,CDM,270,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
"MALE LOCK, DOUBLE",270003150,CDM,270,RC,,,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
LUMBAR PUNCTURE,270003178,CDM,270,RC,,,outpatient,,,144,100.8,,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,111.2,77.22,,88.96,percent of total billed charges,77.22% of total billed charges,95.18,66.1,,76.14,percent of total billed charges,66.1% of total billed charges,119.52,83,,95.62,percent of total billed charges,83% of total,136.8,95,,109.44,percent of total billed charges ,95% of total billed charges,115.2,80,,92.16,percent of total billed charges,78% of total billed charges,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.72,450,
LUMBAR PUNCTURE,270003180,CDM,270,RC,,,outpatient,,,200,140,,158,79,,126.4,percent of total billed charges,79% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,63,,100.8,percent of total billed charges,63% of total billed charges,154.44,77.22,,123.55,percent of total billed charges,77.22% of total billed charges,132.2,66.1,,105.76,percent of total billed charges,66.1% of total billed charges,166,83,,132.8,percent of total billed charges,83% of total,190,95,,152,percent of total billed charges ,95% of total billed charges,160,80,,128,percent of total billed charges,78% of total billed charges,156,78,,124.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,126,63,,100.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,126,63,,100.8,percent of total billed charges,63% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,158,79,,126.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126,450,
URINEMETER BAG,270003188,CDM,270,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
URINE STRAINER,270003190,CDM,270,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
BETADINE PREP SOLUTION 2 OZ,270003210,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
OSTOMY CLAMP,270003230,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ANTI REFLUX VAVLE,270003266,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
GASTRIC LAVAGE TRAY,270003335,CDM,270,RC,,,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,58.17,66.1,,46.54,percent of total billed charges,66.1% of total billed charges,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,55.44,63,,44.35,percent of total billed charges,63% of total billed charges,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55.44,450,
"CATHETER, MALECOT 26 FR",270003412,CDM,270,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
NASAL AIRWAY 6.0 MM,270003541,CDM,270,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
NASAL AIRWAY 7.0,270003542,CDM,270,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
NASAL AIRWAY 8.3,270003543,CDM,270,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
HUMIDIFIER,270004300,CDM,270,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
CONCHA PAK W/ COLUMNS,270004304,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
OXYGEN TUBING,270004305,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
VENTURI MASK DISP,270004306,CDM,270,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
AEROSOL TUBING,270004310,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
FACE TENT DISP,270004312,CDM,270,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
NEBULIZER,270004315,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
INCENTIVE SPIROMETER,270004320,CDM,270,RC,A9284,HCPCS,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,34.37,66.1,,27.5,percent of total billed charges,66.1% of total billed charges,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.76,450,
WATER TRAP DISP,270004326,CDM,270,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
EKG ELECTRODE - RT DISP,270004330,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
CROUP TENT DISP,270004344,CDM,270,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
AEROSOL T ADAPTOR,270004348,CDM,270,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
ADULT NON-REBREATH MASK DISP,270004352,CDM,270,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
PEDIATRIC OXYGEN MASK DISP,270004354,CDM,270,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
EASY RESUSCITATION BAG,270004364,CDM,270,RC,,,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,28.42,66.1,,22.74,percent of total billed charges,66.1% of total billed charges,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.09,450,
ADULT OXIMETER PROBE,270004367,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
INFANT OXIMETER PROBE,270004368,CDM,270,RC,,,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,28.42,66.1,,22.74,percent of total billed charges,66.1% of total billed charges,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.09,450,
PEAK FLOW METER INITIAL ADULT,270004372,CDM,270,RC,A4614,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
NASAL MASK/CIRCUIT,270004378,CDM,270,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
CO2 MONITOR,270004379,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
PULSA VAC INTRAMEDULLARY TIP,270005004,CDM,270,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
OMED VESSEL LOOP,270005040,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
"SNYDER HEMOVAC 400 ML 1/8""""",270005085,CDM,270,RC,,,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,111.05,66.1,,88.84,percent of total billed charges,66.1% of total billed charges,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.84,450,
SNYDER HEMOVAC 400,270005086,CDM,270,RC,,,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,111.05,66.1,,88.84,percent of total billed charges,66.1% of total billed charges,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.84,450,
MINI SNYDER HEMOVAC,270005088,CDM,270,RC,,,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.85,450,
MINI SNYDER HEMOVAC,270005111,CDM,270,RC,,,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
BILLARY BALLOON PROBE 5 FR,270005123,CDM,270,RC,,,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.88,63,,88.7,percent of total billed charges,63% of total billed charges,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,116.34,66.1,,93.07,percent of total billed charges,66.1% of total billed charges,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,110.88,63,,88.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,110.88,63,,88.7,percent of total billed charges,63% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,110.88,450,
BAG DECANTER,270005125,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
FLOURO COVER - C ARM COVER,270005217,CDM,270,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
XEROFORM DRESSING 1 X 8,270005221,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
XEROFORM DRESSING 5 X 9,270005223,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
"CLIP,TROCAR",270005506,CDM,270,RC,,,outpatient,,,1143,800.1,,902.97,79,,722.38,percent of total billed charges,79% of total billed charges,1028.7,90,,822.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,720.09,63,,576.07,percent of total billed charges,63% of total billed charges,882.62,77.22,,706.1,percent of total billed charges,77.22% of total billed charges,755.52,66.1,,604.42,percent of total billed charges,66.1% of total billed charges,948.69,83,,758.95,percent of total billed charges,83% of total,1085.85,95,,868.68,percent of total billed charges ,95% of total billed charges,914.4,80,,731.52,percent of total billed charges,78% of total billed charges,891.54,78,,713.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,720.09,63,,576.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,720.09,63,,576.07,percent of total billed charges,63% of total billed charges,971.55,85,,777.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,902.97,79,,722.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1085.85,
NON-BILLABLE CHARGE SUPPLY,270005555,CDM,270,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
3/4 SHEET,270005816,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
INTRAMEDULLARY BRUSH TIP,270005823,CDM,270,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
"SHIELD CANNULA, 7 CM X 5.5 MM",270005824,CDM,270,RC,,,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.94,450,
HOLTER HOOK UP KIT,270006530,CDM,270,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
SURGICAL SPEARS,270007531,CDM,270,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
SUTURE 884H,270013844,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
SUTURE 923H,270013923,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
SUTURE 8556H,270014246,CDM,270,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
SUTURE 3113-81,270014434,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
1M8522 SYRINGE PUMP SET FILTER,270016165,CDM,270,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
3559-01 PCA ADM SET,270017503,CDM,270,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
1C8130 EXT SET,270017513,CDM,270,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
2C5671 .22MIC FILTER,270017514,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
2C5681 PED T SET,270017517,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
ACE BANDAGE 6' x2,270022632,CDM,270,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
MISC SUPPLY,270025068,CDM,270,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LABOR SUPPLIES,270025083,CDM,270,RC,,,outpatient,,,265,185.5,,209.35,79,,167.48,percent of total billed charges,79% of total billed charges,238.5,90,,190.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,204.63,77.22,,163.7,percent of total billed charges,77.22% of total billed charges,175.17,66.1,,140.14,percent of total billed charges,66.1% of total billed charges,219.95,83,,175.96,percent of total billed charges,83% of total,251.75,95,,201.4,percent of total billed charges ,95% of total billed charges,212,80,,169.6,percent of total billed charges,78% of total billed charges,206.7,78,,165.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,238.5,90,,190.8,percent of total billed charges,90% of total billed charges,212,80,,169.6,percent of total billed charges,80% of total billed charges,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,225.25,85,,180.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,209.35,79,,167.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,166.95,450,
DRESSING  SMALL,270025800,CDM,270,RC,,,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
DRESSING MEDIUM,270025801,CDM,270,RC,,,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
DRESSING  LARGE,270025802,CDM,270,RC,,,outpatient,,,93,65.1,,73.47,79,,58.78,percent of total billed charges,79% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.59,63,,46.87,percent of total billed charges,63% of total billed charges,71.81,77.22,,57.45,percent of total billed charges,77.22% of total billed charges,61.47,66.1,,49.18,percent of total billed charges,66.1% of total billed charges,77.19,83,,61.75,percent of total billed charges,83% of total,88.35,95,,70.68,percent of total billed charges ,95% of total billed charges,74.4,80,,59.52,percent of total billed charges,78% of total billed charges,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,58.59,63,,46.87,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,58.59,63,,46.87,percent of total billed charges,63% of total billed charges,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,73.47,79,,58.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58.59,450,
BARIUM ENEMA EXAM KIT,270050008,CDM,270,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
SMALL BOWEL EXAM KIT,270050020,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
NUC MED AEROSOL KIT,270050048,CDM,270,RC,,,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.56,450,
SNYDER HEMOVAC 400,27005086,CDM,270,RC,,,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,111.05,66.1,,88.84,percent of total billed charges,66.1% of total billed charges,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.84,450,
INFANT OXIMETER PROBE,270075170,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
ADULT PROBE,270075171,CDM,270,RC,,,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
SAFETY DRAIN WITHOUT TUBING,270075817,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
RENAISSA SPIROMETRY SENSY DIS,270075899,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
ENDOTRACH TUBE HOLDER ADULT,270076000,CDM,270,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
OXYGEN MASK,270076573,CDM,270,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
MASK AEROSOL PED,270076602,CDM,270,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
HAWKINS III HDWR BLN 20GX10CM,270077405,CDM,270,RC,,,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.3,450,
DISPOSABLE CAUTERY,270077901,CDM,270,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
NASAL PACKING-400402,270078266,CDM,270,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
NG STRIP,270078885,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
MIC GASTROSTOMY TUBE 24 FR,270079598,CDM,270,RC,B4087,HCPCS,outpatient,,,136,95.2,,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,105.02,77.22,,84.02,percent of total billed charges,77.22% of total billed charges,89.9,66.1,,71.92,percent of total billed charges,66.1% of total billed charges,112.88,83,,90.3,percent of total billed charges,83% of total,129.2,95,,103.36,percent of total billed charges ,95% of total billed charges,108.8,80,,87.04,percent of total billed charges,78% of total billed charges,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,85.68,450,
ESMARK BANDAGE,270079675,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
VENT KIT,270079913,CDM,270,RC,,,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,65.44,66.1,,52.35,percent of total billed charges,66.1% of total billed charges,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.37,450,
O2 CHARGE RECOVERY ROOM,270079914,CDM,270,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
"CARSON FOLEY CATHETER, 16 FR",270090190,CDM,270,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
3 x 4 INTERCEED SHEET,270090222,CDM,270,RC,,,outpatient,,,1272,890.4,,1004.88,79,,803.9,percent of total billed charges,79% of total billed charges,1144.8,90,,915.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,801.36,63,,641.09,percent of total billed charges,63% of total billed charges,982.24,77.22,,785.79,percent of total billed charges,77.22% of total billed charges,840.79,66.1,,672.63,percent of total billed charges,66.1% of total billed charges,1055.76,83,,844.61,percent of total billed charges,83% of total,1208.4,95,,966.72,percent of total billed charges ,95% of total billed charges,1017.6,80,,814.08,percent of total billed charges,78% of total billed charges,992.16,78,,793.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,801.36,63,,641.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,801.36,63,,641.09,percent of total billed charges,63% of total billed charges,1081.2,85,,864.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1004.88,79,,803.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1208.4,
MENISCECTO ELECTRODE KIT DISP,270090306,CDM,270,RC,,,outpatient,,,204,142.8,,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.52,63,,102.82,percent of total billed charges,63% of total billed charges,157.53,77.22,,126.02,percent of total billed charges,77.22% of total billed charges,134.84,66.1,,107.87,percent of total billed charges,66.1% of total billed charges,169.32,83,,135.46,percent of total billed charges,83% of total,193.8,95,,155.04,percent of total billed charges ,95% of total billed charges,163.2,80,,130.56,percent of total billed charges,78% of total billed charges,159.12,78,,127.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,128.52,63,,102.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,128.52,63,,102.82,percent of total billed charges,63% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128.52,450,
POLAR PAD DISP,270090309,CDM,270,RC,,,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,113.69,66.1,,90.95,percent of total billed charges,66.1% of total billed charges,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.36,450,
CRYOTHERAPY - OR,270090369,CDM,270,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
SURGIFLUSH FILTER,270090903,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
OMNI JUG,270090932,CDM,270,RC,,,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,142.12,66.1,,113.7,percent of total billed charges,66.1% of total billed charges,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,135.45,450,
AGGRESSIVE TOOTH BLADE,270090965,CDM,270,RC,,,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
TUBE SET,270090970,CDM,270,RC,,,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,142.12,66.1,,113.7,percent of total billed charges,66.1% of total billed charges,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,135.45,450,
SPLIT SHEET,270100100,CDM,270,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
20 FR HEMATURIA 3-WAY CATHETER,270200294,CDM,270,RC,,,outpatient,,,433,303.1,,342.07,79,,273.66,percent of total billed charges,79% of total billed charges,389.7,90,,311.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.79,63,,218.23,percent of total billed charges,63% of total billed charges,334.36,77.22,,267.49,percent of total billed charges,77.22% of total billed charges,286.21,66.1,,228.97,percent of total billed charges,66.1% of total billed charges,359.39,83,,287.51,percent of total billed charges,83% of total,411.35,95,,329.08,percent of total billed charges ,95% of total billed charges,346.4,80,,277.12,percent of total billed charges,78% of total billed charges,337.74,78,,270.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,272.79,63,,218.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,272.79,63,,218.23,percent of total billed charges,63% of total billed charges,368.05,85,,294.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,342.07,79,,273.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,272.79,450,
SUTURE 636G,270200314,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ETHICON ENDO TROCAR 12 MM DISP,270200343,CDM,270,RC,,,outpatient,,,277,193.9,,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,213.9,77.22,,171.12,percent of total billed charges,77.22% of total billed charges,183.1,66.1,,146.48,percent of total billed charges,66.1% of total billed charges,229.91,83,,183.93,percent of total billed charges,83% of total,263.15,95,,210.52,percent of total billed charges ,95% of total billed charges,221.6,80,,177.28,percent of total billed charges,78% of total billed charges,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.51,450,
4000CC URINARY DRAINAGE BAG,270200503,CDM,270,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
3.0 ROUND MED BURR,270200605,CDM,270,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
AIRE 1000 AD RECOVERY BLANKET,270200767,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
DISPOSABLE SUCTION IRRIGATION,270200829,CDM,270,RC,,,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,171.86,66.1,,137.49,percent of total billed charges,66.1% of total billed charges,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.8,450,
SUTURE 2.0 MONOCRYL,270200998,CDM,270,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
DERMABOND LIQUIBAND FLEX,270201037,CDM,270,RC,,,outpatient,,,155,108.5,,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,119.69,77.22,,95.75,percent of total billed charges,77.22% of total billed charges,102.46,66.1,,81.97,percent of total billed charges,66.1% of total billed charges,128.65,83,,102.92,percent of total billed charges,83% of total,147.25,95,,117.8,percent of total billed charges ,95% of total billed charges,124,80,,99.2,percent of total billed charges,78% of total billed charges,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.65,450,
WOUND DRAINAGE,270201070,CDM,270,RC,,,outpatient,,,222,155.4,,175.38,79,,140.3,percent of total billed charges,79% of total billed charges,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.86,63,,111.89,percent of total billed charges,63% of total billed charges,171.43,77.22,,137.14,percent of total billed charges,77.22% of total billed charges,146.74,66.1,,117.39,percent of total billed charges,66.1% of total billed charges,184.26,83,,147.41,percent of total billed charges,83% of total,210.9,95,,168.72,percent of total billed charges ,95% of total billed charges,177.6,80,,142.08,percent of total billed charges,78% of total billed charges,173.16,78,,138.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,139.86,63,,111.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,139.86,63,,111.89,percent of total billed charges,63% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,175.38,79,,140.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.86,450,
WECK CEL SPEARS,270201076,CDM,270,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
BODY COVER,270201082,CDM,270,RC,,,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
ENT PACK II,270201092,CDM,270,RC,,,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,87.25,66.1,,69.8,percent of total billed charges,66.1% of total billed charges,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.16,450,
LMA MASK-SIZE 4,270201133,CDM,270,RC,,,outpatient,,,699,489.3,,552.21,79,,441.77,percent of total billed charges,79% of total billed charges,629.1,90,,503.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440.37,63,,352.3,percent of total billed charges,63% of total billed charges,539.77,77.22,,431.82,percent of total billed charges,77.22% of total billed charges,462.04,66.1,,369.63,percent of total billed charges,66.1% of total billed charges,580.17,83,,464.14,percent of total billed charges,83% of total,664.05,95,,531.24,percent of total billed charges ,95% of total billed charges,559.2,80,,447.36,percent of total billed charges,78% of total billed charges,545.22,78,,436.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,440.37,63,,352.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,440.37,63,,352.3,percent of total billed charges,63% of total billed charges,594.15,85,,475.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,552.21,79,,441.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,440.37,664.05,
SYNDER HEMOVAC WOUND DRAIN 10M,270201149,CDM,270,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
ADAPTER,270201174,CDM,270,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
MIXING BOWL ONLY,270201195,CDM,270,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SUCTION IRRIGATION,270201228,CDM,270,RC,,,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,157.32,66.1,,125.86,percent of total billed charges,66.1% of total billed charges,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,149.94,450,
CT MEDRAD SYRINGE POWER INJ,270202308,CDM,270,RC,,,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.47,450,
MYRIOGTOMY TUBE,270202750,CDM,270,RC,,,outpatient,,,79,55.3,,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,61,77.22,,48.8,percent of total billed charges,77.22% of total billed charges,52.22,66.1,,41.78,percent of total billed charges,66.1% of total billed charges,65.57,83,,52.46,percent of total billed charges,83% of total,75.05,95,,60.04,percent of total billed charges ,95% of total billed charges,63.2,80,,50.56,percent of total billed charges,78% of total billed charges,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.77,450,
MICRO SAGITAL BLADE,270202927,CDM,270,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
"MASK, CHILD",270202962,CDM,270,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
FOGARTY BILLARY BALLOON PROBE,270202979,CDM,270,RC,,,outpatient,,,201,140.7,,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,155.21,77.22,,124.17,percent of total billed charges,77.22% of total billed charges,132.86,66.1,,106.29,percent of total billed charges,66.1% of total billed charges,166.83,83,,133.46,percent of total billed charges,83% of total,190.95,95,,152.76,percent of total billed charges ,95% of total billed charges,160.8,80,,128.64,percent of total billed charges,78% of total billed charges,156.78,78,,125.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126.63,450,
"CATHETER, CATTELL 8 FR",270202993,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
BALLARD TRACH CARE,270203210,CDM,270,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
ALLEVYN ADHESIVE DRESS 5X5,270203272,CDM,270,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
OPSITE POST-OP COMPOSITE DRSG,270203414,CDM,270,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
8444H-SUTURE,270203442,CDM,270,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
COUDE CATHETER 22 FR,270203865,CDM,270,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
COUDE CATHETER 24FR,270203866,CDM,270,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
TA 90 B SINGLE LOADING UNIT,270204105,CDM,270,RC,,,outpatient,,,843,590.1,,665.97,79,,532.78,percent of total billed charges,79% of total billed charges,758.7,90,,606.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,531.09,63,,424.87,percent of total billed charges,63% of total billed charges,650.96,77.22,,520.77,percent of total billed charges,77.22% of total billed charges,557.22,66.1,,445.78,percent of total billed charges,66.1% of total billed charges,699.69,83,,559.75,percent of total billed charges,83% of total,800.85,95,,640.68,percent of total billed charges ,95% of total billed charges,674.4,80,,539.52,percent of total billed charges,78% of total billed charges,657.54,78,,526.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,531.09,63,,424.87,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,531.09,63,,424.87,percent of total billed charges,63% of total billed charges,716.55,85,,573.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,665.97,79,,532.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,800.85,
TONSIL BOVIE TIP,270204159,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
SHILEY PED.TRACH TUBE 5.0 PED,270204329,CDM,270,RC,,,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,145.95,77.22,,116.76,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.07,450,
ADAPTER MDI 22MM x 22MM,270205064,CDM,270,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
"CATHETER,FOLEY 26FR 3-WAY",270205086,CDM,270,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
"CATHETER,FOLEY 24FR 3-WAY",270205087,CDM,270,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
DISPOSABLE VARICES INJECTOR,270205118,CDM,270,RC,,,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,99.81,66.1,,79.85,percent of total billed charges,66.1% of total billed charges,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.13,63,,76.1,percent of total billed charges,63% of total billed charges,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.13,450,
MASK ELONAGATED PED,270205136,CDM,270,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
ESOPHAGEAL BALLOON QD-14X8,270205179,CDM,270,RC,,,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,233.33,66.1,,186.66,percent of total billed charges,66.1% of total billed charges,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,222.39,450,
PEZZER 34FR CATHETER,270205222,CDM,270,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
ESOPHOGEAL BALLOON DILAT. 16X8,270205236,CDM,270,RC,,,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,233.33,66.1,,186.66,percent of total billed charges,66.1% of total billed charges,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,222.39,450,
QDP QUANTUM DILATOR 10x5.5,270205257,CDM,270,RC,,,outpatient,,,274,191.8,,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,211.58,77.22,,169.26,percent of total billed charges,77.22% of total billed charges,181.11,66.1,,144.89,percent of total billed charges,66.1% of total billed charges,227.42,83,,181.94,percent of total billed charges,83% of total,260.3,95,,208.24,percent of total billed charges ,95% of total billed charges,219.2,80,,175.36,percent of total billed charges,78% of total billed charges,213.72,78,,170.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,172.62,450,
LEEP LOOP 10MM X 10MM 300-118,270205597,CDM,270,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
LEEP LOOP 10MM X 10MM 300-117,270205599,CDM,270,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
LEEP LOOP 20X15MM 300-127 DISP,270205601,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
IOBAN 2 DRAPE 13X13,270205682,CDM,270,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
CX46D SUTURE,270206054,CDM,270,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
PEG KIT-SAFETY PULL 24 FR,270206257,CDM,270,RC,,,outpatient,,,426,298.2,,336.54,79,,269.23,percent of total billed charges,79% of total billed charges,383.4,90,,306.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.38,63,,214.7,percent of total billed charges,63% of total billed charges,328.96,77.22,,263.17,percent of total billed charges,77.22% of total billed charges,281.59,66.1,,225.27,percent of total billed charges,66.1% of total billed charges,353.58,83,,282.86,percent of total billed charges,83% of total,404.7,95,,323.76,percent of total billed charges ,95% of total billed charges,340.8,80,,272.64,percent of total billed charges,78% of total billed charges,332.28,78,,265.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,268.38,63,,214.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,383.4,90,,306.72,percent of total billed charges,90% of total billed charges,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,268.38,63,,214.7,percent of total billed charges,63% of total billed charges,362.1,85,,289.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,336.54,79,,269.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,268.38,450,
MALECOT 24 FR CATHETER,270206323,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
3.5 MM RAZOR CUT BLADE,270206472,CDM,270,RC,,,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,143.44,66.1,,114.75,percent of total billed charges,66.1% of total billed charges,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.71,450,
INSUFFLATION TUBING (S&N),270206491,CDM,270,RC,,,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,76.68,66.1,,61.34,percent of total billed charges,66.1% of total billed charges,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.08,450,
OSTOMY WAFER-SUREFIT 4X4,270206770,CDM,270,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
TONSIL SPONGE,270206983,CDM,270,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
KRONNER MANIPUJECTOR,270206989,CDM,270,RC,,,outpatient,,,222,155.4,,175.38,79,,140.3,percent of total billed charges,79% of total billed charges,199.8,90,,159.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.86,63,,111.89,percent of total billed charges,63% of total billed charges,171.43,77.22,,137.14,percent of total billed charges,77.22% of total billed charges,146.74,66.1,,117.39,percent of total billed charges,66.1% of total billed charges,184.26,83,,147.41,percent of total billed charges,83% of total,210.9,95,,168.72,percent of total billed charges ,95% of total billed charges,177.6,80,,142.08,percent of total billed charges,78% of total billed charges,173.16,78,,138.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,139.86,63,,111.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,139.86,63,,111.89,percent of total billed charges,63% of total billed charges,188.7,85,,150.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,175.38,79,,140.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.86,450,
GASTROSTOMY TUBE 22FR,270207455,CDM,270,RC,,,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
T4 HOOD,270207598,CDM,270,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
MALECOT 24 FR CATHETER,270207730,CDM,270,RC,,,outpatient,,,494,345.8,,390.26,79,,312.21,percent of total billed charges,79% of total billed charges,444.6,90,,355.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,311.22,63,,248.98,percent of total billed charges,63% of total billed charges,381.47,77.22,,305.18,percent of total billed charges,77.22% of total billed charges,326.53,66.1,,261.22,percent of total billed charges,66.1% of total billed charges,410.02,83,,328.02,percent of total billed charges,83% of total,469.3,95,,375.44,percent of total billed charges ,95% of total billed charges,395.2,80,,316.16,percent of total billed charges,78% of total billed charges,385.32,78,,308.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,311.22,63,,248.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,311.22,63,,248.98,percent of total billed charges,63% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,390.26,79,,312.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,311.22,469.3,
FETAL SPIRAL ELECTRODES,270207754,CDM,270,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
CURETTE CURVED REG TIP 7MM,270207891,CDM,270,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
CURETTE CURVED REG TIP 8MM,270207892,CDM,270,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
CURETTE STRAIGHT REG TIP 7MM,270207893,CDM,270,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
HEMOVAC EVACUATOR 100ML,270207916,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SPOT ENDOSCOPIC MARKER,270207990,CDM,270,RC,,,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,76.68,66.1,,61.34,percent of total billed charges,66.1% of total billed charges,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.08,450,
"CATHETER, MALECOT 10FR",270208307,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER, MALECOT 12FR",270208308,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER, MALECOT 14FR",270208309,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER, MALECOT 16FR",270208310,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER, MALECOT 20FR",270208312,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER, MALECOT 22FR",270208313,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER, MALECOTT 34FR",270208314,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER,MALECOT 32FR",270208315,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"CATHETER, MALECOT 36FR",270208316,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
MALE PLUG (OLD),270208385,CDM,270,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
MAX FORCE BALLOON DIL.6MM/18FR,270208517,CDM,270,RC,,,outpatient,,,494,345.8,,390.26,79,,312.21,percent of total billed charges,79% of total billed charges,444.6,90,,355.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,311.22,63,,248.98,percent of total billed charges,63% of total billed charges,381.47,77.22,,305.18,percent of total billed charges,77.22% of total billed charges,326.53,66.1,,261.22,percent of total billed charges,66.1% of total billed charges,410.02,83,,328.02,percent of total billed charges,83% of total,469.3,95,,375.44,percent of total billed charges ,95% of total billed charges,395.2,80,,316.16,percent of total billed charges,78% of total billed charges,385.32,78,,308.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,311.22,63,,248.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,311.22,63,,248.98,percent of total billed charges,63% of total billed charges,419.9,85,,335.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,390.26,79,,312.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,311.22,469.3,
SOFTSEAL LMA MASK SZ 3  DISP.,270208519,CDM,270,RC,,,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,68.74,66.1,,54.99,percent of total billed charges,66.1% of total billed charges,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.52,450,
SOFTSEAL  LMA MASK SZ 4 DISP.,270208520,CDM,270,RC,,,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,68.74,66.1,,54.99,percent of total billed charges,66.1% of total billed charges,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.52,450,
SOFTSEAL LMA MASK SZ 5 DISP.,270208521,CDM,270,RC,,,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,68.74,66.1,,54.99,percent of total billed charges,66.1% of total billed charges,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.52,450,
LMA MASK SIZE 2 DISP,270208536,CDM,270,RC,,,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.71,450,
LMA MASK SIZE 2.5 DISP,270208537,CDM,270,RC,,,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.71,450,
STRAIGHT FAST FIX,270208665,CDM,270,RC,,,outpatient,,,601,420.7,,474.79,79,,379.83,percent of total billed charges,79% of total billed charges,540.9,90,,432.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.63,63,,302.9,percent of total billed charges,63% of total billed charges,464.09,77.22,,371.27,percent of total billed charges,77.22% of total billed charges,397.26,66.1,,317.81,percent of total billed charges,66.1% of total billed charges,498.83,83,,399.06,percent of total billed charges,83% of total,570.95,95,,456.76,percent of total billed charges ,95% of total billed charges,480.8,80,,384.64,percent of total billed charges,78% of total billed charges,468.78,78,,375.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,378.63,63,,302.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,540.9,90,,432.72,percent of total billed charges,90% of total billed charges,480.8,80,,384.64,percent of total billed charges,80% of total billed charges,378.63,63,,302.9,percent of total billed charges,63% of total billed charges,510.85,85,,408.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,474.79,79,,379.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378.63,570.95,
SCULPTOR PROBE (DISPOSABLE),270209228,CDM,270,RC,,,outpatient,,,580,406,,458.2,79,,366.56,percent of total billed charges,79% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.4,63,,292.32,percent of total billed charges,63% of total billed charges,447.88,77.22,,358.3,percent of total billed charges,77.22% of total billed charges,383.38,66.1,,306.7,percent of total billed charges,66.1% of total billed charges,481.4,83,,385.12,percent of total billed charges,83% of total,551,95,,440.8,percent of total billed charges ,95% of total billed charges,464,80,,371.2,percent of total billed charges,78% of total billed charges,452.4,78,,361.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,365.4,63,,292.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,365.4,63,,292.32,percent of total billed charges,63% of total billed charges,493,85,,394.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,458.2,79,,366.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,365.4,551,
INFINITY ANTERIOR VITRECTOMY,270209314,CDM,270,RC,,,outpatient,,,532,372.4,,420.28,79,,336.22,percent of total billed charges,79% of total billed charges,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,335.16,63,,268.13,percent of total billed charges,63% of total billed charges,410.81,77.22,,328.65,percent of total billed charges,77.22% of total billed charges,351.65,66.1,,281.32,percent of total billed charges,66.1% of total billed charges,441.56,83,,353.25,percent of total billed charges,83% of total,505.4,95,,404.32,percent of total billed charges ,95% of total billed charges,425.6,80,,340.48,percent of total billed charges,78% of total billed charges,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,335.16,63,,268.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,335.16,63,,268.13,percent of total billed charges,63% of total billed charges,452.2,85,,361.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,420.28,79,,336.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,335.16,505.4,
SCISSOR CARTRIDGE 5MMX34MM,270209830,CDM,270,RC,,,outpatient,,,363,254.1,,286.77,79,,229.42,percent of total billed charges,79% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.69,63,,182.95,percent of total billed charges,63% of total billed charges,280.31,77.22,,224.25,percent of total billed charges,77.22% of total billed charges,239.94,66.1,,191.95,percent of total billed charges,66.1% of total billed charges,301.29,83,,241.03,percent of total billed charges,83% of total,344.85,95,,275.88,percent of total billed charges ,95% of total billed charges,290.4,80,,232.32,percent of total billed charges,78% of total billed charges,283.14,78,,226.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,228.69,63,,182.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,228.69,63,,182.95,percent of total billed charges,63% of total billed charges,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,286.77,79,,229.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,228.69,450,
FOLEY CATHETER-3 WAY-22FR,270209849,CDM,270,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
RESOLUTION CLIP,270209883,CDM,270,RC,,,outpatient,,,595,416.5,,470.05,79,,376.04,percent of total billed charges,79% of total billed charges,535.5,90,,428.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.85,63,,299.88,percent of total billed charges,63% of total billed charges,459.46,77.22,,367.57,percent of total billed charges,77.22% of total billed charges,393.3,66.1,,314.64,percent of total billed charges,66.1% of total billed charges,493.85,83,,395.08,percent of total billed charges,83% of total,565.25,95,,452.2,percent of total billed charges ,95% of total billed charges,476,80,,380.8,percent of total billed charges,78% of total billed charges,464.1,78,,371.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,374.85,63,,299.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,535.5,90,,428.4,percent of total billed charges,90% of total billed charges,476,80,,380.8,percent of total billed charges,80% of total billed charges,374.85,63,,299.88,percent of total billed charges,63% of total billed charges,505.75,85,,404.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,470.05,79,,376.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,374.85,565.25,
DERMABOND PROPEN,270209884,CDM,270,RC,,,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,62.8,66.1,,50.24,percent of total billed charges,66.1% of total billed charges,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.85,450,
RJ3 GASTRO PEDIATRIC FORCEP,270210011,CDM,270,RC,,,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
BLOOD PRESSURE CUFF CHILD DISP,270210220,CDM,270,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
FOLEY 18FR W/30CC BALLOON,270210251,CDM,270,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PENROSE DRAIN STERILE LTX 18x1,270210507,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
LEEP TUBING SET,270210648,CDM,270,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
PULSAVAC PLUS,270211586,CDM,270,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
QUANTIFY DROPPER BTL (6X12ML),270211685,CDM,270,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
URINE KIT (CLEAN CATCH),270211868,CDM,270,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
JB260 SUTURE,270211963,CDM,270,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
LEEP LOOP 15 X 12MM DISP,270212502,CDM,270,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
PACK ORTHO MAJOR I,270212632,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
MELKER EMERG. CRICOTHYROTOMY,270212845,CDM,270,RC,,,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,328.19,77.22,,262.55,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.75,450,
BILATERAL LIMB SHEET,270212861,CDM,270,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
HARMONIC ACE 36MM,270213108,CDM,270,RC,,,outpatient,,,1529,1070.3,,1207.91,79,,966.33,percent of total billed charges,79% of total billed charges,1376.1,90,,1100.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,963.27,63,,770.62,percent of total billed charges,63% of total billed charges,1180.69,77.22,,944.55,percent of total billed charges,77.22% of total billed charges,1010.67,66.1,,808.54,percent of total billed charges,66.1% of total billed charges,1269.07,83,,1015.26,percent of total billed charges,83% of total,1452.55,95,,1162.04,percent of total billed charges ,95% of total billed charges,1223.2,80,,978.56,percent of total billed charges,78% of total billed charges,1192.62,78,,954.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,963.27,63,,770.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1376.1,90,,1100.88,percent of total billed charges,90% of total billed charges,1223.2,80,,978.56,percent of total billed charges,80% of total billed charges,963.27,63,,770.62,percent of total billed charges,63% of total billed charges,1299.65,85,,1039.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1207.91,79,,966.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1452.55,
MALECOT CATHETER 20 FR RUSCH,270213811,CDM,270,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
MALECOT CATHETER 18FR RUSCH,270213812,CDM,270,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
"PEG KIT,SAFETY PULL 20 FR",270213880,CDM,270,RC,,,outpatient,,,440,308,,347.6,79,,278.08,percent of total billed charges,79% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.2,63,,221.76,percent of total billed charges,63% of total billed charges,339.77,77.22,,271.82,percent of total billed charges,77.22% of total billed charges,290.84,66.1,,232.67,percent of total billed charges,66.1% of total billed charges,365.2,83,,292.16,percent of total billed charges,83% of total,418,95,,334.4,percent of total billed charges ,95% of total billed charges,352,80,,281.6,percent of total billed charges,78% of total billed charges,343.2,78,,274.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,277.2,63,,221.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,277.2,63,,221.76,percent of total billed charges,63% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,347.6,79,,278.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,277.2,450,
MYSTIC II PUMP W/M STYLE,270214848,CDM,270,RC,,,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.94,450,
PLUME AWAY SMOKE EVACUATOR,270215157,CDM,270,RC,,,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,70.73,66.1,,56.58,percent of total billed charges,66.1% of total billed charges,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.41,450,
SAWBLADE,270215275,CDM,270,RC,,,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,160.62,66.1,,128.5,percent of total billed charges,66.1% of total billed charges,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.09,450,
DISPOSABLE PAIN PUMP,270215334,CDM,270,RC,,,outpatient,,,449,314.3,,354.71,79,,283.77,percent of total billed charges,79% of total billed charges,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282.87,63,,226.3,percent of total billed charges,63% of total billed charges,346.72,77.22,,277.38,percent of total billed charges,77.22% of total billed charges,296.79,66.1,,237.43,percent of total billed charges,66.1% of total billed charges,372.67,83,,298.14,percent of total billed charges,83% of total,426.55,95,,341.24,percent of total billed charges ,95% of total billed charges,359.2,80,,287.36,percent of total billed charges,78% of total billed charges,350.22,78,,280.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,282.87,63,,226.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,282.87,63,,226.3,percent of total billed charges,63% of total billed charges,381.65,85,,305.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,354.71,79,,283.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,282.87,450,
DRAPE EXTREMITY HIP,270215355,CDM,270,RC,,,outpatient,,,64,44.8,,50.56,79,,40.45,percent of total billed charges,79% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,63,,32.26,percent of total billed charges,63% of total billed charges,49.42,77.22,,39.54,percent of total billed charges,77.22% of total billed charges,42.3,66.1,,33.84,percent of total billed charges,66.1% of total billed charges,53.12,83,,42.5,percent of total billed charges,83% of total,60.8,95,,48.64,percent of total billed charges ,95% of total billed charges,51.2,80,,40.96,percent of total billed charges,78% of total billed charges,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.32,63,,32.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.32,63,,32.26,percent of total billed charges,63% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,50.56,79,,40.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.32,450,
TWIZZLE ELECTRODE,270215470,CDM,270,RC,,,outpatient,,,577,403.9,,455.83,79,,364.66,percent of total billed charges,79% of total billed charges,519.3,90,,415.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363.51,63,,290.81,percent of total billed charges,63% of total billed charges,445.56,77.22,,356.45,percent of total billed charges,77.22% of total billed charges,381.4,66.1,,305.12,percent of total billed charges,66.1% of total billed charges,478.91,83,,383.13,percent of total billed charges,83% of total,548.15,95,,438.52,percent of total billed charges ,95% of total billed charges,461.6,80,,369.28,percent of total billed charges,78% of total billed charges,450.06,78,,360.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,363.51,63,,290.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,363.51,63,,290.81,percent of total billed charges,63% of total billed charges,490.45,85,,392.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,455.83,79,,364.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,363.51,548.15,
VERSAPOINT LOOP ELECTRODE,270215473,CDM,270,RC,,,outpatient,,,1054,737.8,,832.66,79,,666.13,percent of total billed charges,79% of total billed charges,948.6,90,,758.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,664.02,63,,531.22,percent of total billed charges,63% of total billed charges,813.9,77.22,,651.12,percent of total billed charges,77.22% of total billed charges,696.69,66.1,,557.35,percent of total billed charges,66.1% of total billed charges,874.82,83,,699.86,percent of total billed charges,83% of total,1001.3,95,,801.04,percent of total billed charges ,95% of total billed charges,843.2,80,,674.56,percent of total billed charges,78% of total billed charges,822.12,78,,657.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,664.02,63,,531.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,948.6,90,,758.88,percent of total billed charges,90% of total billed charges,843.2,80,,674.56,percent of total billed charges,80% of total billed charges,664.02,63,,531.22,percent of total billed charges,63% of total billed charges,895.9,85,,716.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,832.66,79,,666.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1001.3,
DISPOSABLE BP CUFF ADULT,270216199,CDM,270,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
DISPOSABLE BP CUFF ADULT LG,270216200,CDM,270,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
CEMEX FAST WITH GENTA,270216211,CDM,270,RC,,,outpatient,,,1011,707.7,,798.69,79,,638.95,percent of total billed charges,79% of total billed charges,909.9,90,,727.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,636.93,63,,509.54,percent of total billed charges,63% of total billed charges,780.69,77.22,,624.55,percent of total billed charges,77.22% of total billed charges,668.27,66.1,,534.62,percent of total billed charges,66.1% of total billed charges,839.13,83,,671.3,percent of total billed charges,83% of total,960.45,95,,768.36,percent of total billed charges ,95% of total billed charges,808.8,80,,647.04,percent of total billed charges,78% of total billed charges,788.58,78,,630.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,636.93,63,,509.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,909.9,90,,727.92,percent of total billed charges,90% of total billed charges,808.8,80,,647.04,percent of total billed charges,80% of total billed charges,636.93,63,,509.54,percent of total billed charges,63% of total billed charges,859.35,85,,687.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,798.69,79,,638.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,960.45,
TENODESIS KIT,270216475,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
PEZZER 38 FR CATH,270216700,CDM,270,RC,,,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
MICRO-OSCILLATOR,270216824,CDM,270,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
GASTROSTOMY 26 FR,270216858,CDM,270,RC,,,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,126.25,66.1,,101,percent of total billed charges,66.1% of total billed charges,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.33,450,
ESOPHAGEAL DILATOR 46 FR,270216966,CDM,270,RC,,,outpatient,,,423,296.1,,334.17,79,,267.34,percent of total billed charges,79% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,326.64,77.22,,261.31,percent of total billed charges,77.22% of total billed charges,279.6,66.1,,223.68,percent of total billed charges,66.1% of total billed charges,351.09,83,,280.87,percent of total billed charges,83% of total,401.85,95,,321.48,percent of total billed charges ,95% of total billed charges,338.4,80,,270.72,percent of total billed charges,78% of total billed charges,329.94,78,,263.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,334.17,79,,267.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,266.49,450,
ESOPHAGEAL DILATOR 54 FR,270216967,CDM,270,RC,,,outpatient,,,496,347.2,,391.84,79,,313.47,percent of total billed charges,79% of total billed charges,446.4,90,,357.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312.48,63,,249.98,percent of total billed charges,63% of total billed charges,383.01,77.22,,306.41,percent of total billed charges,77.22% of total billed charges,327.86,66.1,,262.29,percent of total billed charges,66.1% of total billed charges,411.68,83,,329.34,percent of total billed charges,83% of total,471.2,95,,376.96,percent of total billed charges ,95% of total billed charges,396.8,80,,317.44,percent of total billed charges,78% of total billed charges,386.88,78,,309.504,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,312.48,63,,249.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,446.4,90,,357.12,percent of total billed charges,90% of total billed charges,396.8,80,,317.44,percent of total billed charges,80% of total billed charges,312.48,63,,249.98,percent of total billed charges,63% of total billed charges,421.6,85,,337.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,391.84,79,,313.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,312.48,471.2,
SAW BLADE,270216997,CDM,270,RC,,,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
SAWBLADE-ZIMMER,270217126,CDM,270,RC,,,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,450,
ANTERIOR SEG PROLIFT PELVIC,270217175,CDM,270,RC,,,outpatient,,,4940,3458,,3902.6,79,,3122.08,percent of total billed charges,79% of total billed charges,4446,90,,3556.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3112.2,63,,2489.76,percent of total billed charges,63% of total billed charges,3814.67,77.22,,3051.74,percent of total billed charges,77.22% of total billed charges,3265.34,66.1,,2612.27,percent of total billed charges,66.1% of total billed charges,4100.2,83,,3280.16,percent of total billed charges,83% of total,4693,95,,3754.4,percent of total billed charges ,95% of total billed charges,3952,80,,3161.6,percent of total billed charges,78% of total billed charges,3853.2,78,,3082.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3112.2,63,,2489.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4446,90,,3556.8,percent of total billed charges,90% of total billed charges,3952,80,,3161.6,percent of total billed charges,80% of total billed charges,3112.2,63,,2489.76,percent of total billed charges,63% of total billed charges,4199,85,,3359.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3902.6,79,,3122.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4693,
POSTERIOR SEG PELVIC SYSTEM,270217176,CDM,270,RC,,,outpatient,,,2435,1704.5,,1923.65,79,,1538.92,percent of total billed charges,79% of total billed charges,2191.5,90,,1753.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1534.05,63,,1227.24,percent of total billed charges,63% of total billed charges,1880.31,77.22,,1504.25,percent of total billed charges,77.22% of total billed charges,1609.54,66.1,,1287.63,percent of total billed charges,66.1% of total billed charges,2021.05,83,,1616.84,percent of total billed charges,83% of total,2313.25,95,,1850.6,percent of total billed charges ,95% of total billed charges,1948,80,,1558.4,percent of total billed charges,78% of total billed charges,1899.3,78,,1519.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1534.05,63,,1227.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2191.5,90,,1753.2,percent of total billed charges,90% of total billed charges,1948,80,,1558.4,percent of total billed charges,80% of total billed charges,1534.05,63,,1227.24,percent of total billed charges,63% of total billed charges,2069.75,85,,1655.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1923.65,79,,1538.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2313.25,
OXY EARS,270217249,CDM,270,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
BIO EYE ORBITAL IMPLANT,270217787,CDM,270,RC,,,outpatient,,,2100,1470,,1659,79,,1327.2,percent of total billed charges,79% of total billed charges,1890,90,,1512,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1323,63,,1058.4,percent of total billed charges,63% of total billed charges,1621.62,77.22,,1297.3,percent of total billed charges,77.22% of total billed charges,1388.1,66.1,,1110.48,percent of total billed charges,66.1% of total billed charges,1743,83,,1394.4,percent of total billed charges,83% of total,1995,95,,1596,percent of total billed charges ,95% of total billed charges,1680,80,,1344,percent of total billed charges,78% of total billed charges,1638,78,,1310.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1323,63,,1058.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1323,63,,1058.4,percent of total billed charges,63% of total billed charges,1785,85,,1428,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1659,79,,1327.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1995,
BLOOD PRESSURE CUFF SM 2-T,270217829,CDM,270,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
AHMED GLAUCOMA VALVE FLEXIBLE,270217864,CDM,270,RC,,,outpatient,,,1804,1262.8,,1425.16,79,,1140.13,percent of total billed charges,79% of total billed charges,1623.6,90,,1298.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1136.52,63,,909.22,percent of total billed charges,63% of total billed charges,1393.05,77.22,,1114.44,percent of total billed charges,77.22% of total billed charges,1192.44,66.1,,953.95,percent of total billed charges,66.1% of total billed charges,1497.32,83,,1197.86,percent of total billed charges,83% of total,1713.8,95,,1371.04,percent of total billed charges ,95% of total billed charges,1443.2,80,,1154.56,percent of total billed charges,78% of total billed charges,1407.12,78,,1125.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1136.52,63,,909.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1623.6,90,,1298.88,percent of total billed charges,90% of total billed charges,1443.2,80,,1154.56,percent of total billed charges,80% of total billed charges,1136.52,63,,909.22,percent of total billed charges,63% of total billed charges,1533.4,85,,1226.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1425.16,79,,1140.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1713.8,
SILICONE ROUND DRAINS,270217888,CDM,270,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
EZ FLOW MAX NEB,270217941,CDM,270,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
CAUTERY FINE TIP LO-TEMP,270217999,CDM,270,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
PICC LINE 3 FR SINGLE LUMEN,270218054,CDM,270,RC,,,outpatient,,,149,104.3,,117.71,79,,94.17,percent of total billed charges,79% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.87,63,,75.1,percent of total billed charges,63% of total billed charges,115.06,77.22,,92.05,percent of total billed charges,77.22% of total billed charges,98.49,66.1,,78.79,percent of total billed charges,66.1% of total billed charges,123.67,83,,98.94,percent of total billed charges,83% of total,141.55,95,,113.24,percent of total billed charges ,95% of total billed charges,119.2,80,,95.36,percent of total billed charges,78% of total billed charges,116.22,78,,92.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,93.87,63,,75.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,93.87,63,,75.1,percent of total billed charges,63% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,117.71,79,,94.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.87,450,
FEMORAL CANAL TIP,270218071,CDM,270,RC,,,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
ULTRA FAST AB CURVED NEEDLE,270218125,CDM,270,RC,,,outpatient,,,902,631.4,,712.58,79,,570.06,percent of total billed charges,79% of total billed charges,811.8,90,,649.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,568.26,63,,454.61,percent of total billed charges,63% of total billed charges,696.52,77.22,,557.22,percent of total billed charges,77.22% of total billed charges,596.22,66.1,,476.98,percent of total billed charges,66.1% of total billed charges,748.66,83,,598.93,percent of total billed charges,83% of total,856.9,95,,685.52,percent of total billed charges ,95% of total billed charges,721.6,80,,577.28,percent of total billed charges,78% of total billed charges,703.56,78,,562.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,568.26,63,,454.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,568.26,63,,454.61,percent of total billed charges,63% of total billed charges,766.7,85,,613.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,712.58,79,,570.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,856.9,
ULTRA FAST NEEDLE DELIVERY SYS,270218127,CDM,270,RC,,,outpatient,,,388,271.6,,306.52,79,,245.22,percent of total billed charges,79% of total billed charges,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.44,63,,195.55,percent of total billed charges,63% of total billed charges,299.61,77.22,,239.69,percent of total billed charges,77.22% of total billed charges,256.47,66.1,,205.18,percent of total billed charges,66.1% of total billed charges,322.04,83,,257.63,percent of total billed charges,83% of total,368.6,95,,294.88,percent of total billed charges ,95% of total billed charges,310.4,80,,248.32,percent of total billed charges,78% of total billed charges,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,244.44,63,,195.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,244.44,63,,195.55,percent of total billed charges,63% of total billed charges,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,306.52,79,,245.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,244.44,450,
POLY TRAP WITH 2 SPECIMEN TRAY,270218152,CDM,270,RC,,,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
SUTURE 48G,270218340,CDM,270,RC,,,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
BULB JACKSON PRATT 100CC,270218342,CDM,270,RC,,,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,74.69,66.1,,59.75,percent of total billed charges,66.1% of total billed charges,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.19,450,
5.5 UNCUFFED/PLAIN-MURPHY,270218519,CDM,270,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
6.0 UNCUFFED PLAIN MURPHY,270218520,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
4.0 UNCUFFED/PLAIN-MURPHY,270218521,CDM,270,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
RETROCUTTER 9MM,270218595,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
COLD THERAPY DEVICE DISPOSIBLE,270218651,CDM,270,RC,,,outpatient,,,174,121.8,,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,134.36,77.22,,107.49,percent of total billed charges,77.22% of total billed charges,115.01,66.1,,92.01,percent of total billed charges,66.1% of total billed charges,144.42,83,,115.54,percent of total billed charges,83% of total,165.3,95,,132.24,percent of total billed charges ,95% of total billed charges,139.2,80,,111.36,percent of total billed charges,78% of total billed charges,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.62,450,
10MM CLIP APPLIER,270218669,CDM,270,RC,,,outpatient,,,419,293.3,,331.01,79,,264.81,percent of total billed charges,79% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,263.97,63,,211.18,percent of total billed charges,63% of total billed charges,323.55,77.22,,258.84,percent of total billed charges,77.22% of total billed charges,276.96,66.1,,221.57,percent of total billed charges,66.1% of total billed charges,347.77,83,,278.22,percent of total billed charges,83% of total,398.05,95,,318.44,percent of total billed charges ,95% of total billed charges,335.2,80,,268.16,percent of total billed charges,78% of total billed charges,326.82,78,,261.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,263.97,63,,211.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,263.97,63,,211.18,percent of total billed charges,63% of total billed charges,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,331.01,79,,264.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.97,450,
10MM ENDO POUCH,270218670,CDM,270,RC,,,outpatient,,,204,142.8,,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.52,63,,102.82,percent of total billed charges,63% of total billed charges,157.53,77.22,,126.02,percent of total billed charges,77.22% of total billed charges,134.84,66.1,,107.87,percent of total billed charges,66.1% of total billed charges,169.32,83,,135.46,percent of total billed charges,83% of total,193.8,95,,155.04,percent of total billed charges ,95% of total billed charges,163.2,80,,130.56,percent of total billed charges,78% of total billed charges,159.12,78,,127.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,128.52,63,,102.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,128.52,63,,102.82,percent of total billed charges,63% of total billed charges,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128.52,450,
PASSPORT 8 X 4,270218714,CDM,270,RC,,,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.94,450,
GATOR TUBE,270218856,CDM,270,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
GLV 3 STAT VERATHON PRODUCT,270218901,CDM,270,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
FIBERSTICK #2,270218905,CDM,270,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
CONTRAST INJECTION THERAPY,270219225,CDM,270,RC,,,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
INTERPULSE HANDPIECE SET W/BON,270219240,CDM,270,RC,,,outpatient,,,163,114.1,,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,125.87,77.22,,100.7,percent of total billed charges,77.22% of total billed charges,107.74,66.1,,86.19,percent of total billed charges,66.1% of total billed charges,135.29,83,,108.23,percent of total billed charges,83% of total,154.85,95,,123.88,percent of total billed charges ,95% of total billed charges,130.4,80,,104.32,percent of total billed charges,78% of total billed charges,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.69,450,
8MM LP REAMER,270219438,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
BICAP BIPOLAR HEMOSTASIS 10FR,270219468,CDM,270,RC,,,outpatient,,,377,263.9,,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,291.12,77.22,,232.9,percent of total billed charges,77.22% of total billed charges,249.2,66.1,,199.36,percent of total billed charges,66.1% of total billed charges,312.91,83,,250.33,percent of total billed charges,83% of total,358.15,95,,286.52,percent of total billed charges ,95% of total billed charges,301.6,80,,241.28,percent of total billed charges,78% of total billed charges,294.06,78,,235.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,237.51,450,
FULL BODY BLANKET,270219497,CDM,270,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
PEDIATRIC BLANKET,270219498,CDM,270,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
HOTLINE DISPOSABLE TUBINS,270219511,CDM,270,RC,,,outpatient,,,49,34.3,,38.71,79,,30.97,percent of total billed charges,79% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.87,63,,24.7,percent of total billed charges,63% of total billed charges,37.84,77.22,,30.27,percent of total billed charges,77.22% of total billed charges,32.39,66.1,,25.91,percent of total billed charges,66.1% of total billed charges,40.67,83,,32.54,percent of total billed charges,83% of total,46.55,95,,37.24,percent of total billed charges ,95% of total billed charges,39.2,80,,31.36,percent of total billed charges,78% of total billed charges,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.87,63,,24.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.87,63,,24.7,percent of total billed charges,63% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,38.71,79,,30.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.87,450,
SKIN TEMP PROBE,270219514,CDM,270,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
PDQ2,270219534,CDM,270,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
TUBING SET W/ TWO PNCTURE,270219656,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
SUTURE 1792G 5-0 CHROMIC GUT,270219674,CDM,270,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
BITE BLOCK -MAXI - LATEX FREE,270219788,CDM,270,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
"CAUTERY,NON-STICK 2.5/64MM",270219831,CDM,270,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
DRILL CANNULATED 2.6,270219904,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
GUIDE WIRE TROCAR TIP,270219905,CDM,270,RC,C1713,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,57.51,66.1,,46.01,percent of total billed charges,66.1% of total billed charges,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.81,450,
RETRO DRILL GUIDE PIN NON-CANN,270219906,CDM,270,RC,,,outpatient,,,457,319.9,,361.03,79,,288.82,percent of total billed charges,79% of total billed charges,411.3,90,,329.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,352.9,77.22,,282.32,percent of total billed charges,77.22% of total billed charges,302.08,66.1,,241.66,percent of total billed charges,66.1% of total billed charges,379.31,83,,303.45,percent of total billed charges,83% of total,434.15,95,,347.32,percent of total billed charges ,95% of total billed charges,365.6,80,,292.48,percent of total billed charges,78% of total billed charges,356.46,78,,285.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,411.3,90,,329.04,percent of total billed charges,90% of total billed charges,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,388.45,85,,310.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,361.03,79,,288.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,287.91,450,
REMER LP 9MM,270219907,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
KNOT PUSHER /SUTURE CUTTER,270219908,CDM,270,RC,,,outpatient,,,447,312.9,,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,345.17,77.22,,276.14,percent of total billed charges,77.22% of total billed charges,295.47,66.1,,236.38,percent of total billed charges,66.1% of total billed charges,371.01,83,,296.81,percent of total billed charges,83% of total,424.65,95,,339.72,percent of total billed charges ,95% of total billed charges,357.6,80,,286.08,percent of total billed charges,78% of total billed charges,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,281.61,450,
RUTNER UNIVERSAL WEDGE,270220051,CDM,270,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
FAST FIX STRAIGHT SUTURE,270220068,CDM,270,RC,,,outpatient,,,534,373.8,,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,412.35,77.22,,329.88,percent of total billed charges,77.22% of total billed charges,352.97,66.1,,282.38,percent of total billed charges,66.1% of total billed charges,443.22,83,,354.58,percent of total billed charges,83% of total,507.3,95,,405.84,percent of total billed charges ,95% of total billed charges,427.2,80,,341.76,percent of total billed charges,78% of total billed charges,416.52,78,,333.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,336.42,507.3,
FAST FIX STRAIGHT,270220069,CDM,270,RC,,,outpatient,,,1007,704.9,,795.53,79,,636.42,percent of total billed charges,79% of total billed charges,906.3,90,,725.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,634.41,63,,507.53,percent of total billed charges,63% of total billed charges,777.61,77.22,,622.09,percent of total billed charges,77.22% of total billed charges,665.63,66.1,,532.5,percent of total billed charges,66.1% of total billed charges,835.81,83,,668.65,percent of total billed charges,83% of total,956.65,95,,765.32,percent of total billed charges ,95% of total billed charges,805.6,80,,644.48,percent of total billed charges,78% of total billed charges,785.46,78,,628.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,634.41,63,,507.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,906.3,90,,725.04,percent of total billed charges,90% of total billed charges,805.6,80,,644.48,percent of total billed charges,80% of total billed charges,634.41,63,,507.53,percent of total billed charges,63% of total billed charges,855.95,85,,684.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,795.53,79,,636.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,956.65,
MIXEVAC 3 BONE CEMENT MIXER,270220203,CDM,270,RC,,,outpatient,,,137,95.9,,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,105.79,77.22,,84.63,percent of total billed charges,77.22% of total billed charges,90.56,66.1,,72.45,percent of total billed charges,66.1% of total billed charges,113.71,83,,90.97,percent of total billed charges,83% of total,130.15,95,,104.12,percent of total billed charges ,95% of total billed charges,109.6,80,,87.68,percent of total billed charges,78% of total billed charges,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.31,450,
QD 16 x 8 BALLON DILATOR,270220294,CDM,270,RC,,,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,342.86,77.22,,274.29,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,279.72,450,
BCM,270220297,CDM,270,RC,,,outpatient,,,900,630,,711,79,,568.8,percent of total billed charges,79% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,694.98,77.22,,555.98,percent of total billed charges,77.22% of total billed charges,594.9,66.1,,475.92,percent of total billed charges,66.1% of total billed charges,747,83,,597.6,percent of total billed charges,83% of total,855,95,,684,percent of total billed charges ,95% of total billed charges,720,80,,576,percent of total billed charges,78% of total billed charges,702,78,,561.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,567,63,,453.6,percent of total billed charges,63% of total billed charges,765,85,,612,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,711,79,,568.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,855,
POWERED LDS 15W STAPLER,270220445,CDM,270,RC,,,outpatient,,,458,320.6,,361.82,79,,289.46,percent of total billed charges,79% of total billed charges,412.2,90,,329.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,353.67,77.22,,282.94,percent of total billed charges,77.22% of total billed charges,302.74,66.1,,242.19,percent of total billed charges,66.1% of total billed charges,380.14,83,,304.11,percent of total billed charges,83% of total,435.1,95,,348.08,percent of total billed charges ,95% of total billed charges,366.4,80,,293.12,percent of total billed charges,78% of total billed charges,357.24,78,,285.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,361.82,79,,289.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,288.54,450,
BRUSH TIP RADIAL SPRAY,270220522,CDM,270,RC,,,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
EVAL SUC/IRRIGATION DEVICE,270220523,CDM,270,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
SUCTION IRRIGATOR W/L HOOK,270220601,CDM,270,RC,,,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.71,450,
CYTOLOGY BRUSH 240CM LENGTH,270220624,CDM,270,RC,,,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,18.51,66.1,,14.81,percent of total billed charges,66.1% of total billed charges,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.64,450,
CURETTE STR REGULAR TIP 8MM,270220765,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
GLIDE SCOPE GVL 4,270220795,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
PROLIFT + M PFRA02,270220894,CDM,270,RC,,,outpatient,,,4462,3123.4,,3524.98,79,,2819.98,percent of total billed charges,79% of total billed charges,4015.8,90,,3212.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2811.06,63,,2248.85,percent of total billed charges,63% of total billed charges,3445.56,77.22,,2756.45,percent of total billed charges,77.22% of total billed charges,2949.38,66.1,,2359.5,percent of total billed charges,66.1% of total billed charges,3703.46,83,,2962.77,percent of total billed charges,83% of total,4238.9,95,,3391.12,percent of total billed charges ,95% of total billed charges,3569.6,80,,2855.68,percent of total billed charges,78% of total billed charges,3480.36,78,,2784.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2811.06,63,,2248.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4015.8,90,,3212.64,percent of total billed charges,90% of total billed charges,3569.6,80,,2855.68,percent of total billed charges,80% of total billed charges,2811.06,63,,2248.85,percent of total billed charges,63% of total billed charges,3792.7,85,,3034.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3524.98,79,,2819.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4238.9,
SUTURE X4323 COTTONY II 1MM,270220950,CDM,270,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
PULSA VAC INTRAMEDULLARY TIP,270221066,CDM,270,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
PREFIX PLUG SMALL,270221106,CDM,270,RC,,,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,249.86,66.1,,199.89,percent of total billed charges,66.1% of total billed charges,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,238.14,450,
LIGASURE IMPACT,270221114,CDM,270,RC,,,outpatient,,,2032,1422.4,,1605.28,79,,1284.22,percent of total billed charges,79% of total billed charges,1828.8,90,,1463.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1280.16,63,,1024.13,percent of total billed charges,63% of total billed charges,1569.11,77.22,,1255.29,percent of total billed charges,77.22% of total billed charges,1343.15,66.1,,1074.52,percent of total billed charges,66.1% of total billed charges,1686.56,83,,1349.25,percent of total billed charges,83% of total,1930.4,95,,1544.32,percent of total billed charges ,95% of total billed charges,1625.6,80,,1300.48,percent of total billed charges,78% of total billed charges,1584.96,78,,1267.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1280.16,63,,1024.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1828.8,90,,1463.04,percent of total billed charges,90% of total billed charges,1625.6,80,,1300.48,percent of total billed charges,80% of total billed charges,1280.16,63,,1024.13,percent of total billed charges,63% of total billed charges,1727.2,85,,1381.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1605.28,79,,1284.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1930.4,
STERILE DIS CUFF/W SINGLE,270221118,CDM,270,RC,,,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.93,450,
HIGH FLOW INSUFFLATION TUBING,270221125,CDM,270,RC,,,outpatient,,,202,141.4,,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,155.98,77.22,,124.78,percent of total billed charges,77.22% of total billed charges,133.52,66.1,,106.82,percent of total billed charges,66.1% of total billed charges,167.66,83,,134.13,percent of total billed charges,83% of total,191.9,95,,153.52,percent of total billed charges ,95% of total billed charges,161.6,80,,129.28,percent of total billed charges,78% of total billed charges,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.26,450,
MINI SUTURE TAK KIT,270221169,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
POLYESTERE REC COMP 8X6,270221184,CDM,270,RC,,,outpatient,,,1838,1286.6,,1452.02,79,,1161.62,percent of total billed charges,79% of total billed charges,1654.2,90,,1323.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1157.94,63,,926.35,percent of total billed charges,63% of total billed charges,1419.3,77.22,,1135.44,percent of total billed charges,77.22% of total billed charges,1214.92,66.1,,971.94,percent of total billed charges,66.1% of total billed charges,1525.54,83,,1220.43,percent of total billed charges,83% of total,1746.1,95,,1396.88,percent of total billed charges ,95% of total billed charges,1470.4,80,,1176.32,percent of total billed charges,78% of total billed charges,1433.64,78,,1146.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1157.94,63,,926.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1654.2,90,,1323.36,percent of total billed charges,90% of total billed charges,1470.4,80,,1176.32,percent of total billed charges,80% of total billed charges,1157.94,63,,926.35,percent of total billed charges,63% of total billed charges,1562.3,85,,1249.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1452.02,79,,1161.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1746.1,
POLYESTER REC COMP 10X8,270221185,CDM,270,RC,,,outpatient,,,2794,1955.8,,2207.26,79,,1765.81,percent of total billed charges,79% of total billed charges,2514.6,90,,2011.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760.22,63,,1408.18,percent of total billed charges,63% of total billed charges,2157.53,77.22,,1726.02,percent of total billed charges,77.22% of total billed charges,1846.83,66.1,,1477.46,percent of total billed charges,66.1% of total billed charges,2319.02,83,,1855.22,percent of total billed charges,83% of total,2654.3,95,,2123.44,percent of total billed charges ,95% of total billed charges,2235.2,80,,1788.16,percent of total billed charges,78% of total billed charges,2179.32,78,,1743.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1760.22,63,,1408.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2514.6,90,,2011.68,percent of total billed charges,90% of total billed charges,2235.2,80,,1788.16,percent of total billed charges,80% of total billed charges,1760.22,63,,1408.18,percent of total billed charges,63% of total billed charges,2374.9,85,,1899.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2207.26,79,,1765.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2654.3,
POLYESTER REC COMP 12X8,270221186,CDM,270,RC,,,outpatient,,,3819,2673.3,,3017.01,79,,2413.61,percent of total billed charges,79% of total billed charges,3437.1,90,,2749.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2405.97,63,,1924.78,percent of total billed charges,63% of total billed charges,2949.03,77.22,,2359.22,percent of total billed charges,77.22% of total billed charges,2524.36,66.1,,2019.49,percent of total billed charges,66.1% of total billed charges,3169.77,83,,2535.82,percent of total billed charges,83% of total,3628.05,95,,2902.44,percent of total billed charges ,95% of total billed charges,3055.2,80,,2444.16,percent of total billed charges,78% of total billed charges,2978.82,78,,2383.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2405.97,63,,1924.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3437.1,90,,2749.68,percent of total billed charges,90% of total billed charges,3055.2,80,,2444.16,percent of total billed charges,80% of total billed charges,2405.97,63,,1924.78,percent of total billed charges,63% of total billed charges,3246.15,85,,2596.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3017.01,79,,2413.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3628.05,
CANNULA 7 x 7,270221202,CDM,270,RC,,,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
ACCUSHARP OPTHALMIC KNIFE 1MM,270221223,CDM,270,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
POLYESTER ROUND COMPOSITE,270221242,CDM,270,RC,,,outpatient,,,1396,977.2,,1102.84,79,,882.27,percent of total billed charges,79% of total billed charges,1256.4,90,,1005.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,879.48,63,,703.58,percent of total billed charges,63% of total billed charges,1077.99,77.22,,862.39,percent of total billed charges,77.22% of total billed charges,922.76,66.1,,738.21,percent of total billed charges,66.1% of total billed charges,1158.68,83,,926.94,percent of total billed charges,83% of total,1326.2,95,,1060.96,percent of total billed charges ,95% of total billed charges,1116.8,80,,893.44,percent of total billed charges,78% of total billed charges,1088.88,78,,871.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,879.48,63,,703.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1256.4,90,,1005.12,percent of total billed charges,90% of total billed charges,1116.8,80,,893.44,percent of total billed charges,80% of total billed charges,879.48,63,,703.58,percent of total billed charges,63% of total billed charges,1186.6,85,,949.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1102.84,79,,882.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1326.2,
DRESSING 14 INCH,270221332,CDM,270,RC,,,outpatient,,,163,114.1,,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,125.87,77.22,,100.7,percent of total billed charges,77.22% of total billed charges,107.74,66.1,,86.19,percent of total billed charges,66.1% of total billed charges,135.29,83,,108.23,percent of total billed charges,83% of total,154.85,95,,123.88,percent of total billed charges ,95% of total billed charges,130.4,80,,104.32,percent of total billed charges,78% of total billed charges,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.69,450,
VACUUM DELIVERY KIWI OMNI CUP,270221636,CDM,270,RC,,,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.98,450,
FAST FIX 360,270221638,CDM,270,RC,,,outpatient,,,1301,910.7,,1027.79,79,,822.23,percent of total billed charges,79% of total billed charges,1170.9,90,,936.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,819.63,63,,655.7,percent of total billed charges,63% of total billed charges,1004.63,77.22,,803.7,percent of total billed charges,77.22% of total billed charges,859.96,66.1,,687.97,percent of total billed charges,66.1% of total billed charges,1079.83,83,,863.86,percent of total billed charges,83% of total,1235.95,95,,988.76,percent of total billed charges ,95% of total billed charges,1040.8,80,,832.64,percent of total billed charges,78% of total billed charges,1014.78,78,,811.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,819.63,63,,655.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1170.9,90,,936.72,percent of total billed charges,90% of total billed charges,1040.8,80,,832.64,percent of total billed charges,80% of total billed charges,819.63,63,,655.7,percent of total billed charges,63% of total billed charges,1105.85,85,,884.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1027.79,79,,822.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1235.95,
PED AIR MASK 1096,270221653,CDM,270,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
TRIMENO KIT,270221730,CDM,270,RC,,,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,227.38,66.1,,181.9,percent of total billed charges,66.1% of total billed charges,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,216.72,450,
VISCERA RETAINER SMALL,270222005,CDM,270,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
STIMUPLAST PUDDY 5CC,270222101,CDM,270,RC,,,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
CLEAR CUT SLIT KNIFE 2.75MM,270222149,CDM,270,RC,,,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,53.54,66.1,,42.83,percent of total billed charges,66.1% of total billed charges,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.03,450,
SHAVER EXCALIBER 5.5,270222277,CDM,270,RC,,,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,118.98,66.1,,95.18,percent of total billed charges,66.1% of total billed charges,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.4,450,
SAGITTAL BLADE K2000 OPS,270222288,CDM,270,RC,,,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,450,
PAPARELLA TYPE 2 VENTILATION,270222343,CDM,270,RC,,,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,56.19,66.1,,44.95,percent of total billed charges,66.1% of total billed charges,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.55,450,
VERSAPORT PLUS V2 5MM-12MM TRO,270222350,CDM,270,RC,,,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,159.85,77.22,,127.88,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,130.41,450,
3.0 DISSECTOR SJ,270222565,CDM,270,RC,,,outpatient,,,201,140.7,,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,155.21,77.22,,124.17,percent of total billed charges,77.22% of total billed charges,132.86,66.1,,106.29,percent of total billed charges,66.1% of total billed charges,166.83,83,,133.46,percent of total billed charges,83% of total,190.95,95,,152.76,percent of total billed charges ,95% of total billed charges,160.8,80,,128.64,percent of total billed charges,78% of total billed charges,156.78,78,,125.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126.63,450,
OVAL BURR 5.5,270222567,CDM,270,RC,,,outpatient,,,271,189.7,,214.09,79,,171.27,percent of total billed charges,79% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.73,63,,136.58,percent of total billed charges,63% of total billed charges,209.27,77.22,,167.42,percent of total billed charges,77.22% of total billed charges,179.13,66.1,,143.3,percent of total billed charges,66.1% of total billed charges,224.93,83,,179.94,percent of total billed charges,83% of total,257.45,95,,205.96,percent of total billed charges ,95% of total billed charges,216.8,80,,173.44,percent of total billed charges,78% of total billed charges,211.38,78,,169.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,170.73,63,,136.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,170.73,63,,136.58,percent of total billed charges,63% of total billed charges,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,214.09,79,,171.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,170.73,450,
EVIVA BIOPSY SITE MARKER US,270222579,CDM,270,RC,,,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,144.76,66.1,,115.81,percent of total billed charges,66.1% of total billed charges,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,137.97,450,
GO BLOCK SENSOCAINE,270222583,CDM,270,RC,,,outpatient,,,637,445.9,,503.23,79,,402.58,percent of total billed charges,79% of total billed charges,573.3,90,,458.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401.31,63,,321.05,percent of total billed charges,63% of total billed charges,491.89,77.22,,393.51,percent of total billed charges,77.22% of total billed charges,421.06,66.1,,336.85,percent of total billed charges,66.1% of total billed charges,528.71,83,,422.97,percent of total billed charges,83% of total,605.15,95,,484.12,percent of total billed charges ,95% of total billed charges,509.6,80,,407.68,percent of total billed charges,78% of total billed charges,496.86,78,,397.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,401.31,63,,321.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,401.31,63,,321.05,percent of total billed charges,63% of total billed charges,541.45,85,,433.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,503.23,79,,402.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,401.31,605.15,
CATHETER LAP CHOLANGIOGRAM,270222662,CDM,270,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
SWITCHING STICKS,270222680,CDM,270,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
DRILL 2.0 X 40MM,270222694,CDM,270,RC,,,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,307.34,77.22,,245.87,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,250.74,450,
DRIVER SQUARE TIP 2.0 MM,270222696,CDM,270,RC,,,outpatient,,,400,280,,316,79,,252.8,percent of total billed charges,79% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,63,,201.6,percent of total billed charges,63% of total billed charges,308.88,77.22,,247.1,percent of total billed charges,77.22% of total billed charges,264.4,66.1,,211.52,percent of total billed charges,66.1% of total billed charges,332,83,,265.6,percent of total billed charges,83% of total,380,95,,304,percent of total billed charges ,95% of total billed charges,320,80,,256,percent of total billed charges,78% of total billed charges,312,78,,249.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,252,63,,201.6,percent of total billed charges,63% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,316,79,,252.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,252,450,
DRIVER T10,270222697,CDM,270,RC,,,outpatient,,,400,280,,316,79,,252.8,percent of total billed charges,79% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,63,,201.6,percent of total billed charges,63% of total billed charges,308.88,77.22,,247.1,percent of total billed charges,77.22% of total billed charges,264.4,66.1,,211.52,percent of total billed charges,66.1% of total billed charges,332,83,,265.6,percent of total billed charges,83% of total,380,95,,304,percent of total billed charges ,95% of total billed charges,320,80,,256,percent of total billed charges,78% of total billed charges,312,78,,249.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,252,63,,201.6,percent of total billed charges,63% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,316,79,,252.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,252,450,
FAST FIX 360 STRAIGHT,270222790,CDM,270,RC,,,outpatient,,,1496,1047.2,,1181.84,79,,945.47,percent of total billed charges,79% of total billed charges,1346.4,90,,1077.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,942.48,63,,753.98,percent of total billed charges,63% of total billed charges,1155.21,77.22,,924.17,percent of total billed charges,77.22% of total billed charges,988.86,66.1,,791.09,percent of total billed charges,66.1% of total billed charges,1241.68,83,,993.34,percent of total billed charges,83% of total,1421.2,95,,1136.96,percent of total billed charges ,95% of total billed charges,1196.8,80,,957.44,percent of total billed charges,78% of total billed charges,1166.88,78,,933.504,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,942.48,63,,753.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1346.4,90,,1077.12,percent of total billed charges,90% of total billed charges,1196.8,80,,957.44,percent of total billed charges,80% of total billed charges,942.48,63,,753.98,percent of total billed charges,63% of total billed charges,1271.6,85,,1017.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1181.84,79,,945.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1421.2,
DRILL PIN CLOSED EYELET  4MM,270222847,CDM,270,RC,,,outpatient,,,447,312.9,,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,345.17,77.22,,276.14,percent of total billed charges,77.22% of total billed charges,295.47,66.1,,236.38,percent of total billed charges,66.1% of total billed charges,371.01,83,,296.81,percent of total billed charges,83% of total,424.65,95,,339.72,percent of total billed charges ,95% of total billed charges,357.6,80,,286.08,percent of total billed charges,78% of total billed charges,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,281.61,450,
BIO PATCH FOR PICC LINE,270222939,CDM,270,RC,,,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
CAPIO SUTURE DEVICE,270222964,CDM,270,RC,,,outpatient,,,1206,844.2,,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,1085.4,90,,868.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,931.27,77.22,,745.02,percent of total billed charges,77.22% of total billed charges,797.17,66.1,,637.74,percent of total billed charges,66.1% of total billed charges,1000.98,83,,800.78,percent of total billed charges,83% of total,1145.7,95,,916.56,percent of total billed charges ,95% of total billed charges,964.8,80,,771.84,percent of total billed charges,78% of total billed charges,940.68,78,,752.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,1025.1,85,,820.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1145.7,
POLYPROPYLENE 48 IN SZ 0,270222965,CDM,270,RC,,,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,450,
BONDEK 48 IN SZ 0,270222966,CDM,270,RC,,,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,87.25,66.1,,69.8,percent of total billed charges,66.1% of total billed charges,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.16,450,
INFANT DISPOSABLE BP CUFF,270223012,CDM,270,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
LMA 2.0 FLEXABLE,270223034,CDM,270,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
MPFL TEMPLATE,270223041,CDM,270,RC,,,outpatient,,,1271,889.7,,1004.09,79,,803.27,percent of total billed charges,79% of total billed charges,1143.9,90,,915.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800.73,63,,640.58,percent of total billed charges,63% of total billed charges,981.47,77.22,,785.18,percent of total billed charges,77.22% of total billed charges,840.13,66.1,,672.1,percent of total billed charges,66.1% of total billed charges,1054.93,83,,843.94,percent of total billed charges,83% of total,1207.45,95,,965.96,percent of total billed charges ,95% of total billed charges,1016.8,80,,813.44,percent of total billed charges,78% of total billed charges,991.38,78,,793.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,800.73,63,,640.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1143.9,90,,915.12,percent of total billed charges,90% of total billed charges,1016.8,80,,813.44,percent of total billed charges,80% of total billed charges,800.73,63,,640.58,percent of total billed charges,63% of total billed charges,1080.35,85,,864.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1004.09,79,,803.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1207.45,
POWERGUIDE MIDLINE CATHETER,270223044,CDM,270,RC,,,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,143.44,66.1,,114.75,percent of total billed charges,66.1% of total billed charges,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.71,450,
STAT LOCKS FOR PICC LINES,270223046,CDM,270,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
ULTRASOUND PROBE COVER,270223047,CDM,270,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
DRILL 2.5,270223104,CDM,270,RC,,,outpatient,,,405,283.5,,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,312.74,77.22,,250.19,percent of total billed charges,77.22% of total billed charges,267.71,66.1,,214.17,percent of total billed charges,66.1% of total billed charges,336.15,83,,268.92,percent of total billed charges,83% of total,384.75,95,,307.8,percent of total billed charges ,95% of total billed charges,324,80,,259.2,percent of total billed charges,78% of total billed charges,315.9,78,,252.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,324,80,,259.2,percent of total billed charges,80% of total billed charges,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,344.25,85,,275.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,255.15,450,
LIQUIBAND FLEX,270223261,CDM,270,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
DRILL SLEVES 2.7,270223301,CDM,270,RC,,,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
STAR SLEEVE BLUE,270223304,CDM,270,RC,,,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
CLIP APPLIER LIGAMAX,270223523,CDM,270,RC,,,outpatient,,,939,657.3,,741.81,79,,593.45,percent of total billed charges,79% of total billed charges,845.1,90,,676.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,591.57,63,,473.26,percent of total billed charges,63% of total billed charges,725.1,77.22,,580.08,percent of total billed charges,77.22% of total billed charges,620.68,66.1,,496.54,percent of total billed charges,66.1% of total billed charges,779.37,83,,623.5,percent of total billed charges,83% of total,892.05,95,,713.64,percent of total billed charges ,95% of total billed charges,751.2,80,,600.96,percent of total billed charges,78% of total billed charges,732.42,78,,585.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,591.57,63,,473.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,591.57,63,,473.26,percent of total billed charges,63% of total billed charges,798.15,85,,638.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,741.81,79,,593.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,892.05,
LMA SIZE 2.5 CHILDRENS 20-30KG,270223613,CDM,270,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
BRONCHOSCOPE SIVEL W/ NO SUCT,270223722,CDM,270,RC,,,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
PINS MINI HOLDING,270223760,CDM,270,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
CALIBLATOR ABLATOR ACL RECONST,270223772,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
SUCTION CANNISTER 500ML WND CR,270223784,CDM,270,RC,,,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
DRIVER SQUARE,270223820,CDM,270,RC,,,outpatient,,,400,280,,316,79,,252.8,percent of total billed charges,79% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,63,,201.6,percent of total billed charges,63% of total billed charges,308.88,77.22,,247.1,percent of total billed charges,77.22% of total billed charges,264.4,66.1,,211.52,percent of total billed charges,66.1% of total billed charges,332,83,,265.6,percent of total billed charges,83% of total,380,95,,304,percent of total billed charges ,95% of total billed charges,320,80,,256,percent of total billed charges,78% of total billed charges,312,78,,249.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,252,63,,201.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,252,63,,201.6,percent of total billed charges,63% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,316,79,,252.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,252,450,
REMER LP 5MM,270223958,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
2.5 DRILL,270224029,CDM,270,RC,,,outpatient,,,600,420,,474,79,,379.2,percent of total billed charges,79% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,463.32,77.22,,370.66,percent of total billed charges,77.22% of total billed charges,396.6,66.1,,317.28,percent of total billed charges,66.1% of total billed charges,498,83,,398.4,percent of total billed charges,83% of total,570,95,,456,percent of total billed charges ,95% of total billed charges,480,80,,384,percent of total billed charges,78% of total billed charges,468,78,,374.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,378,63,,302.4,percent of total billed charges,63% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,474,79,,379.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,570,
2.7 DRILL,270224030,CDM,270,RC,,,outpatient,,,475,332.5,,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,427.5,90,,342,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,366.8,77.22,,293.44,percent of total billed charges,77.22% of total billed charges,313.98,66.1,,251.18,percent of total billed charges,66.1% of total billed charges,394.25,83,,315.4,percent of total billed charges,83% of total,451.25,95,,361,percent of total billed charges ,95% of total billed charges,380,80,,304,percent of total billed charges,78% of total billed charges,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,299.25,451.25,
VERSAPOINT BALL ELECTRODE,270224057,CDM,270,RC,,,outpatient,,,948,663.6,,748.92,79,,599.14,percent of total billed charges,79% of total billed charges,853.2,90,,682.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,732.05,77.22,,585.64,percent of total billed charges,77.22% of total billed charges,626.63,66.1,,501.3,percent of total billed charges,66.1% of total billed charges,786.84,83,,629.47,percent of total billed charges,83% of total,900.6,95,,720.48,percent of total billed charges ,95% of total billed charges,758.4,80,,606.72,percent of total billed charges,78% of total billed charges,739.44,78,,591.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,853.2,90,,682.56,percent of total billed charges,90% of total billed charges,758.4,80,,606.72,percent of total billed charges,80% of total billed charges,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,805.8,85,,644.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,748.92,79,,599.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,900.6,
SCOPE WARMER,270224160,CDM,270,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DRILL CANNULATED 2.9,270224175,CDM,270,RC,,,outpatient,,,510,357,,402.9,79,,322.32,percent of total billed charges,79% of total billed charges,459,90,,367.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,321.3,63,,257.04,percent of total billed charges,63% of total billed charges,393.82,77.22,,315.06,percent of total billed charges,77.22% of total billed charges,337.11,66.1,,269.69,percent of total billed charges,66.1% of total billed charges,423.3,83,,338.64,percent of total billed charges,83% of total,484.5,95,,387.6,percent of total billed charges ,95% of total billed charges,408,80,,326.4,percent of total billed charges,78% of total billed charges,397.8,78,,318.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,321.3,63,,257.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,459,90,,367.2,percent of total billed charges,90% of total billed charges,408,80,,326.4,percent of total billed charges,80% of total billed charges,321.3,63,,257.04,percent of total billed charges,63% of total billed charges,433.5,85,,346.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,402.9,79,,322.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,321.3,484.5,
KNEE SHAVER BLADE,270224234,CDM,270,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
STAPLE 28MM,270224336,CDM,270,RC,,,outpatient,,,2145,1501.5,,1694.55,79,,1355.64,percent of total billed charges,79% of total billed charges,1930.5,90,,1544.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1351.35,63,,1081.08,percent of total billed charges,63% of total billed charges,1656.37,77.22,,1325.1,percent of total billed charges,77.22% of total billed charges,1417.85,66.1,,1134.28,percent of total billed charges,66.1% of total billed charges,1780.35,83,,1424.28,percent of total billed charges,83% of total,2037.75,95,,1630.2,percent of total billed charges ,95% of total billed charges,1716,80,,1372.8,percent of total billed charges,78% of total billed charges,1673.1,78,,1338.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1351.35,63,,1081.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1930.5,90,,1544.4,percent of total billed charges,90% of total billed charges,1716,80,,1372.8,percent of total billed charges,80% of total billed charges,1351.35,63,,1081.08,percent of total billed charges,63% of total billed charges,1823.25,85,,1458.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1694.55,79,,1355.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2037.75,
STAPLER ROTICULATOR 55  3.5,270224340,CDM,270,RC,,,outpatient,,,1491,1043.7,,1177.89,79,,942.31,percent of total billed charges,79% of total billed charges,1341.9,90,,1073.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,939.33,63,,751.46,percent of total billed charges,63% of total billed charges,1151.35,77.22,,921.08,percent of total billed charges,77.22% of total billed charges,985.55,66.1,,788.44,percent of total billed charges,66.1% of total billed charges,1237.53,83,,990.02,percent of total billed charges,83% of total,1416.45,95,,1133.16,percent of total billed charges ,95% of total billed charges,1192.8,80,,954.24,percent of total billed charges,78% of total billed charges,1162.98,78,,930.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,939.33,63,,751.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,939.33,63,,751.46,percent of total billed charges,63% of total billed charges,1267.35,85,,1013.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1177.89,79,,942.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1416.45,
4.0 TORPEDO,270224386,CDM,270,RC,,,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,183.76,66.1,,147.01,percent of total billed charges,66.1% of total billed charges,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,175.14,450,
DRILL 2.5,270224443,CDM,270,RC,,,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
RADIAL JAW 4 PEDIATR W/ NEEDLE,270224546,CDM,270,RC,,,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
LMA 1.5,270224551,CDM,270,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DISPOSABLE NEONATAL 02 PROBE,270224563,CDM,270,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
DRILL CANNULATED 2.9,270224632,CDM,270,RC,,,outpatient,,,945,661.5,,746.55,79,,597.24,percent of total billed charges,79% of total billed charges,850.5,90,,680.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,595.35,63,,476.28,percent of total billed charges,63% of total billed charges,729.73,77.22,,583.78,percent of total billed charges,77.22% of total billed charges,624.65,66.1,,499.72,percent of total billed charges,66.1% of total billed charges,784.35,83,,627.48,percent of total billed charges,83% of total,897.75,95,,718.2,percent of total billed charges ,95% of total billed charges,756,80,,604.8,percent of total billed charges,78% of total billed charges,737.1,78,,589.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,595.35,63,,476.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,595.35,63,,476.28,percent of total billed charges,63% of total billed charges,803.25,85,,642.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,746.55,79,,597.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,897.75,
CONCHA COLUMN ONLY,270224665,CDM,270,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
ENDOSCO SOFT TISUE RELESE INST,270224776,CDM,270,RC,,,outpatient,,,676,473.2,,534.04,79,,427.23,percent of total billed charges,79% of total billed charges,608.4,90,,486.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.88,63,,340.7,percent of total billed charges,63% of total billed charges,522.01,77.22,,417.61,percent of total billed charges,77.22% of total billed charges,446.84,66.1,,357.47,percent of total billed charges,66.1% of total billed charges,561.08,83,,448.86,percent of total billed charges,83% of total,642.2,95,,513.76,percent of total billed charges ,95% of total billed charges,540.8,80,,432.64,percent of total billed charges,78% of total billed charges,527.28,78,,421.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,425.88,63,,340.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,608.4,90,,486.72,percent of total billed charges,90% of total billed charges,540.8,80,,432.64,percent of total billed charges,80% of total billed charges,425.88,63,,340.7,percent of total billed charges,63% of total billed charges,574.6,85,,459.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,534.04,79,,427.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,425.88,642.2,
DRILL PROFILE,270224804,CDM,270,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
POLYSTER ROUND COMPOSITE,270224925,CDM,270,RC,,,outpatient,,,1030,721,,813.7,79,,650.96,percent of total billed charges,79% of total billed charges,927,90,,741.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.9,63,,519.12,percent of total billed charges,63% of total billed charges,795.37,77.22,,636.3,percent of total billed charges,77.22% of total billed charges,680.83,66.1,,544.66,percent of total billed charges,66.1% of total billed charges,854.9,83,,683.92,percent of total billed charges,83% of total,978.5,95,,782.8,percent of total billed charges ,95% of total billed charges,824,80,,659.2,percent of total billed charges,78% of total billed charges,803.4,78,,642.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,648.9,63,,519.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,927,90,,741.6,percent of total billed charges,90% of total billed charges,824,80,,659.2,percent of total billed charges,80% of total billed charges,648.9,63,,519.12,percent of total billed charges,63% of total billed charges,875.5,85,,700.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,813.7,79,,650.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,978.5,
QUICKPASS LASSO CRESCENT,270224957,CDM,270,RC,,,outpatient,,,572,400.4,,451.88,79,,361.5,percent of total billed charges,79% of total billed charges,514.8,90,,411.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.36,63,,288.29,percent of total billed charges,63% of total billed charges,441.7,77.22,,353.36,percent of total billed charges,77.22% of total billed charges,378.09,66.1,,302.47,percent of total billed charges,66.1% of total billed charges,474.76,83,,379.81,percent of total billed charges,83% of total,543.4,95,,434.72,percent of total billed charges ,95% of total billed charges,457.6,80,,366.08,percent of total billed charges,78% of total billed charges,446.16,78,,356.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,360.36,63,,288.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,514.8,90,,411.84,percent of total billed charges,90% of total billed charges,457.6,80,,366.08,percent of total billed charges,80% of total billed charges,360.36,63,,288.29,percent of total billed charges,63% of total billed charges,486.2,85,,388.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,451.88,79,,361.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,360.36,543.4,
DRILL KIT SUTURELOCH,270225001,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
DRILL 10MM LP,270225020,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
ALP GARMENT LARGE THIGH-DISPOS,270225028,CDM,270,RC,,,outpatient,,,76,53.2,,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,58.69,77.22,,46.95,percent of total billed charges,77.22% of total billed charges,50.24,66.1,,40.19,percent of total billed charges,66.1% of total billed charges,63.08,83,,50.46,percent of total billed charges,83% of total,72.2,95,,57.76,percent of total billed charges ,95% of total billed charges,60.8,80,,48.64,percent of total billed charges,78% of total billed charges,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.88,450,
SPECULUM W/LIGHT MED DISP,270225068,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
WIRE LINED .045,270225078,CDM,270,RC,,,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
PEP DEVICE W MOUTHPIECE,270225105,CDM,270,RC,,,outpatient,,,127,88.9,,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,98.07,77.22,,78.46,percent of total billed charges,77.22% of total billed charges,83.95,66.1,,67.16,percent of total billed charges,66.1% of total billed charges,105.41,83,,84.33,percent of total billed charges,83% of total,120.65,95,,96.52,percent of total billed charges ,95% of total billed charges,101.6,80,,81.28,percent of total billed charges,78% of total billed charges,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.01,450,
10MM FLIP CUTTER,270225147,CDM,270,RC,,,outpatient,,,846,592.2,,668.34,79,,534.67,percent of total billed charges,79% of total billed charges,761.4,90,,609.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,532.98,63,,426.38,percent of total billed charges,63% of total billed charges,653.28,77.22,,522.62,percent of total billed charges,77.22% of total billed charges,559.21,66.1,,447.37,percent of total billed charges,66.1% of total billed charges,702.18,83,,561.74,percent of total billed charges,83% of total,803.7,95,,642.96,percent of total billed charges ,95% of total billed charges,676.8,80,,541.44,percent of total billed charges,78% of total billed charges,659.88,78,,527.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,532.98,63,,426.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,532.98,63,,426.38,percent of total billed charges,63% of total billed charges,719.1,85,,575.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,668.34,79,,534.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,803.7,
DISPOSABLE KIT 14MM CORKSCREW,270225159,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
90MM X 1.27 MM BLADE SAGITTAL,270225218,CDM,270,RC,,,outpatient,,,173,121.1,,136.67,79,,109.34,percent of total billed charges,79% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.99,63,,87.19,percent of total billed charges,63% of total billed charges,133.59,77.22,,106.87,percent of total billed charges,77.22% of total billed charges,114.35,66.1,,91.48,percent of total billed charges,66.1% of total billed charges,143.59,83,,114.87,percent of total billed charges,83% of total,164.35,95,,131.48,percent of total billed charges ,95% of total billed charges,138.4,80,,110.72,percent of total billed charges,78% of total billed charges,134.94,78,,107.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,108.99,63,,87.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,108.99,63,,87.19,percent of total billed charges,63% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,136.67,79,,109.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.99,450,
MALYUGIN RING,270225392,CDM,270,RC,,,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,130.88,66.1,,104.7,percent of total billed charges,66.1% of total billed charges,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.74,450,
ALEXIS WOUND RETRACTOR LARGE,270225422,CDM,270,RC,,,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
18MM X 90MM BLADE SAGITTAL,270225477,CDM,270,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
10.5 LP REAMER,270225525,CDM,270,RC,,,outpatient,,,418,292.6,,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,322.78,77.22,,258.22,percent of total billed charges,77.22% of total billed charges,276.3,66.1,,221.04,percent of total billed charges,66.1% of total billed charges,346.94,83,,277.55,percent of total billed charges,83% of total,397.1,95,,317.68,percent of total billed charges ,95% of total billed charges,334.4,80,,267.52,percent of total billed charges,78% of total billed charges,326.04,78,,260.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.34,450,
10.5 RATIO CUTTER,270225565,CDM,270,RC,,,outpatient,,,418,292.6,,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,322.78,77.22,,258.22,percent of total billed charges,77.22% of total billed charges,276.3,66.1,,221.04,percent of total billed charges,66.1% of total billed charges,346.94,83,,277.55,percent of total billed charges,83% of total,397.1,95,,317.68,percent of total billed charges ,95% of total billed charges,334.4,80,,267.52,percent of total billed charges,78% of total billed charges,326.04,78,,260.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.34,450,
JP DRAIN 100MM FLAT DRAIN,270225567,CDM,270,RC,,,outpatient,,,149,104.3,,117.71,79,,94.17,percent of total billed charges,79% of total billed charges,134.1,90,,107.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.87,63,,75.1,percent of total billed charges,63% of total billed charges,115.06,77.22,,92.05,percent of total billed charges,77.22% of total billed charges,98.49,66.1,,78.79,percent of total billed charges,66.1% of total billed charges,123.67,83,,98.94,percent of total billed charges,83% of total,141.55,95,,113.24,percent of total billed charges ,95% of total billed charges,119.2,80,,95.36,percent of total billed charges,78% of total billed charges,116.22,78,,92.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,93.87,63,,75.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,93.87,63,,75.1,percent of total billed charges,63% of total billed charges,126.65,85,,101.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,117.71,79,,94.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.87,450,
OUTFLOW TUBING,270225590,CDM,270,RC,,,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,118.98,66.1,,95.18,percent of total billed charges,66.1% of total billed charges,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.4,450,
SUCTIONS MATERIAL,270225591,CDM,270,RC,,,outpatient,,,273,191.1,,215.67,79,,172.54,percent of total billed charges,79% of total billed charges,245.7,90,,196.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,210.81,77.22,,168.65,percent of total billed charges,77.22% of total billed charges,180.45,66.1,,144.36,percent of total billed charges,66.1% of total billed charges,226.59,83,,181.27,percent of total billed charges,83% of total,259.35,95,,207.48,percent of total billed charges ,95% of total billed charges,218.4,80,,174.72,percent of total billed charges,78% of total billed charges,212.94,78,,170.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,171.99,63,,137.59,percent of total billed charges,63% of total billed charges,232.05,85,,185.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,215.67,79,,172.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,171.99,450,
BLANKET PEDIATRIC WARMING,270225638,CDM,270,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
CLEARCUT DUAL BEVEL CRESENT,270225665,CDM,270,RC,,,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,98.75,79,,79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.75,450,
"PROBE COVER WITH GEL 48""",270225690,CDM,270,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
LIGAMAX 10MM CLIP APPLIER,270225692,CDM,270,RC,,,outpatient,,,288,201.6,,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,222.39,77.22,,177.91,percent of total billed charges,77.22% of total billed charges,190.37,66.1,,152.3,percent of total billed charges,66.1% of total billed charges,239.04,83,,191.23,percent of total billed charges,83% of total,273.6,95,,218.88,percent of total billed charges ,95% of total billed charges,230.4,80,,184.32,percent of total billed charges,78% of total billed charges,224.64,78,,179.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,181.44,450,
9 MM FLIPCUTTER,270225726,CDM,270,RC,,,outpatient,,,697,487.9,,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,627.3,90,,501.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,538.22,77.22,,430.58,percent of total billed charges,77.22% of total billed charges,460.72,66.1,,368.58,percent of total billed charges,66.1% of total billed charges,578.51,83,,462.81,percent of total billed charges,83% of total,662.15,95,,529.72,percent of total billed charges ,95% of total billed charges,557.6,80,,446.08,percent of total billed charges,78% of total billed charges,543.66,78,,434.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,439.11,662.15,
MASIMO LNOP PDT SENSOR,270225764,CDM,270,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
1.6 WIRE,270225791,CDM,270,RC,,,outpatient,,,630,441,,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,567,90,,453.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,486.49,77.22,,389.19,percent of total billed charges,77.22% of total billed charges,416.43,66.1,,333.14,percent of total billed charges,66.1% of total billed charges,522.9,83,,418.32,percent of total billed charges,83% of total,598.5,95,,478.8,percent of total billed charges ,95% of total billed charges,504,80,,403.2,percent of total billed charges,78% of total billed charges,491.4,78,,393.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,396.9,598.5,
CLYCEROLPLUS CORNEAS GPC WHOLE,270225793,CDM,270,RC,,,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,425.25,641.25,
FRENCH NASAL TRUMPET 32,270225796,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
FRENCH NASAL TRUMPET 34,270225797,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
QUICK RELEASE DRILL,270225828,CDM,270,RC,,,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
11 MM CUTTER,270225864,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
PARALLEL GRAFT KNIFE,270225874,CDM,270,RC,,,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,62.8,66.1,,50.24,percent of total billed charges,66.1% of total billed charges,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.85,450,
XSTAR SAFETY KNIFE,270225878,CDM,270,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
1.15 SIDE PORT KNIFE,270225879,CDM,270,RC,,,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
DISPOSABLE KIT FIRE,270225884,CDM,270,RC,,,outpatient,,,1447,1012.9,,1143.13,79,,914.5,percent of total billed charges,79% of total billed charges,1302.3,90,,1041.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,911.61,63,,729.29,percent of total billed charges,63% of total billed charges,1117.37,77.22,,893.9,percent of total billed charges,77.22% of total billed charges,956.47,66.1,,765.18,percent of total billed charges,66.1% of total billed charges,1201.01,83,,960.81,percent of total billed charges,83% of total,1374.65,95,,1099.72,percent of total billed charges ,95% of total billed charges,1157.6,80,,926.08,percent of total billed charges,78% of total billed charges,1128.66,78,,902.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,911.61,63,,729.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,911.61,63,,729.29,percent of total billed charges,63% of total billed charges,1229.95,85,,983.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1143.13,79,,914.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1374.65,
PERCUTANEOUS KIT,270225930,CDM,270,RC,,,outpatient,,,709,496.3,,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,547.49,77.22,,437.99,percent of total billed charges,77.22% of total billed charges,468.65,66.1,,374.92,percent of total billed charges,66.1% of total billed charges,588.47,83,,470.78,percent of total billed charges,83% of total,673.55,95,,538.84,percent of total billed charges ,95% of total billed charges,567.2,80,,453.76,percent of total billed charges,78% of total billed charges,553.02,78,,442.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,446.67,673.55,
STIMUPLAST PUTTY 2.5CC,270225950,CDM,270,RC,,,outpatient,,,990,693,,782.1,79,,625.68,percent of total billed charges,79% of total billed charges,891,90,,712.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,623.7,63,,498.96,percent of total billed charges,63% of total billed charges,764.48,77.22,,611.58,percent of total billed charges,77.22% of total billed charges,654.39,66.1,,523.51,percent of total billed charges,66.1% of total billed charges,821.7,83,,657.36,percent of total billed charges,83% of total,940.5,95,,752.4,percent of total billed charges ,95% of total billed charges,792,80,,633.6,percent of total billed charges,78% of total billed charges,772.2,78,,617.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,623.7,63,,498.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,891,90,,712.8,percent of total billed charges,90% of total billed charges,792,80,,633.6,percent of total billed charges,80% of total billed charges,623.7,63,,498.96,percent of total billed charges,63% of total billed charges,841.5,85,,673.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,782.1,79,,625.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,940.5,
L HOOKS,270225991,CDM,270,RC,,,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,113.69,66.1,,90.95,percent of total billed charges,66.1% of total billed charges,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.36,450,
KII BALLOON BLUNT 12MM TROCAR,270225992,CDM,270,RC,,,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,195.93,450,
L.P. REAMER 9.5,270226063,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
C QUR V-PATCH 3.2X3.2 LARGE,270226139,CDM,270,RC,,,outpatient,,,1283,898.1,,1013.57,79,,810.86,percent of total billed charges,79% of total billed charges,1154.7,90,,923.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,808.29,63,,646.63,percent of total billed charges,63% of total billed charges,990.73,77.22,,792.58,percent of total billed charges,77.22% of total billed charges,848.06,66.1,,678.45,percent of total billed charges,66.1% of total billed charges,1064.89,83,,851.91,percent of total billed charges,83% of total,1218.85,95,,975.08,percent of total billed charges ,95% of total billed charges,1026.4,80,,821.12,percent of total billed charges,78% of total billed charges,1000.74,78,,800.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,808.29,63,,646.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1154.7,90,,923.76,percent of total billed charges,90% of total billed charges,1026.4,80,,821.12,percent of total billed charges,80% of total billed charges,808.29,63,,646.63,percent of total billed charges,63% of total billed charges,1090.55,85,,872.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1013.57,79,,810.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1218.85,
ANGEL BCM KIT,270226164,CDM,270,RC,,,outpatient,,,2205,1543.5,,1741.95,79,,1393.56,percent of total billed charges,79% of total billed charges,1984.5,90,,1587.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1389.15,63,,1111.32,percent of total billed charges,63% of total billed charges,1702.7,77.22,,1362.16,percent of total billed charges,77.22% of total billed charges,1457.51,66.1,,1166.01,percent of total billed charges,66.1% of total billed charges,1830.15,83,,1464.12,percent of total billed charges,83% of total,2094.75,95,,1675.8,percent of total billed charges ,95% of total billed charges,1764,80,,1411.2,percent of total billed charges,78% of total billed charges,1719.9,78,,1375.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1389.15,63,,1111.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,90,,1587.6,percent of total billed charges,90% of total billed charges,1764,80,,1411.2,percent of total billed charges,80% of total billed charges,1389.15,63,,1111.32,percent of total billed charges,63% of total billed charges,1874.25,85,,1499.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1741.95,79,,1393.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2094.75,
WHITE RELOAD STAPLES,270226194,CDM,270,RC,,,outpatient,,,1659,1161.3,,1310.61,79,,1048.49,percent of total billed charges,79% of total billed charges,1493.1,90,,1194.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1045.17,63,,836.14,percent of total billed charges,63% of total billed charges,1281.08,77.22,,1024.86,percent of total billed charges,77.22% of total billed charges,1096.6,66.1,,877.28,percent of total billed charges,66.1% of total billed charges,1376.97,83,,1101.58,percent of total billed charges,83% of total,1576.05,95,,1260.84,percent of total billed charges ,95% of total billed charges,1327.2,80,,1061.76,percent of total billed charges,78% of total billed charges,1294.02,78,,1035.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1045.17,63,,836.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1045.17,63,,836.14,percent of total billed charges,63% of total billed charges,1410.15,85,,1128.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1310.61,79,,1048.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1576.05,
BARD VENTRALEX M CIRCLE/STRAP,270226238,CDM,270,RC,,,outpatient,,,1329,930.3,,1049.91,79,,839.93,percent of total billed charges,79% of total billed charges,1196.1,90,,956.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,837.27,63,,669.82,percent of total billed charges,63% of total billed charges,1026.25,77.22,,821,percent of total billed charges,77.22% of total billed charges,878.47,66.1,,702.78,percent of total billed charges,66.1% of total billed charges,1103.07,83,,882.46,percent of total billed charges,83% of total,1262.55,95,,1010.04,percent of total billed charges ,95% of total billed charges,1063.2,80,,850.56,percent of total billed charges,78% of total billed charges,1036.62,78,,829.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,837.27,63,,669.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1196.1,90,,956.88,percent of total billed charges,90% of total billed charges,1063.2,80,,850.56,percent of total billed charges,80% of total billed charges,837.27,63,,669.82,percent of total billed charges,63% of total billed charges,1129.65,85,,903.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1049.91,79,,839.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1262.55,
BARD VENTRALEX L CIRLCE/STRAP,270226239,CDM,270,RC,,,outpatient,,,1614,1129.8,,1275.06,79,,1020.05,percent of total billed charges,79% of total billed charges,1452.6,90,,1162.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1016.82,63,,813.46,percent of total billed charges,63% of total billed charges,1246.33,77.22,,997.06,percent of total billed charges,77.22% of total billed charges,1066.85,66.1,,853.48,percent of total billed charges,66.1% of total billed charges,1339.62,83,,1071.7,percent of total billed charges,83% of total,1533.3,95,,1226.64,percent of total billed charges ,95% of total billed charges,1291.2,80,,1032.96,percent of total billed charges,78% of total billed charges,1258.92,78,,1007.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1016.82,63,,813.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1452.6,90,,1162.08,percent of total billed charges,90% of total billed charges,1291.2,80,,1032.96,percent of total billed charges,80% of total billed charges,1016.82,63,,813.46,percent of total billed charges,63% of total billed charges,1371.9,85,,1097.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1275.06,79,,1020.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1533.3,
12X3 PASSPORT,270226277,CDM,270,RC,,,outpatient,,,236,165.2,,186.44,79,,149.15,percent of total billed charges,79% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.68,63,,118.94,percent of total billed charges,63% of total billed charges,182.24,77.22,,145.79,percent of total billed charges,77.22% of total billed charges,156,66.1,,124.8,percent of total billed charges,66.1% of total billed charges,195.88,83,,156.7,percent of total billed charges,83% of total,224.2,95,,179.36,percent of total billed charges ,95% of total billed charges,188.8,80,,151.04,percent of total billed charges,78% of total billed charges,184.08,78,,147.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,148.68,63,,118.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,148.68,63,,118.94,percent of total billed charges,63% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,186.44,79,,149.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,148.68,450,
PUSH LOCK DRILL,270226278,CDM,270,RC,,,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
EGIA 4 HANDLE STANDARD,270226281,CDM,270,RC,,,outpatient,,,532,372.4,,420.28,79,,336.22,percent of total billed charges,79% of total billed charges,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,335.16,63,,268.13,percent of total billed charges,63% of total billed charges,410.81,77.22,,328.65,percent of total billed charges,77.22% of total billed charges,351.65,66.1,,281.32,percent of total billed charges,66.1% of total billed charges,441.56,83,,353.25,percent of total billed charges,83% of total,505.4,95,,404.32,percent of total billed charges ,95% of total billed charges,425.6,80,,340.48,percent of total billed charges,78% of total billed charges,414.96,78,,331.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,335.16,63,,268.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,478.8,90,,383.04,percent of total billed charges,90% of total billed charges,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,335.16,63,,268.13,percent of total billed charges,63% of total billed charges,452.2,85,,361.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,420.28,79,,336.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,335.16,505.4,
RESCUE ROT TOOTH PED FORCEPS,270226341,CDM,270,RC,,,outpatient,,,326,228.2,,257.54,79,,206.03,percent of total billed charges,79% of total billed charges,293.4,90,,234.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,205.38,63,,164.3,percent of total billed charges,63% of total billed charges,251.74,77.22,,201.39,percent of total billed charges,77.22% of total billed charges,215.49,66.1,,172.39,percent of total billed charges,66.1% of total billed charges,270.58,83,,216.46,percent of total billed charges,83% of total,309.7,95,,247.76,percent of total billed charges ,95% of total billed charges,260.8,80,,208.64,percent of total billed charges,78% of total billed charges,254.28,78,,203.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,205.38,63,,164.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,205.38,63,,164.3,percent of total billed charges,63% of total billed charges,277.1,85,,221.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,257.54,79,,206.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,205.38,450,
STAPLER 31MM DISP,270226346,CDM,270,RC,,,outpatient,,,1803,1262.1,,1424.37,79,,1139.5,percent of total billed charges,79% of total billed charges,1622.7,90,,1298.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1135.89,63,,908.71,percent of total billed charges,63% of total billed charges,1392.28,77.22,,1113.82,percent of total billed charges,77.22% of total billed charges,1191.78,66.1,,953.42,percent of total billed charges,66.1% of total billed charges,1496.49,83,,1197.19,percent of total billed charges,83% of total,1712.85,95,,1370.28,percent of total billed charges ,95% of total billed charges,1442.4,80,,1153.92,percent of total billed charges,78% of total billed charges,1406.34,78,,1125.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1135.89,63,,908.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1622.7,90,,1298.16,percent of total billed charges,90% of total billed charges,1442.4,80,,1153.92,percent of total billed charges,80% of total billed charges,1135.89,63,,908.71,percent of total billed charges,63% of total billed charges,1532.55,85,,1226.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1424.37,79,,1139.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1712.85,
PASSPORT 6 X 2,270226354,CDM,270,RC,,,outpatient,,,500,350,,395,79,,316,percent of total billed charges,79% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,386.1,77.22,,308.88,percent of total billed charges,77.22% of total billed charges,330.5,66.1,,264.4,percent of total billed charges,66.1% of total billed charges,415,83,,332,percent of total billed charges,83% of total,475,95,,380,percent of total billed charges ,95% of total billed charges,400,80,,320,percent of total billed charges,78% of total billed charges,390,78,,312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,315,63,,252,percent of total billed charges,63% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,395,79,,316,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315,475,
PRE-SUTURED LAT ANKLE TEN,270226386,CDM,270,RC,,,outpatient,,,3110,2177,,2456.9,79,,1965.52,percent of total billed charges,79% of total billed charges,2799,90,,2239.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1959.3,63,,1567.44,percent of total billed charges,63% of total billed charges,2401.54,77.22,,1921.23,percent of total billed charges,77.22% of total billed charges,2055.71,66.1,,1644.57,percent of total billed charges,66.1% of total billed charges,2581.3,83,,2065.04,percent of total billed charges,83% of total,2954.5,95,,2363.6,percent of total billed charges ,95% of total billed charges,2488,80,,1990.4,percent of total billed charges,78% of total billed charges,2425.8,78,,1940.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1959.3,63,,1567.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2799,90,,2239.2,percent of total billed charges,90% of total billed charges,2488,80,,1990.4,percent of total billed charges,80% of total billed charges,1959.3,63,,1567.44,percent of total billed charges,63% of total billed charges,2643.5,85,,2114.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2456.9,79,,1965.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2954.5,
RETROCUTTER 9.5 MM,270226445,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
ANTERIROR VITRECTOMY PROBE 23G,270226471,CDM,270,RC,,,outpatient,,,617,431.9,,487.43,79,,389.94,percent of total billed charges,79% of total billed charges,555.3,90,,444.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,476.45,77.22,,381.16,percent of total billed charges,77.22% of total billed charges,407.84,66.1,,326.27,percent of total billed charges,66.1% of total billed charges,512.11,83,,409.69,percent of total billed charges,83% of total,586.15,95,,468.92,percent of total billed charges ,95% of total billed charges,493.6,80,,394.88,percent of total billed charges,78% of total billed charges,481.26,78,,385.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,487.43,79,,389.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.71,586.15,
CATHETER FINE TIP,270226492,CDM,270,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
DIS INST FOR TENODESIS SCREW,270226527,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
SUTURE TAPE,270226531,CDM,270,RC,,,outpatient,,,161,112.7,,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,124.32,77.22,,99.46,percent of total billed charges,77.22% of total billed charges,106.42,66.1,,85.14,percent of total billed charges,66.1% of total billed charges,133.63,83,,106.9,percent of total billed charges,83% of total,152.95,95,,122.36,percent of total billed charges ,95% of total billed charges,128.8,80,,103.04,percent of total billed charges,78% of total billed charges,125.58,78,,100.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.43,450,
SHOULDER DILOTORS/GRASPERS,270226533,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
MESH VENTRALAX 6.4CM/2.5 MED,270226584,CDM,270,RC,,,outpatient,,,1060,742,,837.4,79,,669.92,percent of total billed charges,79% of total billed charges,954,90,,763.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,667.8,63,,534.24,percent of total billed charges,63% of total billed charges,818.53,77.22,,654.82,percent of total billed charges,77.22% of total billed charges,700.66,66.1,,560.53,percent of total billed charges,66.1% of total billed charges,879.8,83,,703.84,percent of total billed charges,83% of total,1007,95,,805.6,percent of total billed charges ,95% of total billed charges,848,80,,678.4,percent of total billed charges,78% of total billed charges,826.8,78,,661.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,667.8,63,,534.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,954,90,,763.2,percent of total billed charges,90% of total billed charges,848,80,,678.4,percent of total billed charges,80% of total billed charges,667.8,63,,534.24,percent of total billed charges,63% of total billed charges,901,85,,720.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,837.4,79,,669.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1007,
NDLE ULTRAPLEX 360 20GA BY 4IN,270226592,CDM,270,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
PUSHLOCK KIT,270226599,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
CANNULATED BIT,270226600,CDM,270,RC,,,outpatient,,,788,551.6,,622.52,79,,498.02,percent of total billed charges,79% of total billed charges,709.2,90,,567.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496.44,63,,397.15,percent of total billed charges,63% of total billed charges,608.49,77.22,,486.79,percent of total billed charges,77.22% of total billed charges,520.87,66.1,,416.7,percent of total billed charges,66.1% of total billed charges,654.04,83,,523.23,percent of total billed charges,83% of total,748.6,95,,598.88,percent of total billed charges ,95% of total billed charges,630.4,80,,504.32,percent of total billed charges,78% of total billed charges,614.64,78,,491.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,496.44,63,,397.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,496.44,63,,397.15,percent of total billed charges,63% of total billed charges,669.8,85,,535.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,622.52,79,,498.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,748.6,
8.25 NOTCHAL CANNOLA,270226624,CDM,270,RC,,,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,97.17,66.1,,77.74,percent of total billed charges,66.1% of total billed charges,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.61,450,
IOL GLIDE SHEETS (35MMX5MM),270226646,CDM,270,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
THREADED TAB,270226665,CDM,270,RC,,,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.29,450,
9.5 LP REAMER,270226683,CDM,270,RC,,,outpatient,,,418,292.6,,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,322.78,77.22,,258.22,percent of total billed charges,77.22% of total billed charges,276.3,66.1,,221.04,percent of total billed charges,66.1% of total billed charges,346.94,83,,277.55,percent of total billed charges,83% of total,397.1,95,,317.68,percent of total billed charges ,95% of total billed charges,334.4,80,,267.52,percent of total billed charges,78% of total billed charges,326.04,78,,260.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.34,450,
COOLCUT CALIBLATOR,270226686,CDM,270,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
KNIFE BLACK 10MM,270226687,CDM,270,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
ACL KIT,270226688,CDM,270,RC,,,outpatient,,,312,218.4,,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,240.93,77.22,,192.74,percent of total billed charges,77.22% of total billed charges,206.23,66.1,,164.98,percent of total billed charges,66.1% of total billed charges,258.96,83,,207.17,percent of total billed charges,83% of total,296.4,95,,237.12,percent of total billed charges ,95% of total billed charges,249.6,80,,199.68,percent of total billed charges,78% of total billed charges,243.36,78,,194.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,196.56,450,
ABDOMINAL BINDER 46 IN,270226739,CDM,270,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
"BINDER ABDOMINAL 63-78""",270226740,CDM,270,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
GPS USER KIT,270226776,CDM,270,RC,,,outpatient,,,900,630,,711,79,,568.8,percent of total billed charges,79% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,694.98,77.22,,555.98,percent of total billed charges,77.22% of total billed charges,594.9,66.1,,475.92,percent of total billed charges,66.1% of total billed charges,747,83,,597.6,percent of total billed charges,83% of total,855,95,,684,percent of total billed charges ,95% of total billed charges,720,80,,576,percent of total billed charges,78% of total billed charges,702,78,,561.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,567,63,,453.6,percent of total billed charges,63% of total billed charges,765,85,,612,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,711,79,,568.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,855,
SUTURE 663H,270226807,CDM,270,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
BLADESLESS TROCOR 11 X 100,270226842,CDM,270,RC,,,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
TROCAR BLADLESS /HANDLE 12X100,270226843,CDM,270,RC,,,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
TROCAR BLADLESS 5X100,270226844,CDM,270,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
TROCAR BLADELESS,270226845,CDM,270,RC,,,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
TROCAR BLADLESS THRED 5X100,270226846,CDM,270,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
TROCAR BLADLESS THRED 12X100,270226847,CDM,270,RC,,,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.92,450,
TROCAR Z THREAD 11X100MM,270226871,CDM,270,RC,,,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
TROCAR LONG BALLOON 12X130 DIS,270226872,CDM,270,RC,,,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
TROCAR KIT 5 X 150,270226884,CDM,270,RC,,,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
TORCO 5 X 150,270226885,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
TORCO 12 X 150,270226886,CDM,270,RC,,,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,53.54,66.1,,42.83,percent of total billed charges,66.1% of total billed charges,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.03,450,
TROCAR 5 X 100,270226895,CDM,270,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
5MM LAP FUSION,270226914,CDM,270,RC,,,outpatient,,,1181,826.7,,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,911.97,77.22,,729.58,percent of total billed charges,77.22% of total billed charges,780.64,66.1,,624.51,percent of total billed charges,66.1% of total billed charges,980.23,83,,784.18,percent of total billed charges,83% of total,1121.95,95,,897.56,percent of total billed charges ,95% of total billed charges,944.8,80,,755.84,percent of total billed charges,78% of total billed charges,921.18,78,,736.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,944.8,80,,755.84,percent of total billed charges,80% of total billed charges,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,1003.85,85,,803.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1121.95,
OPEN FUSION,270226915,CDM,270,RC,,,outpatient,,,348,243.6,,274.92,79,,219.94,percent of total billed charges,79% of total billed charges,313.2,90,,250.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.24,63,,175.39,percent of total billed charges,63% of total billed charges,268.73,77.22,,214.98,percent of total billed charges,77.22% of total billed charges,230.03,66.1,,184.02,percent of total billed charges,66.1% of total billed charges,288.84,83,,231.07,percent of total billed charges,83% of total,330.6,95,,264.48,percent of total billed charges ,95% of total billed charges,278.4,80,,222.72,percent of total billed charges,78% of total billed charges,271.44,78,,217.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,219.24,63,,175.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,219.24,63,,175.39,percent of total billed charges,63% of total billed charges,295.8,85,,236.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,274.92,79,,219.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,219.24,450,
BLADE THIN PREC 9.0X0.38X25.0,270226935,CDM,270,RC,,,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
GPS SHOULDER REV DRILL KIT,270226955,CDM,270,RC,,,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
RELIATACK,270226972,CDM,270,RC,,,outpatient,,,1710,1197,,1350.9,79,,1080.72,percent of total billed charges,79% of total billed charges,1539,90,,1231.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1077.3,63,,861.84,percent of total billed charges,63% of total billed charges,1320.46,77.22,,1056.37,percent of total billed charges,77.22% of total billed charges,1130.31,66.1,,904.25,percent of total billed charges,66.1% of total billed charges,1419.3,83,,1135.44,percent of total billed charges,83% of total,1624.5,95,,1299.6,percent of total billed charges ,95% of total billed charges,1368,80,,1094.4,percent of total billed charges,78% of total billed charges,1333.8,78,,1067.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1077.3,63,,861.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1077.3,63,,861.84,percent of total billed charges,63% of total billed charges,1453.5,85,,1162.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1350.9,79,,1080.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1624.5,
9MM QUAL TENDON BLADE,270226974,CDM,270,RC,,,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,450,
INTRAOSSEOUS BIOPLASTY KIT,270226976,CDM,270,RC,,,outpatient,,,1027,718.9,,811.33,79,,649.06,percent of total billed charges,79% of total billed charges,924.3,90,,739.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.01,63,,517.61,percent of total billed charges,63% of total billed charges,793.05,77.22,,634.44,percent of total billed charges,77.22% of total billed charges,678.85,66.1,,543.08,percent of total billed charges,66.1% of total billed charges,852.41,83,,681.93,percent of total billed charges,83% of total,975.65,95,,780.52,percent of total billed charges ,95% of total billed charges,821.6,80,,657.28,percent of total billed charges,78% of total billed charges,801.06,78,,640.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,647.01,63,,517.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,647.01,63,,517.61,percent of total billed charges,63% of total billed charges,872.95,85,,698.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,811.33,79,,649.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,975.65,
5MM LP REAMER,270226977,CDM,270,RC,,,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,248.85,450,
"BINDER ABDOMINAL SZ 9""H 30-45""",270226990,CDM,270,RC,,,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
OPTIFIX OPEN ABSORBABLE SYSTEM,270226993,CDM,270,RC,,,outpatient,,,862,603.4,,680.98,79,,544.78,percent of total billed charges,79% of total billed charges,775.8,90,,620.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.06,63,,434.45,percent of total billed charges,63% of total billed charges,665.64,77.22,,532.51,percent of total billed charges,77.22% of total billed charges,569.78,66.1,,455.82,percent of total billed charges,66.1% of total billed charges,715.46,83,,572.37,percent of total billed charges,83% of total,818.9,95,,655.12,percent of total billed charges ,95% of total billed charges,689.6,80,,551.68,percent of total billed charges,78% of total billed charges,672.36,78,,537.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,543.06,63,,434.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,775.8,90,,620.64,percent of total billed charges,90% of total billed charges,689.6,80,,551.68,percent of total billed charges,80% of total billed charges,543.06,63,,434.45,percent of total billed charges,63% of total billed charges,732.7,85,,586.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,680.98,79,,544.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,818.9,
KNIFE 2.8MM 45 DEG BEV UP SLIT,270227042,CDM,270,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
BLADE MED NARROW 18.0 X 5.5MM,270227052,CDM,270,RC,,,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
QUICK RELEASE DRIL 2.8 MM,270227082,CDM,270,RC,,,outpatient,,,491,343.7,,387.89,79,,310.31,percent of total billed charges,79% of total billed charges,441.9,90,,353.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,309.33,63,,247.46,percent of total billed charges,63% of total billed charges,379.15,77.22,,303.32,percent of total billed charges,77.22% of total billed charges,324.55,66.1,,259.64,percent of total billed charges,66.1% of total billed charges,407.53,83,,326.02,percent of total billed charges,83% of total,466.45,95,,373.16,percent of total billed charges ,95% of total billed charges,392.8,80,,314.24,percent of total billed charges,78% of total billed charges,382.98,78,,306.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,309.33,63,,247.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,441.9,90,,353.52,percent of total billed charges,90% of total billed charges,392.8,80,,314.24,percent of total billed charges,80% of total billed charges,309.33,63,,247.46,percent of total billed charges,63% of total billed charges,417.35,85,,333.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,387.89,79,,310.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,309.33,466.45,
QUICK RELEASE DRILL 2.0 MM,270227083,CDM,270,RC,,,outpatient,,,491,343.7,,387.89,79,,310.31,percent of total billed charges,79% of total billed charges,441.9,90,,353.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,309.33,63,,247.46,percent of total billed charges,63% of total billed charges,379.15,77.22,,303.32,percent of total billed charges,77.22% of total billed charges,324.55,66.1,,259.64,percent of total billed charges,66.1% of total billed charges,407.53,83,,326.02,percent of total billed charges,83% of total,466.45,95,,373.16,percent of total billed charges ,95% of total billed charges,392.8,80,,314.24,percent of total billed charges,78% of total billed charges,382.98,78,,306.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,309.33,63,,247.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,441.9,90,,353.52,percent of total billed charges,90% of total billed charges,392.8,80,,314.24,percent of total billed charges,80% of total billed charges,309.33,63,,247.46,percent of total billed charges,63% of total billed charges,417.35,85,,333.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,387.89,79,,310.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,309.33,466.45,
TROCAR POINT PIN 3.2 SZ 2.6,270227104,CDM,270,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
CAPSURE FIXATION 30 COUNT,270227110,CDM,270,RC,,,outpatient,,,2126,1488.2,,1679.54,79,,1343.63,percent of total billed charges,79% of total billed charges,1913.4,90,,1530.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1339.38,63,,1071.5,percent of total billed charges,63% of total billed charges,1641.7,77.22,,1313.36,percent of total billed charges,77.22% of total billed charges,1405.29,66.1,,1124.23,percent of total billed charges,66.1% of total billed charges,1764.58,83,,1411.66,percent of total billed charges,83% of total,2019.7,95,,1615.76,percent of total billed charges ,95% of total billed charges,1700.8,80,,1360.64,percent of total billed charges,78% of total billed charges,1658.28,78,,1326.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1339.38,63,,1071.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1913.4,90,,1530.72,percent of total billed charges,90% of total billed charges,1700.8,80,,1360.64,percent of total billed charges,80% of total billed charges,1339.38,63,,1071.5,percent of total billed charges,63% of total billed charges,1807.1,85,,1445.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1679.54,79,,1343.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2019.7,
BANANA KNIFE,270227135,CDM,270,RC,,,outpatient,,,179,125.3,,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.77,63,,90.22,percent of total billed charges,63% of total billed charges,138.22,77.22,,110.58,percent of total billed charges,77.22% of total billed charges,118.32,66.1,,94.66,percent of total billed charges,66.1% of total billed charges,148.57,83,,118.86,percent of total billed charges,83% of total,170.05,95,,136.04,percent of total billed charges ,95% of total billed charges,143.2,80,,114.56,percent of total billed charges,78% of total billed charges,139.62,78,,111.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,112.77,63,,90.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,112.77,63,,90.22,percent of total billed charges,63% of total billed charges,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.77,450,
STIRRUP COVER PAIR 29X43,270227192,CDM,270,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
GEMINI CANNULA,270227195,CDM,270,RC,,,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,97.17,66.1,,77.74,percent of total billed charges,66.1% of total billed charges,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.61,450,
DRILL LONG 2.7,270227201,CDM,270,RC,,,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.85,450,
DRILL 3.5,270227202,CDM,270,RC,,,outpatient,,,201,140.7,,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,155.21,77.22,,124.17,percent of total billed charges,77.22% of total billed charges,132.86,66.1,,106.29,percent of total billed charges,66.1% of total billed charges,166.83,83,,133.46,percent of total billed charges,83% of total,190.95,95,,152.76,percent of total billed charges ,95% of total billed charges,160.8,80,,128.64,percent of total billed charges,78% of total billed charges,156.78,78,,125.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,126.63,63,,101.3,percent of total billed charges,63% of total billed charges,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126.63,450,
DRILL SHORT 2.7,270227203,CDM,270,RC,,,outpatient,,,181,126.7,,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,139.77,77.22,,111.82,percent of total billed charges,77.22% of total billed charges,119.64,66.1,,95.71,percent of total billed charges,66.1% of total billed charges,150.23,83,,120.18,percent of total billed charges,83% of total,171.95,95,,137.56,percent of total billed charges ,95% of total billed charges,144.8,80,,115.84,percent of total billed charges,78% of total billed charges,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,114.03,450,
DRILL 2.0,270227204,CDM,270,RC,,,outpatient,,,181,126.7,,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,139.77,77.22,,111.82,percent of total billed charges,77.22% of total billed charges,119.64,66.1,,95.71,percent of total billed charges,66.1% of total billed charges,150.23,83,,120.18,percent of total billed charges,83% of total,171.95,95,,137.56,percent of total billed charges ,95% of total billed charges,144.8,80,,115.84,percent of total billed charges,78% of total billed charges,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,114.03,450,
MYOSURE LITE,270227245,CDM,270,RC,,,outpatient,,,688,481.6,,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,531.27,77.22,,425.02,percent of total billed charges,77.22% of total billed charges,454.77,66.1,,363.82,percent of total billed charges,66.1% of total billed charges,571.04,83,,456.83,percent of total billed charges,83% of total,653.6,95,,522.88,percent of total billed charges ,95% of total billed charges,550.4,80,,440.32,percent of total billed charges,78% of total billed charges,536.64,78,,429.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,433.44,653.6,
AQUILEX INFLOW TUBING,270227246,CDM,270,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
AQUILEX OUT FLOW TUBING,270227247,CDM,270,RC,,,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
MYOSURE REACH,270227248,CDM,270,RC,,,outpatient,,,3267,2286.9,,2580.93,79,,2064.74,percent of total billed charges,79% of total billed charges,2940.3,90,,2352.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2058.21,63,,1646.57,percent of total billed charges,63% of total billed charges,2522.78,77.22,,2018.22,percent of total billed charges,77.22% of total billed charges,2159.49,66.1,,1727.59,percent of total billed charges,66.1% of total billed charges,2711.61,83,,2169.29,percent of total billed charges,83% of total,3103.65,95,,2482.92,percent of total billed charges ,95% of total billed charges,2613.6,80,,2090.88,percent of total billed charges,78% of total billed charges,2548.26,78,,2038.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2058.21,63,,1646.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2940.3,90,,2352.24,percent of total billed charges,90% of total billed charges,2613.6,80,,2090.88,percent of total billed charges,80% of total billed charges,2058.21,63,,1646.57,percent of total billed charges,63% of total billed charges,2776.95,85,,2221.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2580.93,79,,2064.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3103.65,
3.5 MM DRILL BIT,270227262,CDM,270,RC,,,outpatient,,,475,332.5,,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,427.5,90,,342,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,366.8,77.22,,293.44,percent of total billed charges,77.22% of total billed charges,313.98,66.1,,251.18,percent of total billed charges,66.1% of total billed charges,394.25,83,,315.4,percent of total billed charges,83% of total,451.25,95,,361,percent of total billed charges ,95% of total billed charges,380,80,,304,percent of total billed charges,78% of total billed charges,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,299.25,451.25,
POST OP SHOE MEDIUM,270227295,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
"SHOE, POST OP MALE X-LARGE",270227297,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
CPAP BIPAP MASK S/M ADLT FLWSF,270227302,CDM,270,RC,,,outpatient,,,184,128.8,,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,142.08,77.22,,113.66,percent of total billed charges,77.22% of total billed charges,121.62,66.1,,97.3,percent of total billed charges,66.1% of total billed charges,152.72,83,,122.18,percent of total billed charges,83% of total,174.8,95,,139.84,percent of total billed charges ,95% of total billed charges,147.2,80,,117.76,percent of total billed charges,78% of total billed charges,143.52,78,,114.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.92,450,
CPAP BIPAP MASK LGE ADLT FLWSF,270227303,CDM,270,RC,,,outpatient,,,184,128.8,,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,142.08,77.22,,113.66,percent of total billed charges,77.22% of total billed charges,121.62,66.1,,97.3,percent of total billed charges,66.1% of total billed charges,152.72,83,,122.18,percent of total billed charges,83% of total,174.8,95,,139.84,percent of total billed charges ,95% of total billed charges,147.2,80,,117.76,percent of total billed charges,78% of total billed charges,143.52,78,,114.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.92,450,
TRI-STAPLE RELOADS 60MM,270227313,CDM,270,RC,,,outpatient,,,1320,924,,1042.8,79,,834.24,percent of total billed charges,79% of total billed charges,1188,90,,950.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,831.6,63,,665.28,percent of total billed charges,63% of total billed charges,1019.3,77.22,,815.44,percent of total billed charges,77.22% of total billed charges,872.52,66.1,,698.02,percent of total billed charges,66.1% of total billed charges,1095.6,83,,876.48,percent of total billed charges,83% of total,1254,95,,1003.2,percent of total billed charges ,95% of total billed charges,1056,80,,844.8,percent of total billed charges,78% of total billed charges,1029.6,78,,823.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,831.6,63,,665.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,831.6,63,,665.28,percent of total billed charges,63% of total billed charges,1122,85,,897.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1042.8,79,,834.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1254,
TRI STAPLE RELOADS 45MM,270227314,CDM,270,RC,,,outpatient,,,1295,906.5,,1023.05,79,,818.44,percent of total billed charges,79% of total billed charges,1165.5,90,,932.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,815.85,63,,652.68,percent of total billed charges,63% of total billed charges,1000,77.22,,800,percent of total billed charges,77.22% of total billed charges,856,66.1,,684.8,percent of total billed charges,66.1% of total billed charges,1074.85,83,,859.88,percent of total billed charges,83% of total,1230.25,95,,984.2,percent of total billed charges ,95% of total billed charges,1036,80,,828.8,percent of total billed charges,78% of total billed charges,1010.1,78,,808.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,815.85,63,,652.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,815.85,63,,652.68,percent of total billed charges,63% of total billed charges,1100.75,85,,880.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1023.05,79,,818.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1230.25,
HERNIA PATCH 8CM X 12CM,270227331,CDM,270,RC,,,outpatient,,,1935,1354.5,,1528.65,79,,1222.92,percent of total billed charges,79% of total billed charges,1741.5,90,,1393.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1219.05,63,,975.24,percent of total billed charges,63% of total billed charges,1494.21,77.22,,1195.37,percent of total billed charges,77.22% of total billed charges,1279.04,66.1,,1023.23,percent of total billed charges,66.1% of total billed charges,1606.05,83,,1284.84,percent of total billed charges,83% of total,1838.25,95,,1470.6,percent of total billed charges ,95% of total billed charges,1548,80,,1238.4,percent of total billed charges,78% of total billed charges,1509.3,78,,1207.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1219.05,63,,975.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1741.5,90,,1393.2,percent of total billed charges,90% of total billed charges,1548,80,,1238.4,percent of total billed charges,80% of total billed charges,1219.05,63,,975.24,percent of total billed charges,63% of total billed charges,1644.75,85,,1315.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1528.65,79,,1222.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1838.25,
MYOSURE XL,270227399,CDM,270,RC,,,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
MENISCUS REPAIR NEEDLE,270227400,CDM,270,RC,,,outpatient,,,2227,1558.9,,1759.33,79,,1407.46,percent of total billed charges,79% of total billed charges,2004.3,90,,1603.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1403.01,63,,1122.41,percent of total billed charges,63% of total billed charges,1719.69,77.22,,1375.75,percent of total billed charges,77.22% of total billed charges,1472.05,66.1,,1177.64,percent of total billed charges,66.1% of total billed charges,1848.41,83,,1478.73,percent of total billed charges,83% of total,2115.65,95,,1692.52,percent of total billed charges ,95% of total billed charges,1781.6,80,,1425.28,percent of total billed charges,78% of total billed charges,1737.06,78,,1389.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1403.01,63,,1122.41,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2004.3,90,,1603.44,percent of total billed charges,90% of total billed charges,1781.6,80,,1425.28,percent of total billed charges,80% of total billed charges,1403.01,63,,1122.41,percent of total billed charges,63% of total billed charges,1892.95,85,,1514.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1759.33,79,,1407.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2115.65,
ZONE CANNULE,270227401,CDM,270,RC,,,outpatient,,,537,375.9,,424.23,79,,339.38,percent of total billed charges,79% of total billed charges,483.3,90,,386.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,414.67,77.22,,331.74,percent of total billed charges,77.22% of total billed charges,354.96,66.1,,283.97,percent of total billed charges,66.1% of total billed charges,445.71,83,,356.57,percent of total billed charges,83% of total,510.15,95,,408.12,percent of total billed charges ,95% of total billed charges,429.6,80,,343.68,percent of total billed charges,78% of total billed charges,418.86,78,,335.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,424.23,79,,339.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,338.31,510.15,
ZONE HANDLE,270227402,CDM,270,RC,,,outpatient,,,805,563.5,,635.95,79,,508.76,percent of total billed charges,79% of total billed charges,724.5,90,,579.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,507.15,63,,405.72,percent of total billed charges,63% of total billed charges,621.62,77.22,,497.3,percent of total billed charges,77.22% of total billed charges,532.11,66.1,,425.69,percent of total billed charges,66.1% of total billed charges,668.15,83,,534.52,percent of total billed charges,83% of total,764.75,95,,611.8,percent of total billed charges ,95% of total billed charges,644,80,,515.2,percent of total billed charges,78% of total billed charges,627.9,78,,502.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,507.15,63,,405.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,724.5,90,,579.6,percent of total billed charges,90% of total billed charges,644,80,,515.2,percent of total billed charges,80% of total billed charges,507.15,63,,405.72,percent of total billed charges,63% of total billed charges,684.25,85,,547.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,635.95,79,,508.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,764.75,
AQUILEX TUBING,270227429,CDM,270,RC,,,outpatient,,,277,193.9,,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,213.9,77.22,,171.12,percent of total billed charges,77.22% of total billed charges,183.1,66.1,,146.48,percent of total billed charges,66.1% of total billed charges,229.91,83,,183.93,percent of total billed charges,83% of total,263.15,95,,210.52,percent of total billed charges ,95% of total billed charges,221.6,80,,177.28,percent of total billed charges,78% of total billed charges,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.51,450,
MYOSURE LITE,270227430,CDM,270,RC,,,outpatient,,,1240,868,,979.6,79,,783.68,percent of total billed charges,79% of total billed charges,1116,90,,892.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,781.2,63,,624.96,percent of total billed charges,63% of total billed charges,957.53,77.22,,766.02,percent of total billed charges,77.22% of total billed charges,819.64,66.1,,655.71,percent of total billed charges,66.1% of total billed charges,1029.2,83,,823.36,percent of total billed charges,83% of total,1178,95,,942.4,percent of total billed charges ,95% of total billed charges,992,80,,793.6,percent of total billed charges,78% of total billed charges,967.2,78,,773.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,781.2,63,,624.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1116,90,,892.8,percent of total billed charges,90% of total billed charges,992,80,,793.6,percent of total billed charges,80% of total billed charges,781.2,63,,624.96,percent of total billed charges,63% of total billed charges,1054,85,,843.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,979.6,79,,783.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1178,
MYOSURE REACH,270227431,CDM,270,RC,,,outpatient,,,2168,1517.6,,1712.72,79,,1370.18,percent of total billed charges,79% of total billed charges,1951.2,90,,1560.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1365.84,63,,1092.67,percent of total billed charges,63% of total billed charges,1674.13,77.22,,1339.3,percent of total billed charges,77.22% of total billed charges,1433.05,66.1,,1146.44,percent of total billed charges,66.1% of total billed charges,1799.44,83,,1439.55,percent of total billed charges,83% of total,2059.6,95,,1647.68,percent of total billed charges ,95% of total billed charges,1734.4,80,,1387.52,percent of total billed charges,78% of total billed charges,1691.04,78,,1352.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1365.84,63,,1092.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1951.2,90,,1560.96,percent of total billed charges,90% of total billed charges,1734.4,80,,1387.52,percent of total billed charges,80% of total billed charges,1365.84,63,,1092.67,percent of total billed charges,63% of total billed charges,1842.8,85,,1474.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1712.72,79,,1370.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2059.6,
MYOSURE XL,270227432,CDM,270,RC,,,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
UNIT PUSHER CUTTER,270227745,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
WC POST OP SHOE MEN SMALL,270227763,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
WC POST OP SHOE MEN MEDIUM,270227764,CDM,270,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SNARE 25MM,270227781,CDM,270,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
RUMI UTERINE MANIPULATOR 2.5,270227812,CDM,270,RC,,,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,200.34,450,
RUMI MANIPULATOR 3.0,270227813,CDM,270,RC,,,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,200.34,450,
RUMI UTERINE MANIPULATOR 3.5,270227814,CDM,270,RC,,,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,200.34,450,
RUMI INTRAUTERINE TIPS 5.1 X 6,270227815,CDM,270,RC,,,outpatient,,,171,119.7,,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,132.05,77.22,,105.64,percent of total billed charges,77.22% of total billed charges,113.03,66.1,,90.42,percent of total billed charges,66.1% of total billed charges,141.93,83,,113.54,percent of total billed charges,83% of total,162.45,95,,129.96,percent of total billed charges ,95% of total billed charges,136.8,80,,109.44,percent of total billed charges,78% of total billed charges,133.38,78,,106.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.73,450,
RUMI INTRAUTERINE 6.7 X 6,270227816,CDM,270,RC,,,outpatient,,,171,119.7,,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,132.05,77.22,,105.64,percent of total billed charges,77.22% of total billed charges,113.03,66.1,,90.42,percent of total billed charges,66.1% of total billed charges,141.93,83,,113.54,percent of total billed charges,83% of total,162.45,95,,129.96,percent of total billed charges ,95% of total billed charges,136.8,80,,109.44,percent of total billed charges,78% of total billed charges,133.38,78,,106.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.73,450,
RUMI TIPS 6.7 X 8,270227817,CDM,270,RC,,,outpatient,,,171,119.7,,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,132.05,77.22,,105.64,percent of total billed charges,77.22% of total billed charges,113.03,66.1,,90.42,percent of total billed charges,66.1% of total billed charges,141.93,83,,113.54,percent of total billed charges,83% of total,162.45,95,,129.96,percent of total billed charges ,95% of total billed charges,136.8,80,,109.44,percent of total billed charges,78% of total billed charges,133.38,78,,106.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.73,63,,86.18,percent of total billed charges,63% of total billed charges,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.73,450,
2.0 DRILL,270227890,CDM,270,RC,,,outpatient,,,575,402.5,,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,444.02,77.22,,355.22,percent of total billed charges,77.22% of total billed charges,380.08,66.1,,304.06,percent of total billed charges,66.1% of total billed charges,477.25,83,,381.8,percent of total billed charges,83% of total,546.25,95,,437,percent of total billed charges ,95% of total billed charges,460,80,,368,percent of total billed charges,78% of total billed charges,448.5,78,,358.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,362.25,546.25,
COVID19 HELMET KIT C,270227894,CDM,270,RC,,,outpatient,,,630,441,,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,567,90,,453.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,486.49,77.22,,389.19,percent of total billed charges,77.22% of total billed charges,416.43,66.1,,333.14,percent of total billed charges,66.1% of total billed charges,522.9,83,,418.32,percent of total billed charges,83% of total,598.5,95,,478.8,percent of total billed charges ,95% of total billed charges,504,80,,403.2,percent of total billed charges,78% of total billed charges,491.4,78,,393.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,396.9,598.5,
5.5 55MM JONES SCREW,270227929,CDM,270,RC,,,outpatient,,,2812.5,1968.75,,2221.88,79,,1777.5,percent of total billed charges,79% of total billed charges,2531.25,90,,2025,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1771.88,63,,1417.5,percent of total billed charges,63% of total billed charges,2171.81,77.22,,1737.45,percent of total billed charges,77.22% of total billed charges,1859.06,66.1,,1487.25,percent of total billed charges,66.1% of total billed charges,2334.38,83,,1867.5,percent of total billed charges,83% of total,2671.88,95,,2137.5,percent of total billed charges ,95% of total billed charges,2250,80,,1800,percent of total billed charges,78% of total billed charges,2193.75,78,,1755,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1771.88,63,,1417.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2531.25,90,,2025,percent of total billed charges,90% of total billed charges,2250,80,,1800,percent of total billed charges,80% of total billed charges,1771.88,63,,1417.5,percent of total billed charges,63% of total billed charges,2390.63,85,,1912.504,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2221.88,79,,1777.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2671.88,
3.2 DRILL,270227932,CDM,270,RC,,,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,227.38,66.1,,181.9,percent of total billed charges,66.1% of total billed charges,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,216.72,450,
3.8MM DRILL,270227981,CDM,270,RC,,,outpatient,,,550,385,,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,495,90,,396,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,424.71,77.22,,339.77,percent of total billed charges,77.22% of total billed charges,363.55,66.1,,290.84,percent of total billed charges,66.1% of total billed charges,456.5,83,,365.2,percent of total billed charges,83% of total,522.5,95,,418,percent of total billed charges ,95% of total billed charges,440,80,,352,percent of total billed charges,78% of total billed charges,429,78,,343.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,495,90,,396,percent of total billed charges,90% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,467.5,85,,374,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,346.5,522.5,
3.8MM DRILL,270227982,CDM,270,RC,,,outpatient,,,575,402.5,,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,444.02,77.22,,355.22,percent of total billed charges,77.22% of total billed charges,380.08,66.1,,304.06,percent of total billed charges,66.1% of total billed charges,477.25,83,,381.8,percent of total billed charges,83% of total,546.25,95,,437,percent of total billed charges ,95% of total billed charges,460,80,,368,percent of total billed charges,78% of total billed charges,448.5,78,,358.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,362.25,546.25,
3.8MM CANNULATED DRILL,270227985,CDM,270,RC,,,outpatient,,,1282,897.4,,1012.78,79,,810.22,percent of total billed charges,79% of total billed charges,1153.8,90,,923.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,807.66,63,,646.13,percent of total billed charges,63% of total billed charges,989.96,77.22,,791.97,percent of total billed charges,77.22% of total billed charges,847.4,66.1,,677.92,percent of total billed charges,66.1% of total billed charges,1064.06,83,,851.25,percent of total billed charges,83% of total,1217.9,95,,974.32,percent of total billed charges ,95% of total billed charges,1025.6,80,,820.48,percent of total billed charges,78% of total billed charges,999.96,78,,799.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,807.66,63,,646.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1153.8,90,,923.04,percent of total billed charges,90% of total billed charges,1025.6,80,,820.48,percent of total billed charges,80% of total billed charges,807.66,63,,646.13,percent of total billed charges,63% of total billed charges,1089.7,85,,871.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1012.78,79,,810.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1217.9,
BIPAP CPAP HFT CIRCUIT,270228022,CDM,270,RC,,,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.29,450,
CONCHA SMART TEMP PROBE,270228023,CDM,270,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
CANNULA V60 BIPAP HFT,270228026,CDM,270,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
FIBERLINK,270228173,CDM,270,RC,,,outpatient,,,355,248.5,,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,274.13,77.22,,219.3,percent of total billed charges,77.22% of total billed charges,234.66,66.1,,187.73,percent of total billed charges,66.1% of total billed charges,294.65,83,,235.72,percent of total billed charges,83% of total,337.25,95,,269.8,percent of total billed charges ,95% of total billed charges,284,80,,227.2,percent of total billed charges,78% of total billed charges,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,301.75,85,,241.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,223.65,450,
SWIFT STITCH PASSER,270228174,CDM,270,RC,,,outpatient,,,772,540.4,,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,596.14,77.22,,476.91,percent of total billed charges,77.22% of total billed charges,510.29,66.1,,408.23,percent of total billed charges,66.1% of total billed charges,640.76,83,,512.61,percent of total billed charges,83% of total,733.4,95,,586.72,percent of total billed charges ,95% of total billed charges,617.6,80,,494.08,percent of total billed charges,78% of total billed charges,602.16,78,,481.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,733.4,
TIGERLINK PLUS,270228176,CDM,270,RC,,,outpatient,,,397,277.9,,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,306.56,77.22,,245.25,percent of total billed charges,77.22% of total billed charges,262.42,66.1,,209.94,percent of total billed charges,66.1% of total billed charges,329.51,83,,263.61,percent of total billed charges,83% of total,377.15,95,,301.72,percent of total billed charges ,95% of total billed charges,317.6,80,,254.08,percent of total billed charges,78% of total billed charges,309.66,78,,247.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,250.11,450,
TIGERLINK,270228286,CDM,270,RC,,,outpatient,,,355,248.5,,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,274.13,77.22,,219.3,percent of total billed charges,77.22% of total billed charges,234.66,66.1,,187.73,percent of total billed charges,66.1% of total billed charges,294.65,83,,235.72,percent of total billed charges,83% of total,337.25,95,,269.8,percent of total billed charges ,95% of total billed charges,284,80,,227.2,percent of total billed charges,78% of total billed charges,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,223.65,63,,178.92,percent of total billed charges,63% of total billed charges,301.75,85,,241.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,223.65,450,
FIBERLINK PLUS,270228288,CDM,270,RC,,,outpatient,,,397,277.9,,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,306.56,77.22,,245.25,percent of total billed charges,77.22% of total billed charges,262.42,66.1,,209.94,percent of total billed charges,66.1% of total billed charges,329.51,83,,263.61,percent of total billed charges,83% of total,377.15,95,,301.72,percent of total billed charges ,95% of total billed charges,317.6,80,,254.08,percent of total billed charges,78% of total billed charges,309.66,78,,247.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,250.11,450,
ARTHREX METAL ANCHORS,270228289,CDM,270,RC,,,outpatient,,,575,402.5,,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,444.02,77.22,,355.22,percent of total billed charges,77.22% of total billed charges,380.08,66.1,,304.06,percent of total billed charges,66.1% of total billed charges,477.25,83,,381.8,percent of total billed charges,83% of total,546.25,95,,437,percent of total billed charges ,95% of total billed charges,460,80,,368,percent of total billed charges,78% of total billed charges,448.5,78,,358.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,362.25,546.25,
FREENEEDLE,270228985,CDM,270,RC,,,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.29,450,
DRILL 4MM,270228986,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
FIBERTAPE 1.7 W/ NEEDLE,270228987,CDM,270,RC,,,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,198.3,66.1,,158.64,percent of total billed charges,66.1% of total billed charges,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,189,63,,151.2,percent of total billed charges,63% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,237,79,,189.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,189,450,
TIFERTAPE 7.7 W/ NEEDLE,270228988,CDM,270,RC,,,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,198.3,66.1,,158.64,percent of total billed charges,66.1% of total billed charges,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,189,63,,151.2,percent of total billed charges,63% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,237,79,,189.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,189,450,
TENODESIS KIT W FIBER LOOP,270229032,CDM,270,RC,,,outpatient,,,950,665,,750.5,79,,600.4,percent of total billed charges,79% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,598.5,63,,478.8,percent of total billed charges,63% of total billed charges,733.59,77.22,,586.87,percent of total billed charges,77.22% of total billed charges,627.95,66.1,,502.36,percent of total billed charges,66.1% of total billed charges,788.5,83,,630.8,percent of total billed charges,83% of total,902.5,95,,722,percent of total billed charges ,95% of total billed charges,760,80,,608,percent of total billed charges,78% of total billed charges,741,78,,592.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,598.5,63,,478.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,598.5,63,,478.8,percent of total billed charges,63% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,750.5,79,,600.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,902.5,
CANNULATED DRILL 4.5,270229035,CDM,270,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
OVER DRILL 2.7 MM,270229158,CDM,270,RC,,,outpatient,,,660,462,,521.4,79,,417.12,percent of total billed charges,79% of total billed charges,594,90,,475.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,415.8,63,,332.64,percent of total billed charges,63% of total billed charges,509.65,77.22,,407.72,percent of total billed charges,77.22% of total billed charges,436.26,66.1,,349.01,percent of total billed charges,66.1% of total billed charges,547.8,83,,438.24,percent of total billed charges,83% of total,627,95,,501.6,percent of total billed charges ,95% of total billed charges,528,80,,422.4,percent of total billed charges,78% of total billed charges,514.8,78,,411.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,415.8,63,,332.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,594,90,,475.2,percent of total billed charges,90% of total billed charges,528,80,,422.4,percent of total billed charges,80% of total billed charges,415.8,63,,332.64,percent of total billed charges,63% of total billed charges,561,85,,448.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,521.4,79,,417.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,415.8,627,
SUTURE TAPE BLACK/WHITE,270229173,CDM,270,RC,,,outpatient,,,197,137.9,,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,152.12,77.22,,121.7,percent of total billed charges,77.22% of total billed charges,130.22,66.1,,104.18,percent of total billed charges,66.1% of total billed charges,163.51,83,,130.81,percent of total billed charges,83% of total,187.15,95,,149.72,percent of total billed charges ,95% of total billed charges,157.6,80,,126.08,percent of total billed charges,78% of total billed charges,153.66,78,,122.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.11,450,
STRYKER SAW BLADE,270229233,CDM,270,RC,,,outpatient,,,174,121.8,,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,134.36,77.22,,107.49,percent of total billed charges,77.22% of total billed charges,115.01,66.1,,92.01,percent of total billed charges,66.1% of total billed charges,144.42,83,,115.54,percent of total billed charges,83% of total,165.3,95,,132.24,percent of total billed charges ,95% of total billed charges,139.2,80,,111.36,percent of total billed charges,78% of total billed charges,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.62,450,
UNIVERSAL HEAD POSITIONER,270229282,CDM,270,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
DISPOSABLE KIT 3.9 CORKSCREW,270229283,CDM,270,RC,,,outpatient,,,950,665,,750.5,79,,600.4,percent of total billed charges,79% of total billed charges,855,90,,684,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,598.5,63,,478.8,percent of total billed charges,63% of total billed charges,733.59,77.22,,586.87,percent of total billed charges,77.22% of total billed charges,627.95,66.1,,502.36,percent of total billed charges,66.1% of total billed charges,788.5,83,,630.8,percent of total billed charges,83% of total,902.5,95,,722,percent of total billed charges ,95% of total billed charges,760,80,,608,percent of total billed charges,78% of total billed charges,741,78,,592.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,598.5,63,,478.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,598.5,63,,478.8,percent of total billed charges,63% of total billed charges,807.5,85,,646,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,750.5,79,,600.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,902.5,
PROFILE DRILL 9.5,270229286,CDM,270,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
4.5 BONE TAP,270229306,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
5.5 BONE TAP,270229307,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
FIBULOCK IMPLANT SYSTEM,270229309,CDM,270,RC,,,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
3.7MM DRILL,270229312,CDM,270,RC,,,outpatient,,,465,325.5,,367.35,79,,293.88,percent of total billed charges,79% of total billed charges,418.5,90,,334.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292.95,63,,234.36,percent of total billed charges,63% of total billed charges,359.07,77.22,,287.26,percent of total billed charges,77.22% of total billed charges,307.37,66.1,,245.9,percent of total billed charges,66.1% of total billed charges,385.95,83,,308.76,percent of total billed charges,83% of total,441.75,95,,353.4,percent of total billed charges ,95% of total billed charges,372,80,,297.6,percent of total billed charges,78% of total billed charges,362.7,78,,290.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,292.95,63,,234.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,292.95,63,,234.36,percent of total billed charges,63% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,367.35,79,,293.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,292.95,450,
1.7MM DRILL,270229358,CDM,270,RC,,,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
2.5MM DRILL,270229359,CDM,270,RC,,,outpatient,,,314,219.8,,248.06,79,,198.45,percent of total billed charges,79% of total billed charges,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,197.82,63,,158.26,percent of total billed charges,63% of total billed charges,242.47,77.22,,193.98,percent of total billed charges,77.22% of total billed charges,207.55,66.1,,166.04,percent of total billed charges,66.1% of total billed charges,260.62,83,,208.5,percent of total billed charges,83% of total,298.3,95,,238.64,percent of total billed charges ,95% of total billed charges,251.2,80,,200.96,percent of total billed charges,78% of total billed charges,244.92,78,,195.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,197.82,63,,158.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,197.82,63,,158.26,percent of total billed charges,63% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.06,79,,198.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,197.82,450,
EXACTECH CEMENT BOWL/SPATULA,270229387,CDM,270,RC,,,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,22.47,66.1,,17.98,percent of total billed charges,66.1% of total billed charges,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,21.42,63,,17.14,percent of total billed charges,63% of total billed charges,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.42,450,
OPTETRAK PINS 25MM 130MM 4.0,270229388,CDM,270,RC,,,outpatient,,,828,579.6,,654.12,79,,523.3,percent of total billed charges,79% of total billed charges,745.2,90,,596.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.64,63,,417.31,percent of total billed charges,63% of total billed charges,639.38,77.22,,511.5,percent of total billed charges,77.22% of total billed charges,547.31,66.1,,437.85,percent of total billed charges,66.1% of total billed charges,687.24,83,,549.79,percent of total billed charges,83% of total,786.6,95,,629.28,percent of total billed charges ,95% of total billed charges,662.4,80,,529.92,percent of total billed charges,78% of total billed charges,645.84,78,,516.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,521.64,63,,417.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,745.2,90,,596.16,percent of total billed charges,90% of total billed charges,662.4,80,,529.92,percent of total billed charges,80% of total billed charges,521.64,63,,417.31,percent of total billed charges,63% of total billed charges,703.8,85,,563.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,654.12,79,,523.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,786.6,
OPTETRAK HLDING PIN MINI 3.2MM,270229531,CDM,270,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
CEMEX ISO 1200/I,270229535,CDM,270,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
CPSP-02 MIXING BOWL,270229536,CDM,270,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
APOLLO RF MP50 50 MLTI PORT,270229553,CDM,270,RC,,,outpatient,,,747,522.9,,590.13,79,,472.1,percent of total billed charges,79% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,470.61,63,,376.49,percent of total billed charges,63% of total billed charges,576.83,77.22,,461.46,percent of total billed charges,77.22% of total billed charges,493.77,66.1,,395.02,percent of total billed charges,66.1% of total billed charges,620.01,83,,496.01,percent of total billed charges,83% of total,709.65,95,,567.72,percent of total billed charges ,95% of total billed charges,597.6,80,,478.08,percent of total billed charges,78% of total billed charges,582.66,78,,466.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,470.61,63,,376.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,470.61,63,,376.49,percent of total billed charges,63% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,590.13,79,,472.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,709.65,
QUAD TENDON CUTTING BLADE,270229555,CDM,270,RC,,,outpatient,,,657,459.9,,519.03,79,,415.22,percent of total billed charges,79% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.91,63,,331.13,percent of total billed charges,63% of total billed charges,507.34,77.22,,405.87,percent of total billed charges,77.22% of total billed charges,434.28,66.1,,347.42,percent of total billed charges,66.1% of total billed charges,545.31,83,,436.25,percent of total billed charges,83% of total,624.15,95,,499.32,percent of total billed charges ,95% of total billed charges,525.6,80,,420.48,percent of total billed charges,78% of total billed charges,512.46,78,,409.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,413.91,63,,331.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,413.91,63,,331.13,percent of total billed charges,63% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,519.03,79,,415.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,413.91,624.15,
SCORPIAN NEEDLE KNEE,270229558,CDM,270,RC,,,outpatient,,,731,511.7,,577.49,79,,461.99,percent of total billed charges,79% of total billed charges,657.9,90,,526.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,564.48,77.22,,451.58,percent of total billed charges,77.22% of total billed charges,483.19,66.1,,386.55,percent of total billed charges,66.1% of total billed charges,606.73,83,,485.38,percent of total billed charges,83% of total,694.45,95,,555.56,percent of total billed charges ,95% of total billed charges,584.8,80,,467.84,percent of total billed charges,78% of total billed charges,570.18,78,,456.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,657.9,90,,526.32,percent of total billed charges,90% of total billed charges,584.8,80,,467.84,percent of total billed charges,80% of total billed charges,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,621.35,85,,497.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,577.49,79,,461.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,694.45,
FIBERTAPE,270229561,CDM,270,RC,,,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,200.34,450,
.09 FIBER LINK,270229564,CDM,270,RC,,,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,307.34,77.22,,245.87,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,250.74,450,
.9 TIGER LINK,270229565,CDM,270,RC,,,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,307.34,77.22,,245.87,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,250.74,450,
2.4 DRILL PIN,270229569,CDM,270,RC,,,outpatient,,,523,366.1,,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,403.86,77.22,,323.09,percent of total billed charges,77.22% of total billed charges,345.7,66.1,,276.56,percent of total billed charges,66.1% of total billed charges,434.09,83,,347.27,percent of total billed charges,83% of total,496.85,95,,397.48,percent of total billed charges ,95% of total billed charges,418.4,80,,334.72,percent of total billed charges,78% of total billed charges,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,329.49,496.85,
12X3 PASSPORT,270229571,CDM,270,RC,,,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
TIGERSTICK,270229572,CDM,270,RC,,,outpatient,,,230,161,,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,177.61,77.22,,142.09,percent of total billed charges,77.22% of total billed charges,152.03,66.1,,121.62,percent of total billed charges,66.1% of total billed charges,190.9,83,,152.72,percent of total billed charges,83% of total,218.5,95,,174.8,percent of total billed charges ,95% of total billed charges,184,80,,147.2,percent of total billed charges,78% of total billed charges,179.4,78,,143.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,144.9,450,
GUIDE PIN 3.2MMX343MM,270229598,CDM,270,RC,,,outpatient,,,1841,1288.7,,1454.39,79,,1163.51,percent of total billed charges,79% of total billed charges,1656.9,90,,1325.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1159.83,63,,927.86,percent of total billed charges,63% of total billed charges,1421.62,77.22,,1137.3,percent of total billed charges,77.22% of total billed charges,1216.9,66.1,,973.52,percent of total billed charges,66.1% of total billed charges,1528.03,83,,1222.42,percent of total billed charges,83% of total,1748.95,95,,1399.16,percent of total billed charges ,95% of total billed charges,1472.8,80,,1178.24,percent of total billed charges,78% of total billed charges,1435.98,78,,1148.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1159.83,63,,927.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1656.9,90,,1325.52,percent of total billed charges,90% of total billed charges,1472.8,80,,1178.24,percent of total billed charges,80% of total billed charges,1159.83,63,,927.86,percent of total billed charges,63% of total billed charges,1564.85,85,,1251.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1454.39,79,,1163.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1748.95,
BAL TP GUIDE ROD 3MMX1000MM,270229599,CDM,270,RC,,,outpatient,,,739,517.3,,583.81,79,,467.05,percent of total billed charges,79% of total billed charges,665.1,90,,532.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465.57,63,,372.46,percent of total billed charges,63% of total billed charges,570.66,77.22,,456.53,percent of total billed charges,77.22% of total billed charges,488.48,66.1,,390.78,percent of total billed charges,66.1% of total billed charges,613.37,83,,490.7,percent of total billed charges,83% of total,702.05,95,,561.64,percent of total billed charges ,95% of total billed charges,591.2,80,,472.96,percent of total billed charges,78% of total billed charges,576.42,78,,461.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,465.57,63,,372.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,665.1,90,,532.08,percent of total billed charges,90% of total billed charges,591.2,80,,472.96,percent of total billed charges,80% of total billed charges,465.57,63,,372.46,percent of total billed charges,63% of total billed charges,628.15,85,,502.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,583.81,79,,467.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,702.05,
2.55 MM DRILL BIT,270229600,CDM,270,RC,,,outpatient,,,645,451.5,,509.55,79,,407.64,percent of total billed charges,79% of total billed charges,580.5,90,,464.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406.35,63,,325.08,percent of total billed charges,63% of total billed charges,498.07,77.22,,398.46,percent of total billed charges,77.22% of total billed charges,426.35,66.1,,341.08,percent of total billed charges,66.1% of total billed charges,535.35,83,,428.28,percent of total billed charges,83% of total,612.75,95,,490.2,percent of total billed charges ,95% of total billed charges,516,80,,412.8,percent of total billed charges,78% of total billed charges,503.1,78,,402.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,406.35,63,,325.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,406.35,63,,325.08,percent of total billed charges,63% of total billed charges,548.25,85,,438.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,509.55,79,,407.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,406.35,612.75,
3.5MM DRILL BIT,270229601,CDM,270,RC,,,outpatient,,,799,559.3,,631.21,79,,504.97,percent of total billed charges,79% of total billed charges,719.1,90,,575.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.37,63,,402.7,percent of total billed charges,63% of total billed charges,616.99,77.22,,493.59,percent of total billed charges,77.22% of total billed charges,528.14,66.1,,422.51,percent of total billed charges,66.1% of total billed charges,663.17,83,,530.54,percent of total billed charges,83% of total,759.05,95,,607.24,percent of total billed charges ,95% of total billed charges,639.2,80,,511.36,percent of total billed charges,78% of total billed charges,623.22,78,,498.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,503.37,63,,402.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,503.37,63,,402.7,percent of total billed charges,63% of total billed charges,679.15,85,,543.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,631.21,79,,504.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,759.05,
TRULIANT 4 HEADED BASEPLATE PN,270229770,CDM,270,RC,,,outpatient,,,900,630,,711,79,,568.8,percent of total billed charges,79% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,694.98,77.22,,555.98,percent of total billed charges,77.22% of total billed charges,594.9,66.1,,475.92,percent of total billed charges,66.1% of total billed charges,747,83,,597.6,percent of total billed charges,83% of total,855,95,,684,percent of total billed charges ,95% of total billed charges,720,80,,576,percent of total billed charges,78% of total billed charges,702,78,,561.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,567,63,,453.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,567,63,,453.6,percent of total billed charges,63% of total billed charges,765,85,,612,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,711,79,,568.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,855,
CANNULA 7 x 7,270229793,CDM,270,RC,,,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,97.17,66.1,,77.74,percent of total billed charges,66.1% of total billed charges,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.61,450,
2.5 DRILL BIT,270229814,CDM,270,RC,,,outpatient,,,410,287,,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,369,90,,295.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,316.6,77.22,,253.28,percent of total billed charges,77.22% of total billed charges,271.01,66.1,,216.81,percent of total billed charges,66.1% of total billed charges,340.3,83,,272.24,percent of total billed charges,83% of total,389.5,95,,311.6,percent of total billed charges ,95% of total billed charges,328,80,,262.4,percent of total billed charges,78% of total billed charges,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,348.5,85,,278.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,450,
2.7 DRILL BIT,270229815,CDM,270,RC,,,outpatient,,,487,340.9,,384.73,79,,307.78,percent of total billed charges,79% of total billed charges,438.3,90,,350.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306.81,63,,245.45,percent of total billed charges,63% of total billed charges,376.06,77.22,,300.85,percent of total billed charges,77.22% of total billed charges,321.91,66.1,,257.53,percent of total billed charges,66.1% of total billed charges,404.21,83,,323.37,percent of total billed charges,83% of total,462.65,95,,370.12,percent of total billed charges ,95% of total billed charges,389.6,80,,311.68,percent of total billed charges,78% of total billed charges,379.86,78,,303.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,306.81,63,,245.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,306.81,63,,245.45,percent of total billed charges,63% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,384.73,79,,307.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,306.81,462.65,
KNEE DISP KIT,270229854,CDM,270,RC,,,outpatient,,,920,644,,726.8,79,,581.44,percent of total billed charges,79% of total billed charges,828,90,,662.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,579.6,63,,463.68,percent of total billed charges,63% of total billed charges,710.42,77.22,,568.34,percent of total billed charges,77.22% of total billed charges,608.12,66.1,,486.5,percent of total billed charges,66.1% of total billed charges,763.6,83,,610.88,percent of total billed charges,83% of total,874,95,,699.2,percent of total billed charges ,95% of total billed charges,736,80,,588.8,percent of total billed charges,78% of total billed charges,717.6,78,,574.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,579.6,63,,463.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,828,90,,662.4,percent of total billed charges,90% of total billed charges,736,80,,588.8,percent of total billed charges,80% of total billed charges,579.6,63,,463.68,percent of total billed charges,63% of total billed charges,782,85,,625.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,726.8,79,,581.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,874,
PASSPORT 10X13,270229916,CDM,270,RC,,,outpatient,,,161,112.7,,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,124.32,77.22,,99.46,percent of total billed charges,77.22% of total billed charges,106.42,66.1,,85.14,percent of total billed charges,66.1% of total billed charges,133.63,83,,106.9,percent of total billed charges,83% of total,152.95,95,,122.36,percent of total billed charges ,95% of total billed charges,128.8,80,,103.04,percent of total billed charges,78% of total billed charges,125.58,78,,100.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.43,450,
TRIMANO BEACH CHAIR,270229917,CDM,270,RC,,,outpatient,,,5625,3937.5,,4443.75,79,,3555,percent of total billed charges,79% of total billed charges,5062.5,90,,4050,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3543.75,63,,2835,percent of total billed charges,63% of total billed charges,4343.63,77.22,,3474.9,percent of total billed charges,77.22% of total billed charges,3718.13,66.1,,2974.5,percent of total billed charges,66.1% of total billed charges,4668.75,83,,3735,percent of total billed charges,83% of total,5343.75,95,,4275,percent of total billed charges ,95% of total billed charges,4500,80,,3600,percent of total billed charges,78% of total billed charges,4387.5,78,,3510,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3543.75,63,,2835,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5062.5,90,,4050,percent of total billed charges,90% of total billed charges,4500,80,,3600,percent of total billed charges,80% of total billed charges,3543.75,63,,2835,percent of total billed charges,63% of total billed charges,4781.25,85,,3825,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4443.75,79,,3555,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5343.75,
PUSHLOCK 3.5X19.8,270229918,CDM,270,RC,,,outpatient,,,1688,1181.6,,1333.52,79,,1066.82,percent of total billed charges,79% of total billed charges,1519.2,90,,1215.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1063.44,63,,850.75,percent of total billed charges,63% of total billed charges,1303.47,77.22,,1042.78,percent of total billed charges,77.22% of total billed charges,1115.77,66.1,,892.62,percent of total billed charges,66.1% of total billed charges,1401.04,83,,1120.83,percent of total billed charges,83% of total,1603.6,95,,1282.88,percent of total billed charges ,95% of total billed charges,1350.4,80,,1080.32,percent of total billed charges,78% of total billed charges,1316.64,78,,1053.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1063.44,63,,850.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1519.2,90,,1215.36,percent of total billed charges,90% of total billed charges,1350.4,80,,1080.32,percent of total billed charges,80% of total billed charges,1063.44,63,,850.75,percent of total billed charges,63% of total billed charges,1434.8,85,,1147.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1333.52,79,,1066.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1603.6,
PASSPORT 10X4,270229919,CDM,270,RC,,,outpatient,,,106,74.2,,83.74,79,,66.99,percent of total billed charges,79% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.78,63,,53.42,percent of total billed charges,63% of total billed charges,81.85,77.22,,65.48,percent of total billed charges,77.22% of total billed charges,70.07,66.1,,56.06,percent of total billed charges,66.1% of total billed charges,87.98,83,,70.38,percent of total billed charges,83% of total,100.7,95,,80.56,percent of total billed charges ,95% of total billed charges,84.8,80,,67.84,percent of total billed charges,78% of total billed charges,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.78,63,,53.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.78,63,,53.42,percent of total billed charges,63% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,83.74,79,,66.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.78,450,
ANKLE FRACTURE SYSTEM CADDY,270230013,CDM,270,RC,,,outpatient,,,4500,3150,,3555,79,,2844,percent of total billed charges,79% of total billed charges,4050,90,,3240,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,3474.9,77.22,,2779.92,percent of total billed charges,77.22% of total billed charges,2974.5,66.1,,2379.6,percent of total billed charges,66.1% of total billed charges,3735,83,,2988,percent of total billed charges,83% of total,4275,95,,3420,percent of total billed charges ,95% of total billed charges,3600,80,,2880,percent of total billed charges,78% of total billed charges,3510,78,,2808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4050,90,,3240,percent of total billed charges,90% of total billed charges,3600,80,,2880,percent of total billed charges,80% of total billed charges,2835,63,,2268,percent of total billed charges,63% of total billed charges,3825,85,,3060,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3555,79,,2844,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4275,
SHOULDER TRAY,270230016,CDM,270,RC,,,outpatient,,,1125,787.5,,888.75,79,,711,percent of total billed charges,79% of total billed charges,1012.5,90,,810,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,868.73,77.22,,694.98,percent of total billed charges,77.22% of total billed charges,743.63,66.1,,594.9,percent of total billed charges,66.1% of total billed charges,933.75,83,,747,percent of total billed charges,83% of total,1068.75,95,,855,percent of total billed charges ,95% of total billed charges,900,80,,720,percent of total billed charges,78% of total billed charges,877.5,78,,702,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1012.5,90,,810,percent of total billed charges,90% of total billed charges,900,80,,720,percent of total billed charges,80% of total billed charges,708.75,63,,567,percent of total billed charges,63% of total billed charges,956.25,85,,765,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,888.75,79,,711,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1068.75,
PERCUTANEOUS KIT 2.6,270230054,CDM,270,RC,,,outpatient,,,1219,853.3,,963.01,79,,770.41,percent of total billed charges,79% of total billed charges,1097.1,90,,877.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,767.97,63,,614.38,percent of total billed charges,63% of total billed charges,941.31,77.22,,753.05,percent of total billed charges,77.22% of total billed charges,805.76,66.1,,644.61,percent of total billed charges,66.1% of total billed charges,1011.77,83,,809.42,percent of total billed charges,83% of total,1158.05,95,,926.44,percent of total billed charges ,95% of total billed charges,975.2,80,,780.16,percent of total billed charges,78% of total billed charges,950.82,78,,760.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,767.97,63,,614.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1097.1,90,,877.68,percent of total billed charges,90% of total billed charges,975.2,80,,780.16,percent of total billed charges,80% of total billed charges,767.97,63,,614.38,percent of total billed charges,63% of total billed charges,1036.15,85,,828.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,963.01,79,,770.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1158.05,
TRI STAPLE DEVICE SUL 30 MIL,270266284,CDM,270,RC,,,outpatient,,,861,602.7,,680.19,79,,544.15,percent of total billed charges,79% of total billed charges,774.9,90,,619.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,542.43,63,,433.94,percent of total billed charges,63% of total billed charges,664.86,77.22,,531.89,percent of total billed charges,77.22% of total billed charges,569.12,66.1,,455.3,percent of total billed charges,66.1% of total billed charges,714.63,83,,571.7,percent of total billed charges,83% of total,817.95,95,,654.36,percent of total billed charges ,95% of total billed charges,688.8,80,,551.04,percent of total billed charges,78% of total billed charges,671.58,78,,537.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,542.43,63,,433.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,774.9,90,,619.92,percent of total billed charges,90% of total billed charges,688.8,80,,551.04,percent of total billed charges,80% of total billed charges,542.43,63,,433.94,percent of total billed charges,63% of total billed charges,731.85,85,,585.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,680.19,79,,544.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,817.95,
PERSONAL CARE APPLICATION FE,270500210,CDM,270,RC,,,outpatient,,,600,420,,474,79,,379.2,percent of total billed charges,79% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,463.32,77.22,,370.66,percent of total billed charges,77.22% of total billed charges,396.6,66.1,,317.28,percent of total billed charges,66.1% of total billed charges,498,83,,398.4,percent of total billed charges,83% of total,570,95,,456,percent of total billed charges ,95% of total billed charges,480,80,,384,percent of total billed charges,78% of total billed charges,468,78,,374.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,378,63,,302.4,percent of total billed charges,63% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,474,79,,379.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,570,
PUSH LOCK DRILL,278226278,CDM,270,RC,,,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
OXYHOOD SUPPLIES CP,410060007,CDM,270,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
VENTILATOR SUPPL COMP CH CP,410060040,CDM,270,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
GLASSMAN VISCERA RETRAINER MED,270222006,CDM,271,RC,,,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,76.68,66.1,,61.34,percent of total billed charges,66.1% of total billed charges,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.08,450,
PICC KIT 5FR TRIPLE LUMEN,270222505,CDM,271,RC,,,outpatient,,,634,443.8,,500.86,79,,400.69,percent of total billed charges,79% of total billed charges,570.6,90,,456.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,399.42,63,,319.54,percent of total billed charges,63% of total billed charges,489.57,77.22,,391.66,percent of total billed charges,77.22% of total billed charges,419.07,66.1,,335.26,percent of total billed charges,66.1% of total billed charges,526.22,83,,420.98,percent of total billed charges,83% of total,602.3,95,,481.84,percent of total billed charges ,95% of total billed charges,507.2,80,,405.76,percent of total billed charges,78% of total billed charges,494.52,78,,395.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,399.42,63,,319.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,570.6,90,,456.48,percent of total billed charges,90% of total billed charges,507.2,80,,405.76,percent of total billed charges,80% of total billed charges,399.42,63,,319.54,percent of total billed charges,63% of total billed charges,538.9,85,,431.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,500.86,79,,400.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,399.42,602.3,
FRENCH NASAL TRUMPET 28,270227118,CDM,271,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
G-TUBE MC-KEY 18 FR 1.7CM,270228445,CDM,271,RC,B4087,HCPCS,outpatient,,,288,201.6,,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,222.39,77.22,,177.91,percent of total billed charges,77.22% of total billed charges,190.37,66.1,,152.3,percent of total billed charges,66.1% of total billed charges,239.04,83,,191.23,percent of total billed charges,83% of total,273.6,95,,218.88,percent of total billed charges ,95% of total billed charges,230.4,80,,184.32,percent of total billed charges,78% of total billed charges,224.64,78,,179.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,181.44,450,
GELFOAM SPONG100 MIS,250016827,CDM,272,RC,,,outpatient,,,263,184.1,,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,203.09,77.22,,162.47,percent of total billed charges,77.22% of total billed charges,173.84,66.1,,139.07,percent of total billed charges,66.1% of total billed charges,218.29,83,,174.63,percent of total billed charges,83% of total,249.85,95,,199.88,percent of total billed charges ,95% of total billed charges,210.4,80,,168.32,percent of total billed charges,78% of total billed charges,205.14,78,,164.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165.69,450,
QUIKCLOT HEMOSTAT DRESSING 4X4,250019639,CDM,272,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
SIMPLE PNEUMOTHORAX ASPIRATION,270000008,CDM,272,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
BIOPSY NEEDLE 18 GA x 16CM,270000018,CDM,272,RC,,,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,53.54,66.1,,42.83,percent of total billed charges,66.1% of total billed charges,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.03,63,,40.82,percent of total billed charges,63% of total billed charges,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.03,450,
BIOPSY NEEDLE 20 GA x 16CM,270000019,CDM,272,RC,,,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.53,63,,66.02,percent of total billed charges,63% of total billed charges,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,86.59,66.1,,69.27,percent of total billed charges,66.1% of total billed charges,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,82.53,63,,66.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,82.53,63,,66.02,percent of total billed charges,63% of total billed charges,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.53,450,
BIOPSY NEEDLE 17 GA x13.8 CM,270000020,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
BIOPSY NEEDLE 19 GA X 13.8 CM,270000021,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
BIOPSY NEEDLE 14.5 GA X 15 CM,270000022,CDM,272,RC,,,outpatient,,,239,167.3,,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.57,63,,120.46,percent of total billed charges,63% of total billed charges,184.56,77.22,,147.65,percent of total billed charges,77.22% of total billed charges,157.98,66.1,,126.38,percent of total billed charges,66.1% of total billed charges,198.37,83,,158.7,percent of total billed charges,83% of total,227.05,95,,181.64,percent of total billed charges ,95% of total billed charges,191.2,80,,152.96,percent of total billed charges,78% of total billed charges,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,150.57,63,,120.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,150.57,63,,120.46,percent of total billed charges,63% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,150.57,450,
ULTRA-TAG COLD KIT (GI BLEED),270000033,CDM,272,RC,,,outpatient,,,376,263.2,,297.04,79,,237.63,percent of total billed charges,79% of total billed charges,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.88,63,,189.5,percent of total billed charges,63% of total billed charges,290.35,77.22,,232.28,percent of total billed charges,77.22% of total billed charges,248.54,66.1,,198.83,percent of total billed charges,66.1% of total billed charges,312.08,83,,249.66,percent of total billed charges,83% of total,357.2,95,,285.76,percent of total billed charges ,95% of total billed charges,300.8,80,,240.64,percent of total billed charges,78% of total billed charges,293.28,78,,234.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.88,63,,189.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.88,63,,189.5,percent of total billed charges,63% of total billed charges,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,297.04,79,,237.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.88,450,
GASTROSTOMY TUBE 18FR AVANOS,270000038,CDM,272,RC,,,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.32,450,
EZ PAP KIT,270000131,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
C-LINE DRESSING TRAY,270000143,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
"SPINAL NEEDLE, 18GA x 3",270000328,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
POLYPECTOMY SNARES 27MM 240CM,270000546,CDM,272,RC,,,outpatient,,,237,165.9,,187.23,79,,149.78,percent of total billed charges,79% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.31,63,,119.45,percent of total billed charges,63% of total billed charges,183.01,77.22,,146.41,percent of total billed charges,77.22% of total billed charges,156.66,66.1,,125.33,percent of total billed charges,66.1% of total billed charges,196.71,83,,157.37,percent of total billed charges,83% of total,225.15,95,,180.12,percent of total billed charges ,95% of total billed charges,189.6,80,,151.68,percent of total billed charges,78% of total billed charges,184.86,78,,147.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,149.31,63,,119.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,149.31,63,,119.45,percent of total billed charges,63% of total billed charges,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,187.23,79,,149.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,149.31,450,
UTERINE INJECTOR 2.0,270000583,CDM,272,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
SUTURE 4-0 ETHILON PC-3,270000595,CDM,272,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
CATHETER FOLEY 6FR 1.5CC,270000759,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"PENROSE TUBING, LATEX 1/2X18",270000784,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
SPINAL NEEDLE,270000807,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PERCUTANEOUS PROCEDURE DRAPE,270000811,CDM,272,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
CAUTERY FINE TIP,270000814,CDM,272,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
INFLATION SYSTEM SYRINGE/GAUGE,270000824,CDM,272,RC,,,outpatient,,,200,140,,158,79,,126.4,percent of total billed charges,79% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,63,,100.8,percent of total billed charges,63% of total billed charges,154.44,77.22,,123.55,percent of total billed charges,77.22% of total billed charges,132.2,66.1,,105.76,percent of total billed charges,66.1% of total billed charges,166,83,,132.8,percent of total billed charges,83% of total,190,95,,152,percent of total billed charges ,95% of total billed charges,160,80,,128,percent of total billed charges,78% of total billed charges,156,78,,124.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,126,63,,100.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,126,63,,100.8,percent of total billed charges,63% of total billed charges,170,85,,136,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,158,79,,126.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126,450,
SUTURE Y497G,270000825,CDM,272,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
NASAL CANNULA PED,270000875,CDM,272,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
825H SUTURE 3-0 27 GUT PLAIN,270001160,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
"NEEDLE,SPINAL 18GA",270001185,CDM,272,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
IV CATHETER 16GA,270001264,CDM,272,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
SPINAL NEEDLE 20 GA x 3 1/2 IN,270001315,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
SPINAL NEEDLE  22GA x 3 1/2IN,270001316,CDM,272,RC,,,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
"COBAN STERILE 3""",270001321,CDM,272,RC,,,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
GASTROSTOMY TUBE 14FR KANGAROO,270001346,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
DISPOSIBLE PARACENTESIS TRAY,270001356,CDM,272,RC,,,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,56.19,66.1,,44.95,percent of total billed charges,66.1% of total billed charges,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.55,450,
"JACKSON PRATT RESERVOIR,100ML",270001380,CDM,272,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
IV SET WITH CONTROL CLAMP-RAD,270001427,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PEDICATH KIT,270001478,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
C013D SUTURE,270001479,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
"SPONGE GAUZE, STERILE 4X4",270002020,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
VASELINE GAUZE DRESSING 3X9,270002044,CDM,272,RC,A6223,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"CATHETER, FEMALE KIT",270002300,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
"CATHETER, FOLEY 8FR 3CC",270002301,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
"CATHETER, FOLEY 10FR 3CC",270002302,CDM,272,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
"CATHETER, FOLEY 12FR 3CC",270002303,CDM,272,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
"CATHETER, FOLEY 14FR 5CC",270002304,CDM,272,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
"CATHETER, FOLEY 16FR 5CC",270002305,CDM,272,RC,,,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
"CATHETER, FOLEY 18FR 5CC",270002306,CDM,272,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
"CATHETER, FOLEY 20FR 5CC",270002307,CDM,272,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
"CATHETER, FOLEY 18FR 30CC",270002308,CDM,272,RC,,,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
"CATHETER, FOLEY 22FR 30CC",270002310,CDM,272,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
"CATHETER, FOLEY 26FR 30CC",270002312,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
"CATHETER, FOLEY 2OFR 30CC CONT",270002314,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
"CATHETER, FOLEY 30FR 5 CC",270002315,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
"CATHETER, FOLEY 20FR 30CC 3WAY",270002316,CDM,272,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
CATHETER PLUG,270002318,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
"CATHETER, SUCTION 8FR",270002325,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
"CATHETER, SUCTION 10FR",270002326,CDM,272,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
"CATHETER, SUCTION 12FR",270002327,CDM,272,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
"CATHETER, SUCTION 14FR",270002328,CDM,272,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
"CATHETER, SUCTION 16FR",270002329,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
"CATHETER, SUCTION 18FR",270002330,CDM,272,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
"CATHETER, TRAY CATH A 15FR",270002332,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"CATHETER, TRAY FOLEY 16FR",270002333,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
"CATHETER, TRAY FOLEY 18FR",270002334,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
THORACIC CATHETER 40FR,270002337,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
CATHETER ARGYLE THORACIC 32FR,270002340,CDM,272,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
CATHETER ARGYLE THORACIC 36FR,270002342,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
BILE BAG,270002344,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
"ADAPTOR, I V CONNECTOR J-LOOP",270002453,CDM,272,RC,,,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,25.78,66.1,,20.62,percent of total billed charges,66.1% of total billed charges,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.57,450,
"ADAPTOR, Y-TYPE BLOOD/SOLUTION",270002454,CDM,272,RC,,,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.36,450,
"CATHETER, IV 24X3/4",270002455,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
"CATHETER, IV 20X1",270002456,CDM,272,RC,,,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,40.32,66.1,,32.26,percent of total billed charges,66.1% of total billed charges,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.43,450,
"CATHETER, IV 18X1 1/4",270002457,CDM,272,RC,,,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,40.32,66.1,,32.26,percent of total billed charges,66.1% of total billed charges,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,38.43,63,,30.74,percent of total billed charges,63% of total billed charges,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.43,450,
"CATHETER, IV 20 X 1/14",270002458,CDM,272,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"CATHETER, 22X1",270002459,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"NEEDLE, BUTTERFLY 25GA X3",270002460,CDM,272,RC,,,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
"NEEDLE, BUTTERFLY 23 GA X3/4",270002461,CDM,272,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
"PACK, C-SECTION",270002515,CDM,272,RC,,,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.13,63,,176.9,percent of total billed charges,63% of total billed charges,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,232.01,66.1,,185.61,percent of total billed charges,66.1% of total billed charges,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,221.13,63,,176.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,221.13,63,,176.9,percent of total billed charges,63% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,221.13,450,
"PACK,DELIVERY LDRP",270002516,CDM,272,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
"PACK, GYNECOLOGY",270002517,CDM,272,RC,,,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
"PACK, LAPAROTOMY IV",270002520,CDM,272,RC,,,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
"PACK, LAP/ABDOMINAL PACK",270002524,CDM,272,RC,,,outpatient,,,386,270.2,,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,298.07,77.22,,238.46,percent of total billed charges,77.22% of total billed charges,255.15,66.1,,204.12,percent of total billed charges,66.1% of total billed charges,320.38,83,,256.3,percent of total billed charges,83% of total,366.7,95,,293.36,percent of total billed charges ,95% of total billed charges,308.8,80,,247.04,percent of total billed charges,78% of total billed charges,301.08,78,,240.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,243.18,450,
ENDO TUBE 7.O,270002592,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ENDO TUBE 7.5,270002593,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ENDO TUBE 8.0,270002594,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"BLADE, SURGICAL #10",270002630,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
"BLADE, SURGICAL #11",270002631,CDM,272,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
"BLADE, SURGICAL #15",270002633,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
AMNIHOOK,270002912,CDM,272,RC,,,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
CHOLANGIOGRAM CATHETER 7.5,270003002,CDM,272,RC,,,outpatient,,,248,173.6,,195.92,79,,156.74,percent of total billed charges,79% of total billed charges,223.2,90,,178.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,191.51,77.22,,153.21,percent of total billed charges,77.22% of total billed charges,163.93,66.1,,131.14,percent of total billed charges,66.1% of total billed charges,205.84,83,,164.67,percent of total billed charges,83% of total,235.6,95,,188.48,percent of total billed charges ,95% of total billed charges,198.4,80,,158.72,percent of total billed charges,78% of total billed charges,193.44,78,,154.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,223.2,90,,178.56,percent of total billed charges,90% of total billed charges,198.4,80,,158.72,percent of total billed charges,80% of total billed charges,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,210.8,85,,168.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,195.92,79,,156.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,156.24,450,
ELECTRODE NEEDLE,270003003,CDM,272,RC,,,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
URINEMETER,270003025,CDM,272,RC,,,outpatient,,,234,163.8,,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,180.69,77.22,,144.55,percent of total billed charges,77.22% of total billed charges,154.67,66.1,,123.74,percent of total billed charges,66.1% of total billed charges,194.22,83,,155.38,percent of total billed charges,83% of total,222.3,95,,177.84,percent of total billed charges ,95% of total billed charges,187.2,80,,149.76,percent of total billed charges,78% of total billed charges,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.42,450,
"CATHETER, SUCTION KIT 14 FR",270003042,CDM,272,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"CATHETER, SUCTION KIT 6.5 FR",270003043,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
"CATHETER, SUCTION KIT 10 FR",270003044,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
"SUCTION CATHETER, DELEE 10FR",270003045,CDM,272,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"CATHETER, SUCTION KIT 12FR",270003047,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
"TUBE, SALEM SUMP 16 FR",270003080,CDM,272,RC,,,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
"TUBE, SALEM SUMP 10 FR",270003081,CDM,272,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"TUBE, SALEM SUMP 18 FR",270003082,CDM,272,RC,,,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
"TUBE, SALEM SUMP 12 FR",270003083,CDM,272,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"TUBE, STOMACH 16 FR",270003088,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"TUBE, FEEDING 5 FR",270003092,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"TUBING, PENROSE DRAIN 1/4""""",270003100,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"TUBING, PENROSE DRAIN 1/2""""",270003102,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
URINE LEG BAG,270003192,CDM,272,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
"URINE COLLECTOR, PEDIATRIC",270003194,CDM,272,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
"URINARY, DRAIN BAG",270003196,CDM,272,RC,,,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.92,450,
MALE INCONTINENCE BAG,270003198,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
"OSTOMY BAG 4""""",270003220,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
"OSTOMY BAG, 2 1/4""""",270003225,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
"OSTOMY WAFER, 4""""",270003245,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
"OSTOMY WAFER, 2 1/4""""",270003250,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
OSTOMY STOMA BAG,270003255,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
"AIRWAY, ORAL 60 MM",270003259,CDM,272,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
"AIRWAY, ORAL 80 MM",270003260,CDM,272,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
"AIRWAY, ORAL 40MM",270003261,CDM,272,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
"AIRWAY, ORAL 90 MM",270003262,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
"AIRWAY,ORAL 60MM",270003263,CDM,272,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
"AIRWAY, ORAL 100 MM",270003264,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
LACERATION TRAY,270003300,CDM,272,RC,,,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,98.75,79,,79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.75,450,
SUTURE REMOVAL TRAY,270003310,CDM,272,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
PARACERVICAL PUDENDAL BLOCK TY,270003325,CDM,272,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
ATRUIM CHEST DRAIN,270003330,CDM,272,RC,,,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
"CATHETER, MALECOT 30 FR",270003413,CDM,272,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
"CATHETER, LUBRICATH 14 FR 5CC",270003429,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
"ENDO TUBE 5.0,CUFFED",270003501,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"ENDO TUBE 6.0,CUFFED",270003502,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"ENDO TUBE, 2.5 UNCUFFED",270003505,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ENDO TUBE 4.5 W/O CUFF,270003509,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ENDO TUBE 5.0,270003510,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
NASOPHARYNGEAL AIRWAY 32 FR,270003520,CDM,272,RC,,,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
IRRIGATION TRAY,270003540,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
"TRAY, TRI LUMEN",270003910,CDM,272,RC,,,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.98,450,
"TRAY, THORACENTESIS",270003918,CDM,272,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
AEROCHAMBER,270004358,CDM,272,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
NASAL CANNULA RR,270004360,CDM,272,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
CONCHA WATER ONLY,270004365,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
UNIVERSAL BEAR CIRCUIT,270004366,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
CATTELL T-TUBE 12 FR,270005019,CDM,272,RC,,,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,44.29,66.1,,35.43,percent of total billed charges,66.1% of total billed charges,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.21,450,
CATTELL T-TUBE 16FR,270005021,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
CATTELL T-TUBE 20FR,270005023,CDM,272,RC,,,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,41.64,66.1,,33.31,percent of total billed charges,66.1% of total billed charges,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.69,450,
"BRUSH,CYTOLOGY",270005041,CDM,272,RC,,,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
DISPOSABLE SCALPEL #11,270005055,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
"HEMOCLIP, LARGE",270005516,CDM,272,RC,,,outpatient,,,137,95.9,,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,105.79,77.22,,84.63,percent of total billed charges,77.22% of total billed charges,90.56,66.1,,72.45,percent of total billed charges,66.1% of total billed charges,113.71,83,,90.97,percent of total billed charges,83% of total,130.15,95,,104.12,percent of total billed charges ,95% of total billed charges,109.6,80,,87.68,percent of total billed charges,78% of total billed charges,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.31,450,
"HEMOCLIP, MEDIUM",270005518,CDM,272,RC,,,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,450,
STOCKINETTE 6 IN STERILE,270005818,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
MULTI-FLEX STENT 7.0 X 28CM,270006034,CDM,272,RC,,,outpatient,,,638,446.6,,504.02,79,,403.22,percent of total billed charges,79% of total billed charges,574.2,90,,459.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401.94,63,,321.55,percent of total billed charges,63% of total billed charges,492.66,77.22,,394.13,percent of total billed charges,77.22% of total billed charges,421.72,66.1,,337.38,percent of total billed charges,66.1% of total billed charges,529.54,83,,423.63,percent of total billed charges,83% of total,606.1,95,,484.88,percent of total billed charges ,95% of total billed charges,510.4,80,,408.32,percent of total billed charges,78% of total billed charges,497.64,78,,398.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,401.94,63,,321.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,574.2,90,,459.36,percent of total billed charges,90% of total billed charges,510.4,80,,408.32,percent of total billed charges,80% of total billed charges,401.94,63,,321.55,percent of total billed charges,63% of total billed charges,542.3,85,,433.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,504.02,79,,403.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,401.94,606.1,
BEAVER BLADE,270007527,CDM,272,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
SUTURE U12T,270013012,CDM,272,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
SUTURE RS21,270013021,CDM,272,RC,,,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
SUTURE W31G,270013031,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SUTURE SA64H,270013064,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE SA86G,270013086,CDM,272,RC,,,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
SUTURE S104H,270013104,CDM,272,RC,,,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.92,450,
SUTURE S114H,270013114,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE G121H,270013121,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SUTURE G122H,270013122,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE G123H,270013123,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
"SUTURE, U202H",270013202,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
SUTURE J275H,270013275,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE J315H,270013315,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SUTURE J316H,270013316,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE J317H,270013317,CDM,272,RC,,,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
SUTURE J324H,270013324,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SUTURE J334H,270013334,CDM,272,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
SUTURE J344H,270013344,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE J346H,270013346,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
SUTURE J358H,270013358,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE Z359T,270013359,CDM,272,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
SUTURE J376H,270013376,CDM,272,RC,,,outpatient,,,49,34.3,,38.71,79,,30.97,percent of total billed charges,79% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.87,63,,24.7,percent of total billed charges,63% of total billed charges,37.84,77.22,,30.27,percent of total billed charges,77.22% of total billed charges,32.39,66.1,,25.91,percent of total billed charges,66.1% of total billed charges,40.67,83,,32.54,percent of total billed charges,83% of total,46.55,95,,37.24,percent of total billed charges ,95% of total billed charges,39.2,80,,31.36,percent of total billed charges,78% of total billed charges,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.87,63,,24.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.87,63,,24.7,percent of total billed charges,63% of total billed charges,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,38.71,79,,30.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.87,450,
SUTURE J417H,270013417,CDM,272,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
SUTURE J494G,270013494,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE J496G,270013496,CDM,272,RC,,,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,450,
SUTURE J497G,270013497,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE J522H,270013522,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE J527H,270013527,CDM,272,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
SUTURE J551G2,270013551,CDM,272,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
SUTURE X558H,270013558,CDM,272,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
SUTURE 661G,270013661,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SUTURE 662G,270013662,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE 663G,270013663,CDM,272,RC,,,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.76,450,
SUTURE 664G,270013664,CDM,272,RC,,,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.76,450,
SUTURE 684G,270013684,CDM,272,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
SUTURE 698G,270013698,CDM,272,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
SUTURE 699G,270013699,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE J784G,270013784,CDM,272,RC,,,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.94,450,
SUTURE H821G,270013821,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SUTURE H822G,270013822,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE 824G,270013824,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SUTURE 825G,270013825,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SUTURE K832H,270013832,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE K834H,270013834,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
SUTURE K843H,270013843,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SUTURE 898H,270013898,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
SUTURE J904T,270013904,CDM,272,RC,,,outpatient,,,234,163.8,,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,180.69,77.22,,144.55,percent of total billed charges,77.22% of total billed charges,154.67,66.1,,123.74,percent of total billed charges,66.1% of total billed charges,194.22,83,,155.38,percent of total billed charges,83% of total,222.3,95,,177.84,percent of total billed charges ,95% of total billed charges,187.2,80,,149.76,percent of total billed charges,78% of total billed charges,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.42,450,
SUTURE J905T,270013905,CDM,272,RC,,,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,118.98,66.1,,95.18,percent of total billed charges,66.1% of total billed charges,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.4,450,
SUTURE J906G,270013906,CDM,272,RC,,,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,450,
SUTURE 924H,270013924,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SUTURE SG13T,270014013,CDM,272,RC,,,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
SUTURE 1636G,270014202,CDM,272,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
SUTURE 1667G,270014212,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE 2814G,270014232,CDM,272,RC,,,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
SUTURE 8559H,270014262,CDM,272,RC,,,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
SUTURE 8411H,270014264,CDM,272,RC,,,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
SUTURE PROLENE 5,270014268,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
SUTURE 1698G,270014272,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
SUTURE D1924,270014275,CDM,272,RC,,,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
SUTURE 8665G,270014276,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
4.0 PROLENE SUTURE,270014280,CDM,272,RC,,,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
SUTURE 8698G,270014282,CDM,272,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
SUTURE 8424H,270014290,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
SUTURE Z316H,270014316,CDM,272,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
Z358T SUTURE,270014358,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
SUTURE J359H,270014359,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SUTURE 7612-31,270014430,CDM,272,RC,,,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,65.44,66.1,,52.35,percent of total billed charges,66.1% of total billed charges,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62.37,450,
SUTURE 497G,270014497,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SUTURE 783G,270014783,CDM,272,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
SUTURE 832H,270014832,CDM,272,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
VENTED CONTINUE FLOW SET,270017502,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
J-LOOP 1252,270017519,CDM,272,RC,,,outpatient,,,8,5.6,,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,7.2,90,,5.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.18,77.22,,4.94,percent of total billed charges,77.22% of total billed charges,5.29,66.1,,4.23,percent of total billed charges,66.1% of total billed charges,6.64,83,,5.31,percent of total billed charges,83% of total,7.6,95,,6.08,percent of total billed charges ,95% of total billed charges,6.4,80,,5.12,percent of total billed charges,78% of total billed charges,6.24,78,,4.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.04,63,,4.03,percent of total billed charges,63% of total billed charges,6.8,85,,5.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6.32,79,,5.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.04,450,
2C4040 CYSTO BLADDER SET,270017520,CDM,272,RC,,,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
1C8109 EPIDURIAL SET,270017524,CDM,272,RC,,,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,450,
2C7552 NGT SET,270017543,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
2C5588 IVPB SET,270017547,CDM,272,RC,,,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,138.15,66.1,,110.52,percent of total billed charges,66.1% of total billed charges,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,131.67,450,
2C7534S BURETROL SET,270017548,CDM,272,RC,,,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
PIGGY BACK TUBING SET,270018200,CDM,272,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
ENDO CATCH 10MM,270020085,CDM,272,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
CT BIOPSY TRAY,270020207,CDM,272,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
CT BIOPSY EXAM KIT,270020208,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
DRESSING SMALL STERILE CUSTOM,270025803,CDM,272,RC,,,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
DRESSING MEDIUM STERILE CUSTOM,270025804,CDM,272,RC,,,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,130.88,66.1,,104.7,percent of total billed charges,66.1% of total billed charges,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.74,450,
DRESSING LARGE STERILE CUSTOM,270025805,CDM,272,RC,,,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,171.86,66.1,,137.49,percent of total billed charges,66.1% of total billed charges,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.8,450,
GI EXAM KIT,270050016,CDM,272,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
BREAST NEEDLE LOC. TRAY,270050032,CDM,272,RC,,,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,145.95,77.22,,116.76,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.07,450,
UTERINE INJECTOR 4.0 ZUI,270075087,CDM,272,RC,,,outpatient,,,153,107.1,,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,118.15,77.22,,94.52,percent of total billed charges,77.22% of total billed charges,101.13,66.1,,80.9,percent of total billed charges,66.1% of total billed charges,126.99,83,,101.59,percent of total billed charges,83% of total,145.35,95,,116.28,percent of total billed charges ,95% of total billed charges,122.4,80,,97.92,percent of total billed charges,78% of total billed charges,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.39,450,
"SPINAL TRAY, SPIN O CAN",270075165,CDM,272,RC,,,outpatient,,,234,163.8,,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,180.69,77.22,,144.55,percent of total billed charges,77.22% of total billed charges,154.67,66.1,,123.74,percent of total billed charges,66.1% of total billed charges,194.22,83,,155.38,percent of total billed charges,83% of total,222.3,95,,177.84,percent of total billed charges ,95% of total billed charges,187.2,80,,149.76,percent of total billed charges,78% of total billed charges,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.42,450,
PERIFIX CONT. EPIDURAL TRAY,270077404,CDM,272,RC,,,outpatient,,,233,163.1,,184.07,79,,147.26,percent of total billed charges,79% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,179.92,77.22,,143.94,percent of total billed charges,77.22% of total billed charges,154.01,66.1,,123.21,percent of total billed charges,66.1% of total billed charges,193.39,83,,154.71,percent of total billed charges,83% of total,221.35,95,,177.08,percent of total billed charges ,95% of total billed charges,186.4,80,,149.12,percent of total billed charges,78% of total billed charges,181.74,78,,145.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,184.07,79,,147.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.79,450,
"IV CATHETER, 24 X 9/16",270077457,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
HYSTERO KIT W/ 2 MM INJECTOR,270078542,CDM,272,RC,,,outpatient,,,221,154.7,,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,170.66,77.22,,136.53,percent of total billed charges,77.22% of total billed charges,146.08,66.1,,116.86,percent of total billed charges,66.1% of total billed charges,183.43,83,,146.74,percent of total billed charges,83% of total,209.95,95,,167.96,percent of total billed charges ,95% of total billed charges,176.8,80,,141.44,percent of total billed charges,78% of total billed charges,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.23,450,
IV CATH,270079526,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
ARTHROSCOPY IRRIGATION SET,270079670,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SIGATTAL SAW BLADE,270079908,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
BEAVER BLADE 5700,270090220,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
HOMER MAMMOLOK 20X5.0 NEEDLE,270090233,CDM,272,RC,A4215,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.06,450,
"HOMER,MAMMOLOK 20GA X 7.5CM",270090234,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
"HOMMER MAMMOLOK, 20GA",270090235,CDM,272,RC,,,outpatient,,,153,107.1,,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,118.15,77.22,,94.52,percent of total billed charges,77.22% of total billed charges,101.13,66.1,,80.9,percent of total billed charges,66.1% of total billed charges,126.99,83,,101.59,percent of total billed charges,83% of total,145.35,95,,116.28,percent of total billed charges ,95% of total billed charges,122.4,80,,97.92,percent of total billed charges,78% of total billed charges,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.39,450,
"COBAN, STERILE",270090429,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"HUBER NEEDLE, 20 GA X 3/4""""",270090669,CDM,272,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
PRECISE STAPLER 15 SHOT,270090935,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
4 WAY STOPCOCK,270090990,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
EEA STAPLER 28MM,270091038,CDM,272,RC,,,outpatient,,,3034,2123.8,,2396.86,79,,1917.49,percent of total billed charges,79% of total billed charges,2730.6,90,,2184.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1911.42,63,,1529.14,percent of total billed charges,63% of total billed charges,2342.85,77.22,,1874.28,percent of total billed charges,77.22% of total billed charges,2005.47,66.1,,1604.38,percent of total billed charges,66.1% of total billed charges,2518.22,83,,2014.58,percent of total billed charges,83% of total,2882.3,95,,2305.84,percent of total billed charges ,95% of total billed charges,2427.2,80,,1941.76,percent of total billed charges,78% of total billed charges,2366.52,78,,1893.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1911.42,63,,1529.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2730.6,90,,2184.48,percent of total billed charges,90% of total billed charges,2427.2,80,,1941.76,percent of total billed charges,80% of total billed charges,1911.42,63,,1529.14,percent of total billed charges,63% of total billed charges,2578.9,85,,2063.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2396.86,79,,1917.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2882.3,
8435H SUTURE PROLENE CT NEEDLE,270091059,CDM,272,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
SUTURE 8412H,270091707,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
"STAPLER, DISP.MILTIFIRE GIA 60",270100206,CDM,272,RC,,,outpatient,,,522,365.4,,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,403.09,77.22,,322.47,percent of total billed charges,77.22% of total billed charges,345.04,66.1,,276.03,percent of total billed charges,66.1% of total billed charges,433.26,83,,346.61,percent of total billed charges,83% of total,495.9,95,,396.72,percent of total billed charges ,95% of total billed charges,417.6,80,,334.08,percent of total billed charges,78% of total billed charges,407.16,78,,325.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,328.86,495.9,
SUTURE J959H,270200132,CDM,272,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
HEMOCLIP CLIPMD/LG,270200164,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
SM HEMOCLIP,270200165,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
ALLIGATOR FORCEPT SM DISP,270200272,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
Y-TYPE TUR BLADDER IRRIG SET,270200306,CDM,272,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
SUTURE J603H GLOVER,270200316,CDM,272,RC,,,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
ENDOMAT HYSTEROSCOPY TUBE SET,270200404,CDM,272,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
"SUTURE CHR GUT OCT4 36""""",270200453,CDM,272,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
SUTURE J740D,270200566,CDM,272,RC,,,outpatient,,,178,124.6,,140.62,79,,112.5,percent of total billed charges,79% of total billed charges,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.14,63,,89.71,percent of total billed charges,63% of total billed charges,137.45,77.22,,109.96,percent of total billed charges,77.22% of total billed charges,117.66,66.1,,94.13,percent of total billed charges,66.1% of total billed charges,147.74,83,,118.19,percent of total billed charges,83% of total,169.1,95,,135.28,percent of total billed charges ,95% of total billed charges,142.4,80,,113.92,percent of total billed charges,78% of total billed charges,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,112.14,63,,89.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,112.14,63,,89.71,percent of total billed charges,63% of total billed charges,151.3,85,,121.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,140.62,79,,112.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,112.14,450,
PNEUMOTHORAX CATH ASP SET 9 FR,270200642,CDM,272,RC,C1729,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,207.72,77.22,,166.18,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,169.47,450,
LAP CHOLANGIOGRAM CATH 23CM,270200694,CDM,272,RC,,,outpatient,,,503,352.1,,397.37,79,,317.9,percent of total billed charges,79% of total billed charges,452.7,90,,362.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316.89,63,,253.51,percent of total billed charges,63% of total billed charges,388.42,77.22,,310.74,percent of total billed charges,77.22% of total billed charges,332.48,66.1,,265.98,percent of total billed charges,66.1% of total billed charges,417.49,83,,333.99,percent of total billed charges,83% of total,477.85,95,,382.28,percent of total billed charges ,95% of total billed charges,402.4,80,,321.92,percent of total billed charges,78% of total billed charges,392.34,78,,313.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,316.89,63,,253.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,316.89,63,,253.51,percent of total billed charges,63% of total billed charges,427.55,85,,342.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,397.37,79,,317.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,316.89,477.85,
ENDOLOOPS PDS O LAPAROSCOPIC,270200831,CDM,272,RC,,,outpatient,,,396,277.2,,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.48,63,,199.58,percent of total billed charges,63% of total billed charges,305.79,77.22,,244.63,percent of total billed charges,77.22% of total billed charges,261.76,66.1,,209.41,percent of total billed charges,66.1% of total billed charges,328.68,83,,262.94,percent of total billed charges,83% of total,376.2,95,,300.96,percent of total billed charges ,95% of total billed charges,316.8,80,,253.44,percent of total billed charges,78% of total billed charges,308.88,78,,247.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,249.48,63,,199.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,249.48,63,,199.58,percent of total billed charges,63% of total billed charges,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,249.48,450,
SUTURE 3.0 MONOCRYL CT NEEDLE,270200874,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
SUTURE 2.0 MONOCRYL CT2,270200876,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
SUTURE Y415,270201032,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
SUTURE VICRYL Y944H,270201091,CDM,272,RC,,,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,87.25,66.1,,69.8,percent of total billed charges,66.1% of total billed charges,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.16,450,
COBAN 4IN  STERILE,270201170,CDM,272,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
MICRO OSCILLATION SAW BLADE,270201184,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
DISP HOT BIOPSY,270201190,CDM,272,RC,,,outpatient,,,233,163.1,,184.07,79,,147.26,percent of total billed charges,79% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,179.92,77.22,,143.94,percent of total billed charges,77.22% of total billed charges,154.01,66.1,,123.21,percent of total billed charges,66.1% of total billed charges,193.39,83,,154.71,percent of total billed charges,83% of total,221.35,95,,177.08,percent of total billed charges ,95% of total billed charges,186.4,80,,149.12,percent of total billed charges,78% of total billed charges,181.74,78,,145.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,184.07,79,,147.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.79,450,
SUTURE Y494G,270201238,CDM,272,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
SUTURE RETRIEVAL,270202054,CDM,272,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
LOOP OSTOMY SYSTEM,270202098,CDM,272,RC,,,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,98.75,79,,79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.75,450,
JJ31G  O VICRYL,270202122,CDM,272,RC,,,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,138.15,66.1,,110.52,percent of total billed charges,66.1% of total billed charges,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,131.67,63,,105.34,percent of total billed charges,63% of total billed charges,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,131.67,450,
RADIAL JAW WITH NEEDLE,270202187,CDM,272,RC,,,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,103.78,66.1,,83.02,percent of total billed charges,66.1% of total billed charges,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,98.91,63,,79.13,percent of total billed charges,63% of total billed charges,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.91,450,
TRACHEAL TUBE 6.0,270202418,CDM,272,RC,,,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
TRACH TUBE,270202419,CDM,272,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
OVAL BUR- MEDIUM 4x8MM,270202829,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
SPINAL NEEDLE 20GX3,270202912,CDM,272,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
2.3 MM BURR,270202921,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
"CATTELL T-TUBE,10FR",270202994,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
CATTELL T-TUBE 18FR,270202995,CDM,272,RC,,,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
7MMx20MM CANN INTERFER SCREW,270203003,CDM,272,RC,,,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
HUBER NEEDLE 22G,270203144,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ACL KIT,270203185,CDM,272,RC,,,outpatient,,,520,364,,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,401.54,77.22,,321.23,percent of total billed charges,77.22% of total billed charges,343.72,66.1,,274.98,percent of total billed charges,66.1% of total billed charges,431.6,83,,345.28,percent of total billed charges,83% of total,494,95,,395.2,percent of total billed charges ,95% of total billed charges,416,80,,332.8,percent of total billed charges,78% of total billed charges,405.6,78,,324.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,327.6,494,
CATTELL T-TUBE 14 FR,270203264,CDM,272,RC,,,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,44.29,66.1,,35.43,percent of total billed charges,66.1% of total billed charges,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.21,63,,33.77,percent of total billed charges,63% of total billed charges,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.21,450,
SAW BLADE 25MM,270203341,CDM,272,RC,,,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,56.19,66.1,,44.95,percent of total billed charges,66.1% of total billed charges,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,53.55,63,,42.84,percent of total billed charges,63% of total billed charges,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.55,450,
ARTHREX MASTER INSTRUMENT,270203445,CDM,272,RC,,,outpatient,,,1012,708.4,,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,781.47,77.22,,625.18,percent of total billed charges,77.22% of total billed charges,668.93,66.1,,535.14,percent of total billed charges,66.1% of total billed charges,839.96,83,,671.97,percent of total billed charges,83% of total,961.4,95,,769.12,percent of total billed charges ,95% of total billed charges,809.6,80,,647.68,percent of total billed charges,78% of total billed charges,789.36,78,,631.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,809.6,80,,647.68,percent of total billed charges,80% of total billed charges,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,860.2,85,,688.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,961.4,
COUDE CATHETER 20 FR,270203864,CDM,272,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
DISPOSABLE 2.5MM ROTH RET.NET,270203960,CDM,272,RC,,,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,307.34,77.22,,245.87,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,250.74,450,
GASTROSTOMY TUBE 20 FR,270204034,CDM,272,RC,,,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.32,450,
GASTROSTOMY TUBE 24 FR,270204035,CDM,272,RC,,,outpatient,,,76,53.2,,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,58.69,77.22,,46.95,percent of total billed charges,77.22% of total billed charges,50.24,66.1,,40.19,percent of total billed charges,66.1% of total billed charges,63.08,83,,50.46,percent of total billed charges,83% of total,72.2,95,,57.76,percent of total billed charges ,95% of total billed charges,60.8,80,,48.64,percent of total billed charges,78% of total billed charges,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.88,450,
TRACH TUBE SOFT SEAL,270204189,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
SHILEY TRACH CUFFED SIZE 6,270204331,CDM,272,RC,,,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.56,450,
X834H O ETHIBOND SH NEEDLE,270204529,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
7.0 ETT ORAL RAE,270204908,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
BLADE ELECTRODE,270205094,CDM,272,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ESOPHOGEAL BALLOON DILATOR,270205103,CDM,272,RC,,,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.86,450,
DRILL BIT 310.15,270205160,CDM,272,RC,,,outpatient,,,620,434,,489.8,79,,391.84,percent of total billed charges,79% of total billed charges,558,90,,446.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390.6,63,,312.48,percent of total billed charges,63% of total billed charges,478.76,77.22,,383.01,percent of total billed charges,77.22% of total billed charges,409.82,66.1,,327.86,percent of total billed charges,66.1% of total billed charges,514.6,83,,411.68,percent of total billed charges,83% of total,589,95,,471.2,percent of total billed charges ,95% of total billed charges,496,80,,396.8,percent of total billed charges,78% of total billed charges,483.6,78,,386.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,390.6,63,,312.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,390.6,63,,312.48,percent of total billed charges,63% of total billed charges,527,85,,421.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,489.8,79,,391.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,390.6,589,
ESOPHAGEAL BALLOON QD-12X8,270205178,CDM,272,RC,,,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,233.33,66.1,,186.66,percent of total billed charges,66.1% of total billed charges,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,222.39,450,
TRACH TUBE-SHILEY SZ 8 DISPOS.,270205185,CDM,272,RC,,,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,41.64,66.1,,33.31,percent of total billed charges,66.1% of total billed charges,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.69,450,
FOLEY CATHETER SILICONE 16FR,270205190,CDM,272,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
ESOPHOGEAL BALLOON DILAT. 18X8,270205237,CDM,272,RC,,,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,233.33,66.1,,186.66,percent of total billed charges,66.1% of total billed charges,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,222.39,450,
8685H SUTURE,270205413,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"IV CATHETER 16 G 1 1/4""",270205431,CDM,272,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
LOOP BALL 5 MM 300-159,270205602,CDM,272,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
ELECTRODE STERILE 10 X 10,270205686,CDM,272,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
SUTURE J946H,270206052,CDM,272,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
SUTURE J945H,270206053,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
"SUTURE, MARLEX MESH 3"" X 6""",270206113,CDM,272,RC,,,outpatient,,,224,156.8,,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,172.97,77.22,,138.38,percent of total billed charges,77.22% of total billed charges,148.06,66.1,,118.45,percent of total billed charges,66.1% of total billed charges,185.92,83,,148.74,percent of total billed charges,83% of total,212.8,95,,170.24,percent of total billed charges ,95% of total billed charges,179.2,80,,143.36,percent of total billed charges,78% of total billed charges,174.72,78,,139.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,141.12,450,
SUTURE CX45D,270206212,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
POLYPECTOMY SNARE-ROTATABLE,270206255,CDM,272,RC,,,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,34.37,66.1,,27.5,percent of total billed charges,66.1% of total billed charges,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.76,450,
BIOPSY FORCEP-MAX CAPACITY,270206256,CDM,272,RC,,,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,450,
4.0 ACROMIONIZER BLADE,270206417,CDM,272,RC,,,outpatient,,,224,156.8,,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,172.97,77.22,,138.38,percent of total billed charges,77.22% of total billed charges,148.06,66.1,,118.45,percent of total billed charges,66.1% of total billed charges,185.92,83,,148.74,percent of total billed charges,83% of total,212.8,95,,170.24,percent of total billed charges ,95% of total billed charges,179.2,80,,143.36,percent of total billed charges,78% of total billed charges,174.72,78,,139.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,141.12,450,
4.5 MM INCISOR BLADE,270206486,CDM,272,RC,,,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,57.51,66.1,,46.01,percent of total billed charges,66.1% of total billed charges,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.81,63,,43.85,percent of total billed charges,63% of total billed charges,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.81,450,
2.0 MM DRILL BIT (310.19),270206555,CDM,272,RC,,,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.96,450,
IV START KIT,270206746,CDM,272,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
Z997G SUTURE PDS II,270206800,CDM,272,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
EPIDURAL TRAY-SINGLE DOSE,270206965,CDM,272,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
EPIDURAL TRAY-SINGLE DOSE,270206966,CDM,272,RC,,,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,28.42,66.1,,22.74,percent of total billed charges,66.1% of total billed charges,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.09,450,
X524H SUTURE,270207311,CDM,272,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
BALLOON DILATOR 15-18 MM,270207362,CDM,272,RC,C1726,HCPCS,outpatient,,,534,373.8,,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,412.35,77.22,,329.88,percent of total billed charges,77.22% of total billed charges,352.97,66.1,,282.38,percent of total billed charges,66.1% of total billed charges,443.22,83,,354.58,percent of total billed charges,83% of total,507.3,95,,405.84,percent of total billed charges ,95% of total billed charges,427.2,80,,341.76,percent of total billed charges,78% of total billed charges,416.52,78,,333.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,336.42,507.3,
BALLOON DILATOR 12-15 MM,270207363,CDM,272,RC,C1726,HCPCS,outpatient,,,506,354.2,,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,390.73,77.22,,312.58,percent of total billed charges,77.22% of total billed charges,334.47,66.1,,267.58,percent of total billed charges,66.1% of total billed charges,419.98,83,,335.98,percent of total billed charges,83% of total,480.7,95,,384.56,percent of total billed charges ,95% of total billed charges,404.8,80,,323.84,percent of total billed charges,78% of total billed charges,394.68,78,,315.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,318.78,480.7,
BALLOON DILATOR 10- 12 MM,270207364,CDM,272,RC,C1726,HCPCS,outpatient,,,534,373.8,,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,412.35,77.22,,329.88,percent of total billed charges,77.22% of total billed charges,352.97,66.1,,282.38,percent of total billed charges,66.1% of total billed charges,443.22,83,,354.58,percent of total billed charges,83% of total,507.3,95,,405.84,percent of total billed charges ,95% of total billed charges,427.2,80,,341.76,percent of total billed charges,78% of total billed charges,416.52,78,,333.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,336.42,507.3,
BALLOON DILATOR 15-16.5-18,270207402,CDM,272,RC,C1726,HCPCS,outpatient,,,506,354.2,,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,390.73,77.22,,312.58,percent of total billed charges,77.22% of total billed charges,334.47,66.1,,267.58,percent of total billed charges,66.1% of total billed charges,419.98,83,,335.98,percent of total billed charges,83% of total,480.7,95,,384.56,percent of total billed charges ,95% of total billed charges,404.8,80,,323.84,percent of total billed charges,78% of total billed charges,394.68,78,,315.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,318.78,480.7,
TRACH TUBE ORAL RAE 5.5,270208046,CDM,272,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
"CATHETER, CATTELL 22FR",270208306,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
CATHETER MALECOT 18FR,270208311,CDM,272,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
IV KIT,270209000,CDM,272,RC,,,outpatient,,,187,130.9,,147.73,79,,118.18,percent of total billed charges,79% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.81,63,,94.25,percent of total billed charges,63% of total billed charges,144.4,77.22,,115.52,percent of total billed charges,77.22% of total billed charges,123.61,66.1,,98.89,percent of total billed charges,66.1% of total billed charges,155.21,83,,124.17,percent of total billed charges,83% of total,177.65,95,,142.12,percent of total billed charges ,95% of total billed charges,149.6,80,,119.68,percent of total billed charges,78% of total billed charges,145.86,78,,116.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,117.81,63,,94.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,117.81,63,,94.25,percent of total billed charges,63% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,147.73,79,,118.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.81,450,
7756G 10-0 NYLON SUTURE,270209253,CDM,272,RC,,,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
V448G 10-0 VICRYL,270209255,CDM,272,RC,,,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.49,450,
J547G 8-0 VICRYL,270209256,CDM,272,RC,,,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,18.51,66.1,,14.81,percent of total billed charges,66.1% of total billed charges,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.64,450,
1916G PLAIN GUT 6-0 SUTURE,270209260,CDM,272,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
1780G 6-0 SILK SUTURE,270209261,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
J562G 6-0 VICRYL,270209264,CDM,272,RC,,,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,450,
6-0 PROLENE P1 NEEDLE,270209523,CDM,272,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
FIBROWIRE-BRAIDED #2 SUTURE,270209778,CDM,272,RC,,,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,87.25,66.1,,69.8,percent of total billed charges,66.1% of total billed charges,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,83.16,450,
TROCAR 11X100MM,270209826,CDM,272,RC,,,outpatient,,,174,121.8,,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,134.36,77.22,,107.49,percent of total billed charges,77.22% of total billed charges,115.01,66.1,,92.01,percent of total billed charges,66.1% of total billed charges,144.42,83,,115.54,percent of total billed charges,83% of total,165.3,95,,132.24,percent of total billed charges ,95% of total billed charges,139.2,80,,111.36,percent of total billed charges,78% of total billed charges,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.62,450,
TROCAR FLAT BLADE 5X100MM,270209827,CDM,272,RC,,,outpatient,,,137,95.9,,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,105.79,77.22,,84.63,percent of total billed charges,77.22% of total billed charges,90.56,66.1,,72.45,percent of total billed charges,66.1% of total billed charges,113.71,83,,90.97,percent of total billed charges,83% of total,130.15,95,,104.12,percent of total billed charges ,95% of total billed charges,109.6,80,,87.68,percent of total billed charges,78% of total billed charges,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,86.31,63,,69.05,percent of total billed charges,63% of total billed charges,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.31,450,
T TUBE CATTELL 24FR,270209935,CDM,272,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
J553G 5-0 VICRYL S-24 NEEDLE,270209940,CDM,272,RC,,,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.92,450,
WOUND RETRACTOR- LG,270210023,CDM,272,RC,,,outpatient,,,225,157.5,,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.75,63,,113.4,percent of total billed charges,63% of total billed charges,173.75,77.22,,139,percent of total billed charges,77.22% of total billed charges,148.73,66.1,,118.98,percent of total billed charges,66.1% of total billed charges,186.75,83,,149.4,percent of total billed charges,83% of total,213.75,95,,171,percent of total billed charges ,95% of total billed charges,180,80,,144,percent of total billed charges,78% of total billed charges,175.5,78,,140.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,141.75,63,,113.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,141.75,63,,113.4,percent of total billed charges,63% of total billed charges,191.25,85,,153,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,141.75,450,
IV CATH 14 GA X 1.75,270210208,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
CLIPPER BLADE-DISPOSABLE,270210475,CDM,272,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
DUOVISC VISCOELASTIC SYSTEM,270210559,CDM,272,RC,,,outpatient,,,299,209.3,,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,230.89,77.22,,184.71,percent of total billed charges,77.22% of total billed charges,197.64,66.1,,158.11,percent of total billed charges,66.1% of total billed charges,248.17,83,,198.54,percent of total billed charges,83% of total,284.05,95,,227.24,percent of total billed charges ,95% of total billed charges,239.2,80,,191.36,percent of total billed charges,78% of total billed charges,233.22,78,,186.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,188.37,450,
X424H ETHIBOND XTRA SUTURE,270210927,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
Y426H MONOCRYL 4-0,270210929,CDM,272,RC,,,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
INTRAOCULAR CAUTERY,270211402,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
X833H ETHIBOND 2-0 SH,270211579,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
"FOLEY CATHETER, 30 FR- 30CC",270211996,CDM,272,RC,,,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.74,450,
DEXON S 5-0,270212199,CDM,272,RC,,,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54.18,450,
SAW BLADE 10MM X 50MM,270212298,CDM,272,RC,,,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
7760G ETHICON 9-0,270212638,CDM,272,RC,,,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.36,450,
BICAP BIPOLAR HEMOSTASIS 7FR,270212903,CDM,272,RC,,,outpatient,,,377,263.9,,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,291.12,77.22,,232.9,percent of total billed charges,77.22% of total billed charges,249.2,66.1,,199.36,percent of total billed charges,66.1% of total billed charges,312.91,83,,250.33,percent of total billed charges,83% of total,358.15,95,,286.52,percent of total billed charges ,95% of total billed charges,301.6,80,,241.28,percent of total billed charges,78% of total billed charges,294.06,78,,235.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,237.51,450,
CURETTE STERILE CURVED 12MM,270212943,CDM,272,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
ADULT 10 FRENCH STYLETT,270213359,CDM,272,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
KOALA EXTERNAL BALLOON CATH,270213378,CDM,272,RC,,,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,80.64,66.1,,64.51,percent of total billed charges,66.1% of total billed charges,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.86,450,
BLOOD SOL SET 84 IN,270213547,CDM,272,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
ARTHROSCOPY PUMP TUBING,270213825,CDM,272,RC,,,outpatient,,,257,179.9,,203.03,79,,162.42,percent of total billed charges,79% of total billed charges,231.3,90,,185.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.91,63,,129.53,percent of total billed charges,63% of total billed charges,198.46,77.22,,158.77,percent of total billed charges,77.22% of total billed charges,169.88,66.1,,135.9,percent of total billed charges,66.1% of total billed charges,213.31,83,,170.65,percent of total billed charges,83% of total,244.15,95,,195.32,percent of total billed charges ,95% of total billed charges,205.6,80,,164.48,percent of total billed charges,78% of total billed charges,200.46,78,,160.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,161.91,63,,129.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,161.91,63,,129.53,percent of total billed charges,63% of total billed charges,218.45,85,,174.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,203.03,79,,162.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,161.91,450,
NOVASURE DISPOSABLE DEVICE,270213856,CDM,272,RC,,,outpatient,,,3725,2607.5,,2942.75,79,,2354.2,percent of total billed charges,79% of total billed charges,3352.5,90,,2682,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2346.75,63,,1877.4,percent of total billed charges,63% of total billed charges,2876.45,77.22,,2301.16,percent of total billed charges,77.22% of total billed charges,2462.23,66.1,,1969.78,percent of total billed charges,66.1% of total billed charges,3091.75,83,,2473.4,percent of total billed charges,83% of total,3538.75,95,,2831,percent of total billed charges ,95% of total billed charges,2980,80,,2384,percent of total billed charges,78% of total billed charges,2905.5,78,,2324.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2346.75,63,,1877.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3352.5,90,,2682,percent of total billed charges,90% of total billed charges,2980,80,,2384,percent of total billed charges,80% of total billed charges,2346.75,63,,1877.4,percent of total billed charges,63% of total billed charges,3166.25,85,,2533,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2942.75,79,,2354.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3538.75,
NEEDLE 22G STIMUPLEX,270213888,CDM,272,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
CURETTE CURVED REG TIP 10MM,270214003,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
IV EXTENSION SET 9 IN,270214185,CDM,272,RC,,,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
20GA X 16CM BIOPSY NEEDLE,270214294,CDM,272,RC,,,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,68.74,66.1,,54.99,percent of total billed charges,66.1% of total billed charges,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65.52,450,
PEZZER MODEL 32 FR DRAIN LATEX,270214306,CDM,272,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
PEZZER MODEL 36 FR DRAIN LATEX,270214307,CDM,272,RC,,,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
CURETTE STERILE CURVED 9MM,270214364,CDM,272,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
URO ULTRA BALLOON KIT 5MM,270214366,CDM,272,RC,,,outpatient,,,686,480.2,,541.94,79,,433.55,percent of total billed charges,79% of total billed charges,617.4,90,,493.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,432.18,63,,345.74,percent of total billed charges,63% of total billed charges,529.73,77.22,,423.78,percent of total billed charges,77.22% of total billed charges,453.45,66.1,,362.76,percent of total billed charges,66.1% of total billed charges,569.38,83,,455.5,percent of total billed charges,83% of total,651.7,95,,521.36,percent of total billed charges ,95% of total billed charges,548.8,80,,439.04,percent of total billed charges,78% of total billed charges,535.08,78,,428.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,432.18,63,,345.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,432.18,63,,345.74,percent of total billed charges,63% of total billed charges,583.1,85,,466.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,541.94,79,,433.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,432.18,651.7,
ENDO TUBE 6.5,270214367,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
WOUND RETRACTOR ALEX 5CM 9CM,270214653,CDM,272,RC,,,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
3.0 SUPRAMID EXTRA SUTURE,270214746,CDM,272,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
MULTIFIRE GIA 60 - STAPLER,270214776,CDM,272,RC,,,outpatient,,,759,531.3,,599.61,79,,479.69,percent of total billed charges,79% of total billed charges,683.1,90,,546.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,478.17,63,,382.54,percent of total billed charges,63% of total billed charges,586.1,77.22,,468.88,percent of total billed charges,77.22% of total billed charges,501.7,66.1,,401.36,percent of total billed charges,66.1% of total billed charges,629.97,83,,503.98,percent of total billed charges,83% of total,721.05,95,,576.84,percent of total billed charges ,95% of total billed charges,607.2,80,,485.76,percent of total billed charges,78% of total billed charges,592.02,78,,473.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,478.17,63,,382.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,478.17,63,,382.54,percent of total billed charges,63% of total billed charges,645.15,85,,516.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,599.61,79,,479.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,721.05,
MULTIFIRE GIA 60 LOADING UNIT,270214777,CDM,272,RC,,,outpatient,,,488,341.6,,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,376.83,77.22,,301.46,percent of total billed charges,77.22% of total billed charges,322.57,66.1,,258.06,percent of total billed charges,66.1% of total billed charges,405.04,83,,324.03,percent of total billed charges,83% of total,463.6,95,,370.88,percent of total billed charges ,95% of total billed charges,390.4,80,,312.32,percent of total billed charges,78% of total billed charges,380.64,78,,304.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,390.4,80,,312.32,percent of total billed charges,80% of total billed charges,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,414.8,85,,331.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,307.44,463.6,
DRILL BITS 1/8 IN,270215139,CDM,272,RC,,,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,151.2,450,
CONTRAST INJECTION THERAPY NEE,270215315,CDM,272,RC,,,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,166.57,66.1,,133.26,percent of total billed charges,66.1% of total billed charges,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.76,450,
NERVE BLOCK TRAY,270215333,CDM,272,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
RETROCUTTER 10MM,270215458,CDM,272,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
EAGLE ENDOSCOPIC KITTNER,270215553,CDM,272,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
4.5 TENODESIS DRILL,270216473,CDM,272,RC,,,outpatient,,,657,459.9,,519.03,79,,415.22,percent of total billed charges,79% of total billed charges,591.3,90,,473.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.91,63,,331.13,percent of total billed charges,63% of total billed charges,507.34,77.22,,405.87,percent of total billed charges,77.22% of total billed charges,434.28,66.1,,347.42,percent of total billed charges,66.1% of total billed charges,545.31,83,,436.25,percent of total billed charges,83% of total,624.15,95,,499.32,percent of total billed charges ,95% of total billed charges,525.6,80,,420.48,percent of total billed charges,78% of total billed charges,512.46,78,,409.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,413.91,63,,331.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,413.91,63,,331.13,percent of total billed charges,63% of total billed charges,558.45,85,,446.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,519.03,79,,415.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,413.91,624.15,
DISPOSABLE KNEE POSITIONER,270216929,CDM,272,RC,,,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,423.94,77.22,,339.15,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,345.87,521.55,
"CATHETER, FOLEY 14 FR",270217017,CDM,272,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"1/8"" DRILL BIT",270217289,CDM,272,RC,,,outpatient,,,787,550.9,,621.73,79,,497.38,percent of total billed charges,79% of total billed charges,708.3,90,,566.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.81,63,,396.65,percent of total billed charges,63% of total billed charges,607.72,77.22,,486.18,percent of total billed charges,77.22% of total billed charges,520.21,66.1,,416.17,percent of total billed charges,66.1% of total billed charges,653.21,83,,522.57,percent of total billed charges,83% of total,747.65,95,,598.12,percent of total billed charges ,95% of total billed charges,629.6,80,,503.68,percent of total billed charges,78% of total billed charges,613.86,78,,491.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,495.81,63,,396.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,495.81,63,,396.65,percent of total billed charges,63% of total billed charges,668.95,85,,535.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,621.73,79,,497.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,747.65,
DOUBLE END TROCAR .062,270217433,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
DOUBLE END TROCAR .045,270217434,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
TROCAR ENDOPATH XCEL 5,270217460,CDM,272,RC,,,outpatient,,,453,317.1,,357.87,79,,286.3,percent of total billed charges,79% of total billed charges,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.39,63,,228.31,percent of total billed charges,63% of total billed charges,349.81,77.22,,279.85,percent of total billed charges,77.22% of total billed charges,299.43,66.1,,239.54,percent of total billed charges,66.1% of total billed charges,375.99,83,,300.79,percent of total billed charges,83% of total,430.35,95,,344.28,percent of total billed charges ,95% of total billed charges,362.4,80,,289.92,percent of total billed charges,78% of total billed charges,353.34,78,,282.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,285.39,63,,228.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,407.7,90,,326.16,percent of total billed charges,90% of total billed charges,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,285.39,63,,228.31,percent of total billed charges,63% of total billed charges,385.05,85,,308.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,357.87,79,,286.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,285.39,450,
STIMUPLEX NEEDLE 20 x 6,270217649,CDM,272,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
STIMUPLEX NEEDLE 20 x 6,270217679,CDM,272,RC,,,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
SCORPION NEEDLE,270217855,CDM,272,RC,,,outpatient,,,500,350,,395,79,,316,percent of total billed charges,79% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,386.1,77.22,,308.88,percent of total billed charges,77.22% of total billed charges,330.5,66.1,,264.4,percent of total billed charges,66.1% of total billed charges,415,83,,332,percent of total billed charges,83% of total,475,95,,380,percent of total billed charges ,95% of total billed charges,400,80,,320,percent of total billed charges,78% of total billed charges,390,78,,312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,315,63,,252,percent of total billed charges,63% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,395,79,,316,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315,475,
SAW BLADE,270217887,CDM,272,RC,,,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,160.62,66.1,,128.5,percent of total billed charges,66.1% of total billed charges,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.09,450,
1.8 MM DRILL BIT,270218046,CDM,272,RC,,,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
DOUBLE END TROCAR .035,270218202,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
TRACHEAL TUBE 6.0,270218318,CDM,272,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
"AIRWAY, ORAL 70MM",270218319,CDM,272,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
MICRO OSCILLATOR BLADE,270218431,CDM,272,RC,,,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,25.78,66.1,,20.62,percent of total billed charges,66.1% of total billed charges,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.57,450,
SAGITTAL BLADE 90.0MM x 25.4MM,270218636,CDM,272,RC,,,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.02,450,
BREAST BIOPSY NEEDLE,270218694,CDM,272,RC,C1819,HCPCS,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,62.8,66.1,,50.24,percent of total billed charges,66.1% of total billed charges,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.85,450,
NEONATAL AMBU BAG DISP,270218815,CDM,272,RC,,,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,41.64,66.1,,33.31,percent of total billed charges,66.1% of total billed charges,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.69,450,
CANNULA 5.75,270218904,CDM,272,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
PACK EYE,270218907,CDM,272,RC,,,outpatient,,,402,281.4,,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,310.42,77.22,,248.34,percent of total billed charges,77.22% of total billed charges,265.72,66.1,,212.58,percent of total billed charges,66.1% of total billed charges,333.66,83,,266.93,percent of total billed charges,83% of total,381.9,95,,305.52,percent of total billed charges ,95% of total billed charges,321.6,80,,257.28,percent of total billed charges,78% of total billed charges,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,253.26,450,
SUTURE J566G7-0 VICRYL,270219028,CDM,272,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
SAGITTAL BLADE,270219235,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
STETHOSCOPE PROBE 18FR ESO,270219513,CDM,272,RC,,,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
SUTURE YA1024Q,270219535,CDM,272,RC,,,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,48.91,66.1,,39.13,percent of total billed charges,66.1% of total billed charges,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.62,450,
Y TYPE BLOOD SET,270219655,CDM,272,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
#2 FIBERLOOP STRAIGHT NEEDLE,270219902,CDM,272,RC,,,outpatient,,,197,137.9,,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,152.12,77.22,,121.7,percent of total billed charges,77.22% of total billed charges,130.22,66.1,,104.18,percent of total billed charges,66.1% of total billed charges,163.51,83,,130.81,percent of total billed charges,83% of total,187.15,95,,149.72,percent of total billed charges ,95% of total billed charges,157.6,80,,126.08,percent of total billed charges,78% of total billed charges,153.66,78,,122.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.11,450,
KNIFE 15 DEGREE BLADE,270219912,CDM,272,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
PISTOL GRIP OPTIVIEW TROCAR,270220141,CDM,272,RC,,,outpatient,,,507,354.9,,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,391.51,77.22,,313.21,percent of total billed charges,77.22% of total billed charges,335.13,66.1,,268.1,percent of total billed charges,66.1% of total billed charges,420.81,83,,336.65,percent of total billed charges,83% of total,481.65,95,,385.32,percent of total billed charges ,95% of total billed charges,405.6,80,,324.48,percent of total billed charges,78% of total billed charges,395.46,78,,316.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,405.6,80,,324.48,percent of total billed charges,80% of total billed charges,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,430.95,85,,344.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,319.41,481.65,
DRILL BIT 2.5,270220182,CDM,272,RC,,,outpatient,,,234,163.8,,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,180.69,77.22,,144.55,percent of total billed charges,77.22% of total billed charges,154.67,66.1,,123.74,percent of total billed charges,66.1% of total billed charges,194.22,83,,155.38,percent of total billed charges,83% of total,222.3,95,,177.84,percent of total billed charges ,95% of total billed charges,187.2,80,,149.76,percent of total billed charges,78% of total billed charges,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.42,450,
ESOPHAGEAL STETHOSCOPE W/TEMP,270220253,CDM,272,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
IV CATHETER 14 GA,270220282,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
CANNULA GEMINI,270220320,CDM,272,RC,,,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.94,450,
INFANT NASAL CANNULA,270220344,CDM,272,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
FIBERWIRE W LONG NEEDLES 2.0,270220371,CDM,272,RC,,,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,74.69,66.1,,59.75,percent of total billed charges,66.1% of total billed charges,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.19,450,
DRILL BIT 3.5MM,270220410,CDM,272,RC,,,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,195.93,450,
BLUNT TIP LAPAROSCOPIC SEALER,270220558,CDM,272,RC,,,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
STOPCOCK 4-WAY LARGE BORE,270220591,CDM,272,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
SUTURE 1669H,270220664,CDM,272,RC,,,outpatient,,,5,3.5,,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,4.5,90,,3.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,3.86,77.22,,3.09,percent of total billed charges,77.22% of total billed charges,3.31,66.1,,2.65,percent of total billed charges,66.1% of total billed charges,4.15,83,,3.32,percent of total billed charges,83% of total,4.75,95,,3.8,percent of total billed charges ,95% of total billed charges,4,80,,3.2,percent of total billed charges,78% of total billed charges,3.9,78,,3.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.15,63,,2.52,percent of total billed charges,63% of total billed charges,4.25,85,,3.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.95,79,,3.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.15,450,
CANNULATED HEADED REAMER 6MM,270220678,CDM,272,RC,,,outpatient,,,537,375.9,,424.23,79,,339.38,percent of total billed charges,79% of total billed charges,483.3,90,,386.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,414.67,77.22,,331.74,percent of total billed charges,77.22% of total billed charges,354.96,66.1,,283.97,percent of total billed charges,66.1% of total billed charges,445.71,83,,356.57,percent of total billed charges,83% of total,510.15,95,,408.12,percent of total billed charges ,95% of total billed charges,429.6,80,,343.68,percent of total billed charges,78% of total billed charges,418.86,78,,335.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,424.23,79,,339.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,338.31,510.15,
CANNULA 8.25,270220681,CDM,272,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
APOLLO 90 BIPOLAR ABLATION WAN,270220739,CDM,272,RC,,,outpatient,,,713,499.1,,563.27,79,,450.62,percent of total billed charges,79% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,449.19,63,,359.35,percent of total billed charges,63% of total billed charges,550.58,77.22,,440.46,percent of total billed charges,77.22% of total billed charges,471.29,66.1,,377.03,percent of total billed charges,66.1% of total billed charges,591.79,83,,473.43,percent of total billed charges,83% of total,677.35,95,,541.88,percent of total billed charges ,95% of total billed charges,570.4,80,,456.32,percent of total billed charges,78% of total billed charges,556.14,78,,444.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,449.19,63,,359.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,449.19,63,,359.35,percent of total billed charges,63% of total billed charges,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,563.27,79,,450.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,449.19,677.35,
CRYSTAL CANNULA SMOOTH,270220753,CDM,272,RC,,,outpatient,,,520,364,,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,401.54,77.22,,321.23,percent of total billed charges,77.22% of total billed charges,343.72,66.1,,274.98,percent of total billed charges,66.1% of total billed charges,431.6,83,,345.28,percent of total billed charges,83% of total,494,95,,395.2,percent of total billed charges ,95% of total billed charges,416,80,,332.8,percent of total billed charges,78% of total billed charges,405.6,78,,324.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,327.6,494,
SUTURE TI CRON SIZE 5,270220919,CDM,272,RC,,,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
KNIFE 10MM DOUBLE,270221092,CDM,272,RC,,,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,117.18,450,
STERILE DISP CUFF W/SINGLE BLA,270221119,CDM,272,RC,,,outpatient,,,58,40.6,,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,52.2,90,,41.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,44.79,77.22,,35.83,percent of total billed charges,77.22% of total billed charges,38.34,66.1,,30.67,percent of total billed charges,66.1% of total billed charges,48.14,83,,38.51,percent of total billed charges,83% of total,55.1,95,,44.08,percent of total billed charges ,95% of total billed charges,46.4,80,,37.12,percent of total billed charges,78% of total billed charges,45.24,78,,36.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,36.54,63,,29.23,percent of total billed charges,63% of total billed charges,49.3,85,,39.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.82,79,,36.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.54,450,
HEMOCLIP SMALL,270221132,CDM,272,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
UCL SUTURE PASSING KIT,270221171,CDM,272,RC,,,outpatient,,,2234,1563.8,,1764.86,79,,1411.89,percent of total billed charges,79% of total billed charges,2010.6,90,,1608.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1407.42,63,,1125.94,percent of total billed charges,63% of total billed charges,1725.09,77.22,,1380.07,percent of total billed charges,77.22% of total billed charges,1476.67,66.1,,1181.34,percent of total billed charges,66.1% of total billed charges,1854.22,83,,1483.38,percent of total billed charges,83% of total,2122.3,95,,1697.84,percent of total billed charges ,95% of total billed charges,1787.2,80,,1429.76,percent of total billed charges,78% of total billed charges,1742.52,78,,1394.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1407.42,63,,1125.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2010.6,90,,1608.48,percent of total billed charges,90% of total billed charges,1787.2,80,,1429.76,percent of total billed charges,80% of total billed charges,1407.42,63,,1125.94,percent of total billed charges,63% of total billed charges,1898.9,85,,1519.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1764.86,79,,1411.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2122.3,
DRILL BIT 2.0,270221215,CDM,272,RC,,,outpatient,,,261,182.7,,206.19,79,,164.95,percent of total billed charges,79% of total billed charges,234.9,90,,187.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.43,63,,131.54,percent of total billed charges,63% of total billed charges,201.54,77.22,,161.23,percent of total billed charges,77.22% of total billed charges,172.52,66.1,,138.02,percent of total billed charges,66.1% of total billed charges,216.63,83,,173.3,percent of total billed charges,83% of total,247.95,95,,198.36,percent of total billed charges ,95% of total billed charges,208.8,80,,167.04,percent of total billed charges,78% of total billed charges,203.58,78,,162.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,164.43,63,,131.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,164.43,63,,131.54,percent of total billed charges,63% of total billed charges,221.85,85,,177.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,206.19,79,,164.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,164.43,450,
SUTIRE 1915G,270221583,CDM,272,RC,,,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,18.51,66.1,,14.81,percent of total billed charges,66.1% of total billed charges,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.64,450,
SUTURE 7796G,270221779,CDM,272,RC,,,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
LIGASURE ADVANCE PISTOL GRIP,270221887,CDM,272,RC,,,outpatient,,,2190,1533,,1730.1,79,,1384.08,percent of total billed charges,79% of total billed charges,1971,90,,1576.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1379.7,63,,1103.76,percent of total billed charges,63% of total billed charges,1691.12,77.22,,1352.9,percent of total billed charges,77.22% of total billed charges,1447.59,66.1,,1158.07,percent of total billed charges,66.1% of total billed charges,1817.7,83,,1454.16,percent of total billed charges,83% of total,2080.5,95,,1664.4,percent of total billed charges ,95% of total billed charges,1752,80,,1401.6,percent of total billed charges,78% of total billed charges,1708.2,78,,1366.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1379.7,63,,1103.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1971,90,,1576.8,percent of total billed charges,90% of total billed charges,1752,80,,1401.6,percent of total billed charges,80% of total billed charges,1379.7,63,,1103.76,percent of total billed charges,63% of total billed charges,1861.5,85,,1489.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1730.1,79,,1384.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2080.5,
MINI SUTURE TAK KIT,270221984,CDM,272,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
BONE CUTTER 5.5,270222121,CDM,272,RC,,,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,450,
SABRE 4.0 MM,270222133,CDM,272,RC,,,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
DISSECTOR SHAVER 4.0,270222270,CDM,272,RC,,,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,161.28,66.1,,129.02,percent of total billed charges,66.1% of total billed charges,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.72,450,
DISSECTOR 4.0MM CURVED,270222271,CDM,272,RC,,,outpatient,,,303,212.1,,239.37,79,,191.5,percent of total billed charges,79% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.89,63,,152.71,percent of total billed charges,63% of total billed charges,233.98,77.22,,187.18,percent of total billed charges,77.22% of total billed charges,200.28,66.1,,160.22,percent of total billed charges,66.1% of total billed charges,251.49,83,,201.19,percent of total billed charges,83% of total,287.85,95,,230.28,percent of total billed charges ,95% of total billed charges,242.4,80,,193.92,percent of total billed charges,78% of total billed charges,236.34,78,,189.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.89,63,,152.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.89,63,,152.71,percent of total billed charges,63% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,239.37,79,,191.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.89,450,
3.5 DISSACTOR,270222272,CDM,272,RC,,,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,161.28,66.1,,129.02,percent of total billed charges,66.1% of total billed charges,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.72,450,
4.0 OVAL BURR,270222488,CDM,272,RC,,,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,161.28,66.1,,129.02,percent of total billed charges,66.1% of total billed charges,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.72,450,
ROUND BURR 4.0MM,270222566,CDM,272,RC,,,outpatient,,,68,47.6,,53.72,79,,42.98,percent of total billed charges,79% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.84,63,,34.27,percent of total billed charges,63% of total billed charges,52.51,77.22,,42.01,percent of total billed charges,77.22% of total billed charges,44.95,66.1,,35.96,percent of total billed charges,66.1% of total billed charges,56.44,83,,45.15,percent of total billed charges,83% of total,64.6,95,,51.68,percent of total billed charges ,95% of total billed charges,54.4,80,,43.52,percent of total billed charges,78% of total billed charges,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.84,63,,34.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.84,63,,34.27,percent of total billed charges,63% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,53.72,79,,42.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.84,450,
EVIVA 20MM BIOP DEVICE/VERT AP,270222574,CDM,272,RC,,,outpatient,,,643,450.1,,507.97,79,,406.38,percent of total billed charges,79% of total billed charges,578.7,90,,462.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.09,63,,324.07,percent of total billed charges,63% of total billed charges,496.52,77.22,,397.22,percent of total billed charges,77.22% of total billed charges,425.02,66.1,,340.02,percent of total billed charges,66.1% of total billed charges,533.69,83,,426.95,percent of total billed charges,83% of total,610.85,95,,488.68,percent of total billed charges ,95% of total billed charges,514.4,80,,411.52,percent of total billed charges,78% of total billed charges,501.54,78,,401.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,405.09,63,,324.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,405.09,63,,324.07,percent of total billed charges,63% of total billed charges,546.55,85,,437.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,507.97,79,,406.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,405.09,610.85,
ATEC CANISTER EVIVA,270222575,CDM,272,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
SUTURE J496H,270222610,CDM,272,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
CHOLANGIOGRAPHY KIT,270222628,CDM,272,RC,,,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,111.05,66.1,,88.84,percent of total billed charges,66.1% of total billed charges,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,105.84,63,,84.67,percent of total billed charges,63% of total billed charges,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105.84,450,
SUTURE R691G,270222629,CDM,272,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
ENDOLOOP COATED VICRYL 0 18,270222751,CDM,272,RC,,,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,233.33,66.1,,186.66,percent of total billed charges,66.1% of total billed charges,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,222.39,450,
CO2 NASAL CANN W/SINGLE USE,270222845,CDM,272,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
KIMVENT FLEX,270223031,CDM,272,RC,,,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
TROCAR ENDOPATH XCEL 5MM,270223302,CDM,272,RC,,,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,97.83,66.1,,78.26,percent of total billed charges,66.1% of total billed charges,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.24,450,
PEG KIT - ENDOVIVE SAFETY,270223313,CDM,272,RC,,,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
SUTURE J206G,270223455,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
90 DEGREE SUTURE PASSER,270223497,CDM,272,RC,,,outpatient,,,572,400.4,,451.88,79,,361.5,percent of total billed charges,79% of total billed charges,514.8,90,,411.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.36,63,,288.29,percent of total billed charges,63% of total billed charges,441.7,77.22,,353.36,percent of total billed charges,77.22% of total billed charges,378.09,66.1,,302.47,percent of total billed charges,66.1% of total billed charges,474.76,83,,379.81,percent of total billed charges,83% of total,543.4,95,,434.72,percent of total billed charges ,95% of total billed charges,457.6,80,,366.08,percent of total billed charges,78% of total billed charges,446.16,78,,356.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,360.36,63,,288.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,514.8,90,,411.84,percent of total billed charges,90% of total billed charges,457.6,80,,366.08,percent of total billed charges,80% of total billed charges,360.36,63,,288.29,percent of total billed charges,63% of total billed charges,486.2,85,,388.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,451.88,79,,361.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,360.36,543.4,
SUTURE 737G,270223658,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
CHOLANGIOGRAM CATHETER 4.5,270223679,CDM,272,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
INTRODUCER DISPOSIBLE,270223680,CDM,272,RC,,,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,88.57,66.1,,70.86,percent of total billed charges,66.1% of total billed charges,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,84.42,450,
BREATHING CIRCUIT - PEDIATRIC,270223718,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
ON-Q SELECT A FLOW,270223854,CDM,272,RC,,,outpatient,,,410,287,,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,369,90,,295.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,316.6,77.22,,253.28,percent of total billed charges,77.22% of total billed charges,271.01,66.1,,216.81,percent of total billed charges,66.1% of total billed charges,340.3,83,,272.24,percent of total billed charges,83% of total,389.5,95,,311.6,percent of total billed charges ,95% of total billed charges,328,80,,262.4,percent of total billed charges,78% of total billed charges,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,348.5,85,,278.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,450,
5CC FRENCH LATEX CATHETER,270223897,CDM,272,RC,,,outpatient,,,24,16.8,,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,21.6,90,,17.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,18.53,77.22,,14.82,percent of total billed charges,77.22% of total billed charges,15.86,66.1,,12.69,percent of total billed charges,66.1% of total billed charges,19.92,83,,15.94,percent of total billed charges,83% of total,22.8,95,,18.24,percent of total billed charges ,95% of total billed charges,19.2,80,,15.36,percent of total billed charges,78% of total billed charges,18.72,78,,14.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.12,63,,12.1,percent of total billed charges,63% of total billed charges,20.4,85,,16.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.96,79,,15.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.12,450,
DRILL BIT 2.5MM,270224143,CDM,272,RC,,,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
DRILL BIT 3.5MM,270224145,CDM,272,RC,,,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
DRILL BIT 2.0,270224203,CDM,272,RC,,,outpatient,,,550,385,,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,495,90,,396,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,424.71,77.22,,339.77,percent of total billed charges,77.22% of total billed charges,363.55,66.1,,290.84,percent of total billed charges,66.1% of total billed charges,456.5,83,,365.2,percent of total billed charges,83% of total,522.5,95,,418,percent of total billed charges ,95% of total billed charges,440,80,,352,percent of total billed charges,78% of total billed charges,429,78,,343.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,495,90,,396,percent of total billed charges,90% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,467.5,85,,374,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,346.5,522.5,
SALTER CANNULA,270224225,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
DRILL BIT 2.7MM,270224284,CDM,272,RC,,,outpatient,,,500,350,,395,79,,316,percent of total billed charges,79% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,386.1,77.22,,308.88,percent of total billed charges,77.22% of total billed charges,330.5,66.1,,264.4,percent of total billed charges,66.1% of total billed charges,415,83,,332,percent of total billed charges,83% of total,475,95,,380,percent of total billed charges ,95% of total billed charges,400,80,,320,percent of total billed charges,78% of total billed charges,390,78,,312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,315,63,,252,percent of total billed charges,63% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,395,79,,316,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315,475,
SURGIFISH,270224460,CDM,272,RC,,,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.29,450,
CATHETER TROCAR ARGYLE 24FR,270224555,CDM,272,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
SURGICAL CLIPPER BLADE,270224628,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
COLPOTOMIZ 35 OR TUBE,270224683,CDM,272,RC,,,outpatient,,,247,172.9,,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,190.73,77.22,,152.58,percent of total billed charges,77.22% of total billed charges,163.27,66.1,,130.62,percent of total billed charges,66.1% of total billed charges,205.01,83,,164.01,percent of total billed charges,83% of total,234.65,95,,187.72,percent of total billed charges ,95% of total billed charges,197.6,80,,158.08,percent of total billed charges,78% of total billed charges,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.61,450,
COLPOTOMIZ 45 OR TUBE,270224684,CDM,272,RC,,,outpatient,,,372,260.4,,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,287.26,77.22,,229.81,percent of total billed charges,77.22% of total billed charges,245.89,66.1,,196.71,percent of total billed charges,66.1% of total billed charges,308.76,83,,247.01,percent of total billed charges,83% of total,353.4,95,,282.72,percent of total billed charges ,95% of total billed charges,297.6,80,,238.08,percent of total billed charges,78% of total billed charges,290.16,78,,232.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,234.36,450,
DRILL BIT PERIPHERAL 2.7MM,270224732,CDM,272,RC,,,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
DRILL BIT 3.2MM CENTRAL SCREW,270224733,CDM,272,RC,,,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
DRILL BIT 2.5MM,270224747,CDM,272,RC,,,outpatient,,,234,163.8,,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,180.69,77.22,,144.55,percent of total billed charges,77.22% of total billed charges,154.67,66.1,,123.74,percent of total billed charges,66.1% of total billed charges,194.22,83,,155.38,percent of total billed charges,83% of total,222.3,95,,177.84,percent of total billed charges ,95% of total billed charges,187.2,80,,149.76,percent of total billed charges,78% of total billed charges,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,147.42,63,,117.94,percent of total billed charges,63% of total billed charges,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,147.42,450,
VACUTAINER LUER LOCK ACCESS,270224787,CDM,272,RC,,,outpatient,,,4,2.8,,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,3.6,90,,2.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.09,77.22,,2.47,percent of total billed charges,77.22% of total billed charges,2.64,66.1,,2.11,percent of total billed charges,66.1% of total billed charges,3.32,83,,2.66,percent of total billed charges,83% of total,3.8,95,,3.04,percent of total billed charges ,95% of total billed charges,3.2,80,,2.56,percent of total billed charges,78% of total billed charges,3.12,78,,2.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2.52,63,,2.02,percent of total billed charges,63% of total billed charges,3.4,85,,2.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3.16,79,,2.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,2.52,450,
DRILL BIT 2.0 MM,270224803,CDM,272,RC,,,outpatient,,,487,340.9,,384.73,79,,307.78,percent of total billed charges,79% of total billed charges,438.3,90,,350.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306.81,63,,245.45,percent of total billed charges,63% of total billed charges,376.06,77.22,,300.85,percent of total billed charges,77.22% of total billed charges,321.91,66.1,,257.53,percent of total billed charges,66.1% of total billed charges,404.21,83,,323.37,percent of total billed charges,83% of total,462.65,95,,370.12,percent of total billed charges ,95% of total billed charges,389.6,80,,311.68,percent of total billed charges,78% of total billed charges,379.86,78,,303.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,306.81,63,,245.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,306.81,63,,245.45,percent of total billed charges,63% of total billed charges,413.95,85,,331.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,384.73,79,,307.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,306.81,462.65,
SUTURE J214H,270224898,CDM,272,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
NEEDLE MULTIFIRE,270224951,CDM,272,RC,,,outpatient,,,607,424.9,,479.53,79,,383.62,percent of total billed charges,79% of total billed charges,546.3,90,,437.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382.41,63,,305.93,percent of total billed charges,63% of total billed charges,468.73,77.22,,374.98,percent of total billed charges,77.22% of total billed charges,401.23,66.1,,320.98,percent of total billed charges,66.1% of total billed charges,503.81,83,,403.05,percent of total billed charges,83% of total,576.65,95,,461.32,percent of total billed charges ,95% of total billed charges,485.6,80,,388.48,percent of total billed charges,78% of total billed charges,473.46,78,,378.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,382.41,63,,305.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,382.41,63,,305.93,percent of total billed charges,63% of total billed charges,515.95,85,,412.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,479.53,79,,383.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,382.41,576.65,
GUIDEWIRE,270224985,CDM,272,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
SUTURE J671G,270225080,CDM,272,RC,,,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,11.24,66.1,,8.99,percent of total billed charges,66.1% of total billed charges,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.71,63,,8.57,percent of total billed charges,63% of total billed charges,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.71,450,
GUIDE PIN 2MM,270225098,CDM,272,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
DRILL BIT CANNULATED 3.5,270225099,CDM,272,RC,,,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
BLADE SAGITTAL 90MM X 1.37 MM,270225216,CDM,272,RC,,,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
BLADE SAGITTAL 90MM X 1.19MM,270225217,CDM,272,RC,,,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,62.8,66.1,,50.24,percent of total billed charges,66.1% of total billed charges,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.85,63,,47.88,percent of total billed charges,63% of total billed charges,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.85,450,
DRILL BIT 2.2 MM,270225319,CDM,272,RC,,,outpatient,,,352,246.4,,278.08,79,,222.46,percent of total billed charges,79% of total billed charges,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.76,63,,177.41,percent of total billed charges,63% of total billed charges,271.81,77.22,,217.45,percent of total billed charges,77.22% of total billed charges,232.67,66.1,,186.14,percent of total billed charges,66.1% of total billed charges,292.16,83,,233.73,percent of total billed charges,83% of total,334.4,95,,267.52,percent of total billed charges ,95% of total billed charges,281.6,80,,225.28,percent of total billed charges,78% of total billed charges,274.56,78,,219.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,221.76,63,,177.41,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,221.76,63,,177.41,percent of total billed charges,63% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.08,79,,222.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,221.76,450,
DRIVER BIT 2.2 X 17 MM,270225320,CDM,272,RC,,,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
SAGITTAL BLADE 13.0,270225380,CDM,272,RC,,,outpatient,,,156,109.2,,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,120.46,77.22,,96.37,percent of total billed charges,77.22% of total billed charges,103.12,66.1,,82.5,percent of total billed charges,66.1% of total billed charges,129.48,83,,103.58,percent of total billed charges,83% of total,148.2,95,,118.56,percent of total billed charges ,95% of total billed charges,124.8,80,,99.84,percent of total billed charges,78% of total billed charges,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.28,450,
2.4 DRILL PIN,270225416,CDM,272,RC,,,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
DRILL BIT 2.2MM,270225434,CDM,272,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
DISSECTOR 3.5 CURVED,270225443,CDM,272,RC,,,outpatient,,,181,126.7,,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,139.77,77.22,,111.82,percent of total billed charges,77.22% of total billed charges,119.64,66.1,,95.71,percent of total billed charges,66.1% of total billed charges,150.23,83,,120.18,percent of total billed charges,83% of total,171.95,95,,137.56,percent of total billed charges ,95% of total billed charges,144.8,80,,115.84,percent of total billed charges,78% of total billed charges,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,114.03,450,
270225489,270225489,CDM,272,RC,,,outpatient,,,145,101.5,,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.35,63,,73.08,percent of total billed charges,63% of total billed charges,111.97,77.22,,89.58,percent of total billed charges,77.22% of total billed charges,95.85,66.1,,76.68,percent of total billed charges,66.1% of total billed charges,120.35,83,,96.28,percent of total billed charges,83% of total,137.75,95,,110.2,percent of total billed charges ,95% of total billed charges,116,80,,92.8,percent of total billed charges,78% of total billed charges,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.35,63,,73.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.35,63,,73.08,percent of total billed charges,63% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.35,450,
LMA SZ 4 MERLYN MEDICAL,270225517,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
LMA SZ 5 MERLYN MEDICAL,270225557,CDM,272,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
BALLOON DILATOR 18-20 MM,270225696,CDM,272,RC,C1726,HCPCS,outpatient,,,534,373.8,,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,480.6,90,,384.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,412.35,77.22,,329.88,percent of total billed charges,77.22% of total billed charges,352.97,66.1,,282.38,percent of total billed charges,66.1% of total billed charges,443.22,83,,354.58,percent of total billed charges,83% of total,507.3,95,,405.84,percent of total billed charges ,95% of total billed charges,427.2,80,,341.76,percent of total billed charges,78% of total billed charges,416.52,78,,333.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,336.42,63,,269.14,percent of total billed charges,63% of total billed charges,453.9,85,,363.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,421.86,79,,337.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,336.42,507.3,
2.9 MM DRILL BIT,270225716,CDM,272,RC,,,outpatient,,,352,246.4,,278.08,79,,222.46,percent of total billed charges,79% of total billed charges,316.8,90,,253.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.76,63,,177.41,percent of total billed charges,63% of total billed charges,271.81,77.22,,217.45,percent of total billed charges,77.22% of total billed charges,232.67,66.1,,186.14,percent of total billed charges,66.1% of total billed charges,292.16,83,,233.73,percent of total billed charges,83% of total,334.4,95,,267.52,percent of total billed charges ,95% of total billed charges,281.6,80,,225.28,percent of total billed charges,78% of total billed charges,274.56,78,,219.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,221.76,63,,177.41,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,221.76,63,,177.41,percent of total billed charges,63% of total billed charges,299.2,85,,239.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.08,79,,222.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,221.76,450,
SUTURE L112G 3-0 CHROMIC GUT,270225734,CDM,272,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
SUTURE D3220,270225759,CDM,272,RC,,,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
STRUCTURAL DRILL BIT,270225766,CDM,272,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
BONE CUTTER 4.0,270225767,CDM,272,RC,,,outpatient,,,181,126.7,,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,139.77,77.22,,111.82,percent of total billed charges,77.22% of total billed charges,119.64,66.1,,95.71,percent of total billed charges,66.1% of total billed charges,150.23,83,,120.18,percent of total billed charges,83% of total,171.95,95,,137.56,percent of total billed charges ,95% of total billed charges,144.8,80,,115.84,percent of total billed charges,78% of total billed charges,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,114.03,63,,91.22,percent of total billed charges,63% of total billed charges,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,114.03,450,
CLIPPER BLADE,270225780,CDM,272,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
SUTURE RS22,270225782,CDM,272,RC,,,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.93,450,
SUTURE J270H,270225838,CDM,272,RC,,,outpatient,,,2,1.4,,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,1.8,90,,1.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.54,77.22,,1.23,percent of total billed charges,77.22% of total billed charges,1.32,66.1,,1.06,percent of total billed charges,66.1% of total billed charges,1.66,83,,1.33,percent of total billed charges,83% of total,1.9,95,,1.52,percent of total billed charges ,95% of total billed charges,1.6,80,,1.28,percent of total billed charges,78% of total billed charges,1.56,78,,1.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.26,63,,1.01,percent of total billed charges,63% of total billed charges,1.7,85,,1.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1.58,79,,1.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.26,450,
TRACH TUBE 5.5 CUFF ORAL RAE,270225896,CDM,272,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
TRACH TUBE 6.0 CUFF ORAL RAE,270225897,CDM,272,RC,,,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,6.61,66.1,,5.29,percent of total billed charges,66.1% of total billed charges,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.3,63,,5.04,percent of total billed charges,63% of total billed charges,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.3,450,
2.9 PUSH LOCK DRILL BIT,270225924,CDM,272,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
SUTURE TAPE,270225931,CDM,272,RC,,,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
SUTURE J974,270225966,CDM,272,RC,,,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,70.73,66.1,,56.58,percent of total billed charges,66.1% of total billed charges,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.41,450,
"SUTURE Z346 0/36"" PDS",270225993,CDM,272,RC,,,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.29,450,
"CATHETER, INTRODUCER 15FR",270226043,CDM,272,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
RESOLUTION 360 CLIP 2.8MM,270226100,CDM,272,RC,,,outpatient,,,897,627.9,,708.63,79,,566.9,percent of total billed charges,79% of total billed charges,807.3,90,,645.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.11,63,,452.09,percent of total billed charges,63% of total billed charges,692.66,77.22,,554.13,percent of total billed charges,77.22% of total billed charges,592.92,66.1,,474.34,percent of total billed charges,66.1% of total billed charges,744.51,83,,595.61,percent of total billed charges,83% of total,852.15,95,,681.72,percent of total billed charges ,95% of total billed charges,717.6,80,,574.08,percent of total billed charges,78% of total billed charges,699.66,78,,559.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,565.11,63,,452.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,565.11,63,,452.09,percent of total billed charges,63% of total billed charges,762.45,85,,609.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,708.63,79,,566.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,852.15,
ROTATABLE SNARE MEDIUM 20MM,270226101,CDM,272,RC,,,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.98,450,
CAPTIVATOR II 25MM ROUNDED,270226102,CDM,272,RC,,,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
YUEH CATHETER,270226184,CDM,272,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
PARIETEX PROGRIP MESH L-14X9CM,270226235,CDM,272,RC,,,outpatient,,,912,638.4,,720.48,79,,576.38,percent of total billed charges,79% of total billed charges,820.8,90,,656.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.56,63,,459.65,percent of total billed charges,63% of total billed charges,704.25,77.22,,563.4,percent of total billed charges,77.22% of total billed charges,602.83,66.1,,482.26,percent of total billed charges,66.1% of total billed charges,756.96,83,,605.57,percent of total billed charges,83% of total,866.4,95,,693.12,percent of total billed charges ,95% of total billed charges,729.6,80,,583.68,percent of total billed charges,78% of total billed charges,711.36,78,,569.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,574.56,63,,459.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,820.8,90,,656.64,percent of total billed charges,90% of total billed charges,729.6,80,,583.68,percent of total billed charges,80% of total billed charges,574.56,63,,459.65,percent of total billed charges,63% of total billed charges,775.2,85,,620.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,720.48,79,,576.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,866.4,
HEMOLOK ML CLIP WECK,270226267,CDM,272,RC,,,outpatient,,,106,74.2,,83.74,79,,66.99,percent of total billed charges,79% of total billed charges,95.4,90,,76.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.78,63,,53.42,percent of total billed charges,63% of total billed charges,81.85,77.22,,65.48,percent of total billed charges,77.22% of total billed charges,70.07,66.1,,56.06,percent of total billed charges,66.1% of total billed charges,87.98,83,,70.38,percent of total billed charges,83% of total,100.7,95,,80.56,percent of total billed charges ,95% of total billed charges,84.8,80,,67.84,percent of total billed charges,78% of total billed charges,82.68,78,,66.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.78,63,,53.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.78,63,,53.42,percent of total billed charges,63% of total billed charges,90.1,85,,72.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,83.74,79,,66.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.78,450,
HEMOLOK L CLIP,270226268,CDM,272,RC,,,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,70.73,66.1,,56.58,percent of total billed charges,66.1% of total billed charges,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.41,450,
TRI STAPLE ARTICULATION MEDIUM,270226282,CDM,272,RC,,,outpatient,,,652,456.4,,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,503.47,77.22,,402.78,percent of total billed charges,77.22% of total billed charges,430.97,66.1,,344.78,percent of total billed charges,66.1% of total billed charges,541.16,83,,432.93,percent of total billed charges,83% of total,619.4,95,,495.52,percent of total billed charges ,95% of total billed charges,521.6,80,,417.28,percent of total billed charges,78% of total billed charges,508.56,78,,406.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,521.6,80,,417.28,percent of total billed charges,80% of total billed charges,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,554.2,85,,443.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,410.76,619.4,
TRI STAPLE ARTICULATING,270226283,CDM,272,RC,,,outpatient,,,856,599.2,,676.24,79,,540.99,percent of total billed charges,79% of total billed charges,770.4,90,,616.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,539.28,63,,431.42,percent of total billed charges,63% of total billed charges,661,77.22,,528.8,percent of total billed charges,77.22% of total billed charges,565.82,66.1,,452.66,percent of total billed charges,66.1% of total billed charges,710.48,83,,568.38,percent of total billed charges,83% of total,813.2,95,,650.56,percent of total billed charges ,95% of total billed charges,684.8,80,,547.84,percent of total billed charges,78% of total billed charges,667.68,78,,534.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,539.28,63,,431.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,770.4,90,,616.32,percent of total billed charges,90% of total billed charges,684.8,80,,547.84,percent of total billed charges,80% of total billed charges,539.28,63,,431.42,percent of total billed charges,63% of total billed charges,727.6,85,,582.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,676.24,79,,540.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,813.2,
SUTURE Z334H,270226304,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
CARTER THOMASON CLOSURE SYSTEM,270226305,CDM,272,RC,,,outpatient,,,323,226.1,,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,249.42,77.22,,199.54,percent of total billed charges,77.22% of total billed charges,213.5,66.1,,170.8,percent of total billed charges,66.1% of total billed charges,268.09,83,,214.47,percent of total billed charges,83% of total,306.85,95,,245.48,percent of total billed charges ,95% of total billed charges,258.4,80,,206.72,percent of total billed charges,78% of total billed charges,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,203.49,450,
OBTRYX II MIDURETHRAL SLING,270226310,CDM,272,RC,,,outpatient,,,3465,2425.5,,2737.35,79,,2189.88,percent of total billed charges,79% of total billed charges,3118.5,90,,2494.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2182.95,63,,1746.36,percent of total billed charges,63% of total billed charges,2675.67,77.22,,2140.54,percent of total billed charges,77.22% of total billed charges,2290.37,66.1,,1832.3,percent of total billed charges,66.1% of total billed charges,2875.95,83,,2300.76,percent of total billed charges,83% of total,3291.75,95,,2633.4,percent of total billed charges ,95% of total billed charges,2772,80,,2217.6,percent of total billed charges,78% of total billed charges,2702.7,78,,2162.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2182.95,63,,1746.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3118.5,90,,2494.8,percent of total billed charges,90% of total billed charges,2772,80,,2217.6,percent of total billed charges,80% of total billed charges,2182.95,63,,1746.36,percent of total billed charges,63% of total billed charges,2945.25,85,,2356.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2737.35,79,,2189.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3291.75,
REAMER CANNULATED 7.5,270226311,CDM,272,RC,,,outpatient,,,538,376.6,,425.02,79,,340.02,percent of total billed charges,79% of total billed charges,484.2,90,,387.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,338.94,63,,271.15,percent of total billed charges,63% of total billed charges,415.44,77.22,,332.35,percent of total billed charges,77.22% of total billed charges,355.62,66.1,,284.5,percent of total billed charges,66.1% of total billed charges,446.54,83,,357.23,percent of total billed charges,83% of total,511.1,95,,408.88,percent of total billed charges ,95% of total billed charges,430.4,80,,344.32,percent of total billed charges,78% of total billed charges,419.64,78,,335.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,338.94,63,,271.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,484.2,90,,387.36,percent of total billed charges,90% of total billed charges,430.4,80,,344.32,percent of total billed charges,80% of total billed charges,338.94,63,,271.15,percent of total billed charges,63% of total billed charges,457.3,85,,365.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,425.02,79,,340.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,338.94,511.1,
NEEDLE DISPOSABLE 12 CM,270226323,CDM,272,RC,,,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
HUBER INFUS SET 19GX1.5 DISP,270226509,CDM,272,RC,,,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,27.1,66.1,,21.68,percent of total billed charges,66.1% of total billed charges,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.83,63,,20.66,percent of total billed charges,63% of total billed charges,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.83,450,
8.25 CANNULA,270226528,CDM,272,RC,,,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
SCORPION NEEDLE,270226529,CDM,272,RC,,,outpatient,,,500,350,,395,79,,316,percent of total billed charges,79% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,386.1,77.22,,308.88,percent of total billed charges,77.22% of total billed charges,330.5,66.1,,264.4,percent of total billed charges,66.1% of total billed charges,415,83,,332,percent of total billed charges,83% of total,475,95,,380,percent of total billed charges ,95% of total billed charges,400,80,,320,percent of total billed charges,78% of total billed charges,390,78,,312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,315,63,,252,percent of total billed charges,63% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,395,79,,316,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315,475,
7 X 7 CANNULA,270226530,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
SAFETY SLIT KNIFE 2.58MM 45D,270226536,CDM,272,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
5.0 DRILL BIT,270226538,CDM,272,RC,,,outpatient,,,1712,1198.4,,1352.48,79,,1081.98,percent of total billed charges,79% of total billed charges,1540.8,90,,1232.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1078.56,63,,862.85,percent of total billed charges,63% of total billed charges,1322.01,77.22,,1057.61,percent of total billed charges,77.22% of total billed charges,1131.63,66.1,,905.3,percent of total billed charges,66.1% of total billed charges,1420.96,83,,1136.77,percent of total billed charges,83% of total,1626.4,95,,1301.12,percent of total billed charges ,95% of total billed charges,1369.6,80,,1095.68,percent of total billed charges,78% of total billed charges,1335.36,78,,1068.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1078.56,63,,862.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1540.8,90,,1232.64,percent of total billed charges,90% of total billed charges,1369.6,80,,1095.68,percent of total billed charges,80% of total billed charges,1078.56,63,,862.85,percent of total billed charges,63% of total billed charges,1455.2,85,,1164.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1352.48,79,,1081.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1626.4,
2.9 CANNULATED DRILL BIT,270226546,CDM,272,RC,,,outpatient,,,855,598.5,,675.45,79,,540.36,percent of total billed charges,79% of total billed charges,769.5,90,,615.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,538.65,63,,430.92,percent of total billed charges,63% of total billed charges,660.23,77.22,,528.18,percent of total billed charges,77.22% of total billed charges,565.16,66.1,,452.13,percent of total billed charges,66.1% of total billed charges,709.65,83,,567.72,percent of total billed charges,83% of total,812.25,95,,649.8,percent of total billed charges ,95% of total billed charges,684,80,,547.2,percent of total billed charges,78% of total billed charges,666.9,78,,533.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,538.65,63,,430.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,769.5,90,,615.6,percent of total billed charges,90% of total billed charges,684,80,,547.2,percent of total billed charges,80% of total billed charges,538.65,63,,430.92,percent of total billed charges,63% of total billed charges,726.75,85,,581.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,675.45,79,,540.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,812.25,
SUCTION CATHETER 18FR,270226551,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
DRILL BIT 4MM,270226601,CDM,272,RC,,,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,199.08,450,
"GUIDEWIRE 7""",270226602,CDM,272,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
"GUIDEWIRE 6""",270226603,CDM,272,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
OSCILLATING BLADE 18MM X5.5MM,270226647,CDM,272,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
OSCILLATING BLADE 25MM X 9MM,270226648,CDM,272,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
1.8 MM DRILL BIT,270226653,CDM,272,RC,,,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
2.4 MM DRILL BIT,270226654,CDM,272,RC,,,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
1.5 MM DRILL BIT,270226657,CDM,272,RC,,,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.86,450,
2.00 MM DRILL BIT,270226658,CDM,272,RC,,,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.86,450,
2.0 DRILL BIT,270226666,CDM,272,RC,,,outpatient,,,127,88.9,,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,98.07,77.22,,78.46,percent of total billed charges,77.22% of total billed charges,83.95,66.1,,67.16,percent of total billed charges,66.1% of total billed charges,105.41,83,,84.33,percent of total billed charges,83% of total,120.65,95,,96.52,percent of total billed charges ,95% of total billed charges,101.6,80,,81.28,percent of total billed charges,78% of total billed charges,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,80.01,63,,64.01,percent of total billed charges,63% of total billed charges,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.01,450,
3.0 DRILL BIT,270226667,CDM,272,RC,,,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.34,450,
1.7 DRILL BIT,270226672,CDM,272,RC,,,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,118.98,66.1,,95.18,percent of total billed charges,66.1% of total billed charges,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.4,450,
SCORPION MULTIFIRE NEEDLE,270226681,CDM,272,RC,,,outpatient,,,639,447.3,,504.81,79,,403.85,percent of total billed charges,79% of total billed charges,575.1,90,,460.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,402.57,63,,322.06,percent of total billed charges,63% of total billed charges,493.44,77.22,,394.75,percent of total billed charges,77.22% of total billed charges,422.38,66.1,,337.9,percent of total billed charges,66.1% of total billed charges,530.37,83,,424.3,percent of total billed charges,83% of total,607.05,95,,485.64,percent of total billed charges ,95% of total billed charges,511.2,80,,408.96,percent of total billed charges,78% of total billed charges,498.42,78,,398.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,402.57,63,,322.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,575.1,90,,460.08,percent of total billed charges,90% of total billed charges,511.2,80,,408.96,percent of total billed charges,80% of total billed charges,402.57,63,,322.06,percent of total billed charges,63% of total billed charges,543.15,85,,434.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,504.81,79,,403.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,402.57,607.05,
9.5 RETROCUTTER,270226682,CDM,272,RC,,,outpatient,,,418,292.6,,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,322.78,77.22,,258.22,percent of total billed charges,77.22% of total billed charges,276.3,66.1,,221.04,percent of total billed charges,66.1% of total billed charges,346.94,83,,277.55,percent of total billed charges,83% of total,397.1,95,,317.68,percent of total billed charges ,95% of total billed charges,334.4,80,,267.52,percent of total billed charges,78% of total billed charges,326.04,78,,260.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,263.34,450,
BIOPSY NEEDLE 13 GA,270226724,CDM,272,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
ULTRACORE BIOPSY CLIPS,270226725,CDM,272,RC,A4648,HCPCS,outpatient,,,423,296.1,,334.17,79,,267.34,percent of total billed charges,79% of total billed charges,380.7,90,,304.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,326.64,77.22,,261.31,percent of total billed charges,77.22% of total billed charges,279.6,66.1,,223.68,percent of total billed charges,66.1% of total billed charges,351.09,83,,280.87,percent of total billed charges,83% of total,401.85,95,,321.48,percent of total billed charges ,95% of total billed charges,338.4,80,,270.72,percent of total billed charges,78% of total billed charges,329.94,78,,263.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,266.49,63,,213.19,percent of total billed charges,63% of total billed charges,359.55,85,,287.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,334.17,79,,267.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,266.49,450,
BIOPSY NEEDLE 14 GA X 15 CM,270226732,CDM,272,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
SUTURE MCP945H,270226749,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
SUTURE J 947H,270226761,CDM,272,RC,,,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
AIRWAY 7.5CM RAPID RHINO,270226765,CDM,272,RC,,,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
TROCAR POINT PIN 3.2MM SZ 2.3,270226777,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
TROCAR POINT PIN 3.2MM SZ 5.1,270226778,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
BLADE W 18 MM X L 100 X 1.19,270226803,CDM,272,RC,,,outpatient,,,165,115.5,,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,127.41,77.22,,101.93,percent of total billed charges,77.22% of total billed charges,109.07,66.1,,87.26,percent of total billed charges,66.1% of total billed charges,136.95,83,,109.56,percent of total billed charges,83% of total,156.75,95,,125.4,percent of total billed charges ,95% of total billed charges,132,80,,105.6,percent of total billed charges,78% of total billed charges,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.95,450,
SUTURE 8684G 3.O PROLENE,270226806,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
SUTURE J427H,270226808,CDM,272,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
SAW BLAD 5.5 18MM,270226811,CDM,272,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
DBL ENDED TROCAT TIP 1.4 MM,270226819,CDM,272,RC,,,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,18.51,66.1,,14.81,percent of total billed charges,66.1% of total billed charges,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.64,63,,14.11,percent of total billed charges,63% of total billed charges,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.64,450,
DBL ENDED TROCAR TIP 1.6MM 150,270226823,CDM,272,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
DRILL BIT 1.5 MM,270226832,CDM,272,RC,,,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,97.83,66.1,,78.26,percent of total billed charges,66.1% of total billed charges,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.24,450,
DRILL BIT 2.0 MM,270226833,CDM,272,RC,,,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,97.83,66.1,,78.26,percent of total billed charges,66.1% of total billed charges,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.24,450,
CLIP EPIX UNIVERSAL,270226848,CDM,272,RC,,,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
CANNULA SET W DISTAL HOLD 5.5,270226852,CDM,272,RC,,,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
SABRE 3.8MM X 13,270226868,CDM,272,RC,,,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,160.62,66.1,,128.5,percent of total billed charges,66.1% of total billed charges,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,153.09,450,
SUTURE,270226883,CDM,272,RC,,,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,9.25,66.1,,7.4,percent of total billed charges,66.1% of total billed charges,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.82,63,,7.06,percent of total billed charges,63% of total billed charges,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.82,450,
TROCAR POINT PIN 3.2MMX3.0,270226903,CDM,272,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
GASTROSTOMY TUBE 14FR,270226978,CDM,272,RC,,,outpatient,,,76,53.2,,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,58.69,77.22,,46.95,percent of total billed charges,77.22% of total billed charges,50.24,66.1,,40.19,percent of total billed charges,66.1% of total billed charges,63.08,83,,50.46,percent of total billed charges,83% of total,72.2,95,,57.76,percent of total billed charges ,95% of total billed charges,60.8,80,,48.64,percent of total billed charges,78% of total billed charges,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.88,450,
DRILL BIT 4.5 MM,270226999,CDM,272,RC,,,outpatient,,,341,238.7,,269.39,79,,215.51,percent of total billed charges,79% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.83,63,,171.86,percent of total billed charges,63% of total billed charges,263.32,77.22,,210.66,percent of total billed charges,77.22% of total billed charges,225.4,66.1,,180.32,percent of total billed charges,66.1% of total billed charges,283.03,83,,226.42,percent of total billed charges,83% of total,323.95,95,,259.16,percent of total billed charges ,95% of total billed charges,272.8,80,,218.24,percent of total billed charges,78% of total billed charges,265.98,78,,212.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.83,63,,171.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.83,63,,171.86,percent of total billed charges,63% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,269.39,79,,215.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.83,450,
DRILL BIT 3.2 MM,270227000,CDM,272,RC,,,outpatient,,,341,238.7,,269.39,79,,215.51,percent of total billed charges,79% of total billed charges,306.9,90,,245.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.83,63,,171.86,percent of total billed charges,63% of total billed charges,263.32,77.22,,210.66,percent of total billed charges,77.22% of total billed charges,225.4,66.1,,180.32,percent of total billed charges,66.1% of total billed charges,283.03,83,,226.42,percent of total billed charges,83% of total,323.95,95,,259.16,percent of total billed charges ,95% of total billed charges,272.8,80,,218.24,percent of total billed charges,78% of total billed charges,265.98,78,,212.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.83,63,,171.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.83,63,,171.86,percent of total billed charges,63% of total billed charges,289.85,85,,231.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,269.39,79,,215.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.83,450,
DRILL BIT 2.7 MM,270227001,CDM,272,RC,,,outpatient,,,473,331.1,,373.67,79,,298.94,percent of total billed charges,79% of total billed charges,425.7,90,,340.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.99,63,,238.39,percent of total billed charges,63% of total billed charges,365.25,77.22,,292.2,percent of total billed charges,77.22% of total billed charges,312.65,66.1,,250.12,percent of total billed charges,66.1% of total billed charges,392.59,83,,314.07,percent of total billed charges,83% of total,449.35,95,,359.48,percent of total billed charges ,95% of total billed charges,378.4,80,,302.72,percent of total billed charges,78% of total billed charges,368.94,78,,295.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,297.99,63,,238.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,425.7,90,,340.56,percent of total billed charges,90% of total billed charges,378.4,80,,302.72,percent of total billed charges,80% of total billed charges,297.99,63,,238.39,percent of total billed charges,63% of total billed charges,402.05,85,,321.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,373.67,79,,298.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,297.99,450,
DRILL BIT 1.25 MM,270227002,CDM,272,RC,,,outpatient,,,581,406.7,,458.99,79,,367.19,percent of total billed charges,79% of total billed charges,522.9,90,,418.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.03,63,,292.82,percent of total billed charges,63% of total billed charges,448.65,77.22,,358.92,percent of total billed charges,77.22% of total billed charges,384.04,66.1,,307.23,percent of total billed charges,66.1% of total billed charges,482.23,83,,385.78,percent of total billed charges,83% of total,551.95,95,,441.56,percent of total billed charges ,95% of total billed charges,464.8,80,,371.84,percent of total billed charges,78% of total billed charges,453.18,78,,362.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,366.03,63,,292.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,366.03,63,,292.82,percent of total billed charges,63% of total billed charges,493.85,85,,395.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,458.99,79,,367.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,366.03,551.95,
KII OPTICAL ACCESS 12X150MM,270227005,CDM,272,RC,,,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,166.57,66.1,,133.26,percent of total billed charges,66.1% of total billed charges,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,158.76,63,,127.01,percent of total billed charges,63% of total billed charges,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,158.76,450,
SURGIFOAM 8CMX12.5CMX10CM,270227251,CDM,272,RC,,,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
NOVASURE ADVANCED STERILE,270227328,CDM,272,RC,,,outpatient,,,2561,1792.7,,2023.19,79,,1618.55,percent of total billed charges,79% of total billed charges,2304.9,90,,1843.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1613.43,63,,1290.74,percent of total billed charges,63% of total billed charges,1977.6,77.22,,1582.08,percent of total billed charges,77.22% of total billed charges,1692.82,66.1,,1354.26,percent of total billed charges,66.1% of total billed charges,2125.63,83,,1700.5,percent of total billed charges,83% of total,2432.95,95,,1946.36,percent of total billed charges ,95% of total billed charges,2048.8,80,,1639.04,percent of total billed charges,78% of total billed charges,1997.58,78,,1598.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1613.43,63,,1290.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1613.43,63,,1290.74,percent of total billed charges,63% of total billed charges,2176.85,85,,1741.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2023.19,79,,1618.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2432.95,
DRILL BIT 1.8 MM,270227407,CDM,272,RC,,,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
DRILL BIT 2.4 MM,270227408,CDM,272,RC,,,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
SCOPE SEAL,270227433,CDM,272,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
DRILL BIT 2.5,270227592,CDM,272,RC,,,outpatient,,,475,332.5,,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,427.5,90,,342,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,366.8,77.22,,293.44,percent of total billed charges,77.22% of total billed charges,313.98,66.1,,251.18,percent of total billed charges,66.1% of total billed charges,394.25,83,,315.4,percent of total billed charges,83% of total,451.25,95,,361,percent of total billed charges ,95% of total billed charges,380,80,,304,percent of total billed charges,78% of total billed charges,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,299.25,451.25,
DRILL BIT 3.5,270227597,CDM,272,RC,,,outpatient,,,475,332.5,,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,427.5,90,,342,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,366.8,77.22,,293.44,percent of total billed charges,77.22% of total billed charges,313.98,66.1,,251.18,percent of total billed charges,66.1% of total billed charges,394.25,83,,315.4,percent of total billed charges,83% of total,451.25,95,,361,percent of total billed charges ,95% of total billed charges,380,80,,304,percent of total billed charges,78% of total billed charges,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,299.25,451.25,
SUTURE DP990G,270227706,CDM,272,RC,,,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,13.88,66.1,,11.1,percent of total billed charges,66.1% of total billed charges,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.23,63,,10.58,percent of total billed charges,63% of total billed charges,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.23,450,
CURETTE 13 MM3/8 BASE RIGID ST,270227707,CDM,272,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
NEEDLEMASTER INJ NEEDLE,270227777,CDM,272,RC,,,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,80.64,66.1,,64.51,percent of total billed charges,66.1% of total billed charges,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.86,450,
HEMOSTASIS CLIP,270227778,CDM,272,RC,,,outpatient,,,402,281.4,,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,310.42,77.22,,248.34,percent of total billed charges,77.22% of total billed charges,265.72,66.1,,212.58,percent of total billed charges,66.1% of total billed charges,333.66,83,,266.93,percent of total billed charges,83% of total,381.9,95,,305.52,percent of total billed charges ,95% of total billed charges,321.6,80,,257.28,percent of total billed charges,78% of total billed charges,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,253.26,450,
BIOPSY NEEDLE 2.8 CM,270227782,CDM,272,RC,,,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
HOT BIOPSY FORCEPS W/NEED 2.8,270227784,CDM,272,RC,,,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
ESPOCAN SPINAL/EPI SET,270227820,CDM,272,RC,,,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,27.76,66.1,,22.21,percent of total billed charges,66.1% of total billed charges,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,26.46,63,,21.17,percent of total billed charges,63% of total billed charges,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26.46,450,
GLIDESCOPE BLADE MAC S-4,270227845,CDM,272,RC,,,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
GLIDESCOPE BLADE MAC S-3,270227846,CDM,272,RC,,,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
MIDLINE CATH 20G/8FULL TRAY,270227916,CDM,272,RC,,,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.86,450,
BARD MARQUEE BIO NEEDLE 14 GA,270227971,CDM,272,RC,,,outpatient,,,221,154.7,,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,170.66,77.22,,136.53,percent of total billed charges,77.22% of total billed charges,146.08,66.1,,116.86,percent of total billed charges,66.1% of total billed charges,183.43,83,,146.74,percent of total billed charges,83% of total,209.95,95,,167.96,percent of total billed charges ,95% of total billed charges,176.8,80,,141.44,percent of total billed charges,78% of total billed charges,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,139.23,450,
3.2MM GUIDE PIN,270227983,CDM,272,RC,,,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
2.0MM GUIDE PIN,270227984,CDM,272,RC,,,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,328.19,77.22,,262.55,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.75,450,
TRI LUMEN 6 POWER INJECTABLE,270228085,CDM,272,RC,,,outpatient,,,299,209.3,,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,230.89,77.22,,184.71,percent of total billed charges,77.22% of total billed charges,197.64,66.1,,158.11,percent of total billed charges,66.1% of total billed charges,248.17,83,,198.54,percent of total billed charges,83% of total,284.05,95,,227.24,percent of total billed charges ,95% of total billed charges,239.2,80,,191.36,percent of total billed charges,78% of total billed charges,233.22,78,,186.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,188.37,450,
VOYANT MARYLAND FUSION 37 CM,270228091,CDM,272,RC,,,outpatient,,,1023,716.1,,808.17,79,,646.54,percent of total billed charges,79% of total billed charges,920.7,90,,736.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,644.49,63,,515.59,percent of total billed charges,63% of total billed charges,789.96,77.22,,631.97,percent of total billed charges,77.22% of total billed charges,676.2,66.1,,540.96,percent of total billed charges,66.1% of total billed charges,849.09,83,,679.27,percent of total billed charges,83% of total,971.85,95,,777.48,percent of total billed charges ,95% of total billed charges,818.4,80,,654.72,percent of total billed charges,78% of total billed charges,797.94,78,,638.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,644.49,63,,515.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,920.7,90,,736.56,percent of total billed charges,90% of total billed charges,818.4,80,,654.72,percent of total billed charges,80% of total billed charges,644.49,63,,515.59,percent of total billed charges,63% of total billed charges,869.55,85,,695.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,808.17,79,,646.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,971.85,
VOYANT FUSION 2MM,270228092,CDM,272,RC,,,outpatient,,,1023,716.1,,808.17,79,,646.54,percent of total billed charges,79% of total billed charges,920.7,90,,736.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,644.49,63,,515.59,percent of total billed charges,63% of total billed charges,789.96,77.22,,631.97,percent of total billed charges,77.22% of total billed charges,676.2,66.1,,540.96,percent of total billed charges,66.1% of total billed charges,849.09,83,,679.27,percent of total billed charges,83% of total,971.85,95,,777.48,percent of total billed charges ,95% of total billed charges,818.4,80,,654.72,percent of total billed charges,78% of total billed charges,797.94,78,,638.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,644.49,63,,515.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,920.7,90,,736.56,percent of total billed charges,90% of total billed charges,818.4,80,,654.72,percent of total billed charges,80% of total billed charges,644.49,63,,515.59,percent of total billed charges,63% of total billed charges,869.55,85,,695.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,808.17,79,,646.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,971.85,
VOYANT OPEN FUSION 20 CM,270228093,CDM,272,RC,,,outpatient,,,787,550.9,,621.73,79,,497.38,percent of total billed charges,79% of total billed charges,708.3,90,,566.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.81,63,,396.65,percent of total billed charges,63% of total billed charges,607.72,77.22,,486.18,percent of total billed charges,77.22% of total billed charges,520.21,66.1,,416.17,percent of total billed charges,66.1% of total billed charges,653.21,83,,522.57,percent of total billed charges,83% of total,747.65,95,,598.12,percent of total billed charges ,95% of total billed charges,629.6,80,,503.68,percent of total billed charges,78% of total billed charges,613.86,78,,491.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,495.81,63,,396.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,495.81,63,,396.65,percent of total billed charges,63% of total billed charges,668.95,85,,535.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,621.73,79,,497.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,747.65,
CANNULA 8.25,270228175,CDM,272,RC,,,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.94,450,
CANNULA 8.25 X7,270228287,CDM,272,RC,,,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,97.17,66.1,,77.74,percent of total billed charges,66.1% of total billed charges,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.61,450,
US EVIVA NEEDLE GUIDE,270228291,CDM,272,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
US ATEC TISSUE FILTER,270228292,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
US HAND PIECES,270228293,CDM,272,RC,,,outpatient,,,615,430.5,,485.85,79,,388.68,percent of total billed charges,79% of total billed charges,553.5,90,,442.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,387.45,63,,309.96,percent of total billed charges,63% of total billed charges,474.9,77.22,,379.92,percent of total billed charges,77.22% of total billed charges,406.52,66.1,,325.22,percent of total billed charges,66.1% of total billed charges,510.45,83,,408.36,percent of total billed charges,83% of total,584.25,95,,467.4,percent of total billed charges ,95% of total billed charges,492,80,,393.6,percent of total billed charges,78% of total billed charges,479.7,78,,383.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,387.45,63,,309.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,387.45,63,,309.96,percent of total billed charges,63% of total billed charges,522.75,85,,418.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,485.85,79,,388.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,387.45,584.25,
US TUMARK E13-S-X,270228295,CDM,272,RC,,,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.7,450,
US TUMARK E13-S-Q,270228296,CDM,272,RC,,,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.7,450,
US TUMARK E13-P-X,270228297,CDM,272,RC,,,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.7,450,
PERL FLEX NEEDLE LOC DEVICE,270228413,CDM,272,RC,,,outpatient,,,780,546,,616.2,79,,492.96,percent of total billed charges,79% of total billed charges,702,90,,561.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,491.4,63,,393.12,percent of total billed charges,63% of total billed charges,602.32,77.22,,481.86,percent of total billed charges,77.22% of total billed charges,515.58,66.1,,412.46,percent of total billed charges,66.1% of total billed charges,647.4,83,,517.92,percent of total billed charges,83% of total,741,95,,592.8,percent of total billed charges ,95% of total billed charges,624,80,,499.2,percent of total billed charges,78% of total billed charges,608.4,78,,486.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,491.4,63,,393.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,491.4,63,,393.12,percent of total billed charges,63% of total billed charges,663,85,,530.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,616.2,79,,492.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,741,
LARYNGOSCOPE BLADE SIZE 3 MED,270228417,CDM,272,RC,,,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,25.78,66.1,,20.62,percent of total billed charges,66.1% of total billed charges,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.57,450,
MCGRATH MAC BLADE SIZE 4,270228435,CDM,272,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
SHOULDER TRAY,270228530,CDM,272,RC,,,outpatient,,,1012,708.4,,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,781.47,77.22,,625.18,percent of total billed charges,77.22% of total billed charges,668.93,66.1,,535.14,percent of total billed charges,66.1% of total billed charges,839.96,83,,671.97,percent of total billed charges,83% of total,961.4,95,,769.12,percent of total billed charges ,95% of total billed charges,809.6,80,,647.68,percent of total billed charges,78% of total billed charges,789.36,78,,631.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,809.6,80,,647.68,percent of total billed charges,80% of total billed charges,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,860.2,85,,688.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,961.4,
PEG KIT 24FR PULL (AVANOS),270228550,CDM,272,RC,,,outpatient,,,247,172.9,,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,190.73,77.22,,152.58,percent of total billed charges,77.22% of total billed charges,163.27,66.1,,130.62,percent of total billed charges,66.1% of total billed charges,205.01,83,,164.01,percent of total billed charges,83% of total,234.65,95,,187.72,percent of total billed charges ,95% of total billed charges,197.6,80,,158.08,percent of total billed charges,78% of total billed charges,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.61,450,
OPTIFIX AT 30-TACK TACKER,270228556,CDM,272,RC,,,outpatient,,,1327.5,929.25,,1048.73,79,,838.98,percent of total billed charges,79% of total billed charges,1194.75,90,,955.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,836.33,63,,669.06,percent of total billed charges,63% of total billed charges,1025.1,77.22,,820.08,percent of total billed charges,77.22% of total billed charges,877.48,66.1,,701.98,percent of total billed charges,66.1% of total billed charges,1101.83,83,,881.46,percent of total billed charges,83% of total,1261.13,95,,1008.9,percent of total billed charges ,95% of total billed charges,1062,80,,849.6,percent of total billed charges,78% of total billed charges,1035.45,78,,828.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,836.33,63,,669.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1194.75,90,,955.8,percent of total billed charges,90% of total billed charges,1062,80,,849.6,percent of total billed charges,80% of total billed charges,836.33,63,,669.06,percent of total billed charges,63% of total billed charges,1128.38,85,,902.704,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1048.73,79,,838.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1261.13,
PEG KIT 20FR PULL,270228559,CDM,272,RC,,,outpatient,,,247,172.9,,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,190.73,77.22,,152.58,percent of total billed charges,77.22% of total billed charges,163.27,66.1,,130.62,percent of total billed charges,66.1% of total billed charges,205.01,83,,164.01,percent of total billed charges,83% of total,234.65,95,,187.72,percent of total billed charges ,95% of total billed charges,197.6,80,,158.08,percent of total billed charges,78% of total billed charges,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.61,450,
INSUFFLATION TUBING UHI OLYMPU,270228909,CDM,272,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
SUCTION TUBING,270228910,CDM,272,RC,,,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,48.91,66.1,,39.13,percent of total billed charges,66.1% of total billed charges,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,46.62,63,,37.3,percent of total billed charges,63% of total billed charges,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.62,450,
1.3MM SUTURE TAPE,270228954,CDM,272,RC,,,outpatient,,,197,137.9,,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,152.12,77.22,,121.7,percent of total billed charges,77.22% of total billed charges,130.22,66.1,,104.18,percent of total billed charges,66.1% of total billed charges,163.51,83,,130.81,percent of total billed charges,83% of total,187.15,95,,149.72,percent of total billed charges ,95% of total billed charges,157.6,80,,126.08,percent of total billed charges,78% of total billed charges,153.66,78,,122.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.11,450,
TUNGSTEN LOOP ELECTRODE 20X12,270229102,CDM,272,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
TUNGSTEN LOOP ELECTRODE 12X15,270229104,CDM,272,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
DRILL BIT 2.0 MM,270229159,CDM,272,RC,,,outpatient,,,660,462,,521.4,79,,417.12,percent of total billed charges,79% of total billed charges,594,90,,475.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,415.8,63,,332.64,percent of total billed charges,63% of total billed charges,509.65,77.22,,407.72,percent of total billed charges,77.22% of total billed charges,436.26,66.1,,349.01,percent of total billed charges,66.1% of total billed charges,547.8,83,,438.24,percent of total billed charges,83% of total,627,95,,501.6,percent of total billed charges ,95% of total billed charges,528,80,,422.4,percent of total billed charges,78% of total billed charges,514.8,78,,411.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,415.8,63,,332.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,594,90,,475.2,percent of total billed charges,90% of total billed charges,528,80,,422.4,percent of total billed charges,80% of total billed charges,415.8,63,,332.64,percent of total billed charges,63% of total billed charges,561,85,,448.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,521.4,79,,417.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,415.8,627,
POM SCOPE MASK,270229178,CDM,272,RC,,,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
BIOLOGICAL INDICATOR,270229236,CDM,272,RC,,,outpatient,,,1728,1209.6,,1365.12,79,,1092.1,percent of total billed charges,79% of total billed charges,1555.2,90,,1244.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1088.64,63,,870.91,percent of total billed charges,63% of total billed charges,1334.36,77.22,,1067.49,percent of total billed charges,77.22% of total billed charges,1142.21,66.1,,913.77,percent of total billed charges,66.1% of total billed charges,1434.24,83,,1147.39,percent of total billed charges,83% of total,1641.6,95,,1313.28,percent of total billed charges ,95% of total billed charges,1382.4,80,,1105.92,percent of total billed charges,78% of total billed charges,1347.84,78,,1078.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1088.64,63,,870.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1555.2,90,,1244.16,percent of total billed charges,90% of total billed charges,1382.4,80,,1105.92,percent of total billed charges,80% of total billed charges,1088.64,63,,870.91,percent of total billed charges,63% of total billed charges,1468.8,85,,1175.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1365.12,79,,1092.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1641.6,
GUIDEWIRE 1.6,270229262,CDM,272,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
DRILL BIT,270229263,CDM,272,RC,,,outpatient,,,488,341.6,,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,376.83,77.22,,301.46,percent of total billed charges,77.22% of total billed charges,322.57,66.1,,258.06,percent of total billed charges,66.1% of total billed charges,405.04,83,,324.03,percent of total billed charges,83% of total,463.6,95,,370.88,percent of total billed charges ,95% of total billed charges,390.4,80,,312.32,percent of total billed charges,78% of total billed charges,380.64,78,,304.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,390.4,80,,312.32,percent of total billed charges,80% of total billed charges,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,414.8,85,,331.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,307.44,463.6,
DRILL BIT 2.9,270229285,CDM,272,RC,,,outpatient,,,488,341.6,,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,376.83,77.22,,301.46,percent of total billed charges,77.22% of total billed charges,322.57,66.1,,258.06,percent of total billed charges,66.1% of total billed charges,405.04,83,,324.03,percent of total billed charges,83% of total,463.6,95,,370.88,percent of total billed charges ,95% of total billed charges,390.4,80,,312.32,percent of total billed charges,78% of total billed charges,380.64,78,,304.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,390.4,80,,312.32,percent of total billed charges,80% of total billed charges,307.44,63,,245.95,percent of total billed charges,63% of total billed charges,414.8,85,,331.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,307.44,463.6,
SAGITTAL BLADE 90L x 25MMW,270229379,CDM,272,RC,,,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
SAGITTAL BLADE 100L x 18MMW,270229380,CDM,272,RC,,,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
ETHICON STRATAFIX SUTURE,270229381,CDM,272,RC,,,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.06,450,
MEPILEX AG DRESSING 4X10,270229382,CDM,272,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
LRU PILLOW,270229384,CDM,272,RC,,,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,450,
SAGITTAL SAW BLADE 25MM x100MM,270229399,CDM,272,RC,,,outpatient,,,174,121.8,,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,134.36,77.22,,107.49,percent of total billed charges,77.22% of total billed charges,115.01,66.1,,92.01,percent of total billed charges,66.1% of total billed charges,144.42,83,,115.54,percent of total billed charges,83% of total,165.3,95,,132.24,percent of total billed charges ,95% of total billed charges,139.2,80,,111.36,percent of total billed charges,78% of total billed charges,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,109.62,63,,87.7,percent of total billed charges,63% of total billed charges,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,109.62,450,
MIDLINE CATH 20G/10CMFULL TRAY,270229527,CDM,272,RC,,,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,198.3,66.1,,158.64,percent of total billed charges,66.1% of total billed charges,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,189,63,,151.2,percent of total billed charges,63% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,237,79,,189.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,189,450,
MIDLINE CATH 20G/8PGFULL TRAY,270229528,CDM,272,RC,,,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,198.3,66.1,,158.64,percent of total billed charges,66.1% of total billed charges,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,189,63,,151.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,189,63,,151.2,percent of total billed charges,63% of total billed charges,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,237,79,,189.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,189,450,
MIDLINE CATH 20G/10BASIC TRAY,270229529,CDM,272,RC,,,outpatient,,,184,128.8,,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,142.08,77.22,,113.66,percent of total billed charges,77.22% of total billed charges,121.62,66.1,,97.3,percent of total billed charges,66.1% of total billed charges,152.72,83,,122.18,percent of total billed charges,83% of total,174.8,95,,139.84,percent of total billed charges ,95% of total billed charges,147.2,80,,117.76,percent of total billed charges,78% of total billed charges,143.52,78,,114.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.92,450,
DISSECTOR LAP/KITTNER 5MM,270229634,CDM,272,RC,,,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
SUTURE 2-0/737G PERMAHAND SILK,270229707,CDM,272,RC,,,outpatient,,,6,4.2,,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,5.4,90,,4.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,4.63,77.22,,3.7,percent of total billed charges,77.22% of total billed charges,3.97,66.1,,3.18,percent of total billed charges,66.1% of total billed charges,4.98,83,,3.98,percent of total billed charges,83% of total,5.7,95,,4.56,percent of total billed charges ,95% of total billed charges,4.8,80,,3.84,percent of total billed charges,78% of total billed charges,4.68,78,,3.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,3.78,63,,3.02,percent of total billed charges,63% of total billed charges,5.1,85,,4.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4.74,79,,3.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.78,450,
SCORPION NEEDLE,270229722,CDM,272,RC,,,outpatient,,,731,511.7,,577.49,79,,461.99,percent of total billed charges,79% of total billed charges,657.9,90,,526.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,564.48,77.22,,451.58,percent of total billed charges,77.22% of total billed charges,483.19,66.1,,386.55,percent of total billed charges,66.1% of total billed charges,606.73,83,,485.38,percent of total billed charges,83% of total,694.45,95,,555.56,percent of total billed charges ,95% of total billed charges,584.8,80,,467.84,percent of total billed charges,78% of total billed charges,570.18,78,,456.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,657.9,90,,526.32,percent of total billed charges,90% of total billed charges,584.8,80,,467.84,percent of total billed charges,80% of total billed charges,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,621.35,85,,497.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,577.49,79,,461.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,694.45,
CANNULA 8.25 X7,270229805,CDM,272,RC,,,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
SURECAN SAFETY 11 NEEDLE 20G,272202346,CDM,272,RC,,,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
ENDOTRACHEAL TUBE 2.5,272208123,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ENDOTRACHEAL TUBE 3.0,272208124,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
ENDOTRACHEAL TUBE 3.5,272208125,CDM,272,RC,,,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
DRAINAGE CATH 12 FR LOCKING PI,272214300,CDM,272,RC,,,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.98,450,
BAKRI BALLOON SYSTEM,272220859,CDM,272,RC,C2628,HCPCS,outpatient,,,622,435.4,,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,480.31,77.22,,384.25,percent of total billed charges,77.22% of total billed charges,411.14,66.1,,328.91,percent of total billed charges,66.1% of total billed charges,516.26,83,,413.01,percent of total billed charges,83% of total,590.9,95,,472.72,percent of total billed charges ,95% of total billed charges,497.6,80,,398.08,percent of total billed charges,78% of total billed charges,485.16,78,,388.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,528.7,85,,422.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,391.86,590.9,
VENT STAR,272222254,CDM,272,RC,,,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
NEEDLE GUIDE KIT 21 GA,272222514,CDM,272,RC,,,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
NEO TEE MERCURY A00400,272222630,CDM,272,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
LOOP ELECTRODE 20X10,272223955,CDM,272,RC,,,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.9,450,
NASAL CANNULA NEWBORN N4901,272225842,CDM,272,RC,,,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.68,450,
POLYGRIP MASH RIGHT 14 X 9 CM,272226236,CDM,272,RC,,,outpatient,,,891,623.7,,703.89,79,,563.11,percent of total billed charges,79% of total billed charges,801.9,90,,641.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,561.33,63,,449.06,percent of total billed charges,63% of total billed charges,688.03,77.22,,550.42,percent of total billed charges,77.22% of total billed charges,588.95,66.1,,471.16,percent of total billed charges,66.1% of total billed charges,739.53,83,,591.62,percent of total billed charges,83% of total,846.45,95,,677.16,percent of total billed charges ,95% of total billed charges,712.8,80,,570.24,percent of total billed charges,78% of total billed charges,694.98,78,,555.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,561.33,63,,449.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,561.33,63,,449.06,percent of total billed charges,63% of total billed charges,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,703.89,79,,563.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,846.45,
BOVIE HIGH-TEMP CAUTERIES,272226492,CDM,272,RC,,,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
CATHETER ARGYLE TROCAR 28 FR,272227025,CDM,272,RC,,,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,34.37,66.1,,27.5,percent of total billed charges,66.1% of total billed charges,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.76,450,
LOOP ELECTRODE,272229104,CDM,272,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
JADA BALLOON SYSTEM,272229247,CDM,272,RC,C2628,HCPCS,outpatient,,,2914,2039.8,,2302.06,79,,1841.65,percent of total billed charges,79% of total billed charges,2622.6,90,,2098.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1835.82,63,,1468.66,percent of total billed charges,63% of total billed charges,2250.19,77.22,,1800.15,percent of total billed charges,77.22% of total billed charges,1926.15,66.1,,1540.92,percent of total billed charges,66.1% of total billed charges,2418.62,83,,1934.9,percent of total billed charges,83% of total,2768.3,95,,2214.64,percent of total billed charges ,95% of total billed charges,2331.2,80,,1864.96,percent of total billed charges,78% of total billed charges,2272.92,78,,1818.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1835.82,63,,1468.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2622.6,90,,2098.08,percent of total billed charges,90% of total billed charges,2331.2,80,,1864.96,percent of total billed charges,80% of total billed charges,1835.82,63,,1468.66,percent of total billed charges,63% of total billed charges,2476.9,85,,1981.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2302.06,79,,1841.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2768.3,
"HUBER NEEDLE 20G x 1""",272229323,CDM,272,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
C-SECTION PROTECTOR RETRACTOR,272229784,CDM,272,RC,,,outpatient,,,258,180.6,,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,199.23,77.22,,159.38,percent of total billed charges,77.22% of total billed charges,170.54,66.1,,136.43,percent of total billed charges,66.1% of total billed charges,214.14,83,,171.31,percent of total billed charges,83% of total,245.1,95,,196.08,percent of total billed charges ,95% of total billed charges,206.4,80,,165.12,percent of total billed charges,78% of total billed charges,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,162.54,450,
CENTURION VIT KIT ALCON LAB,272229931,CDM,272,RC,,,outpatient,,,3055,2138.5,,2413.45,79,,1930.76,percent of total billed charges,79% of total billed charges,2749.5,90,,2199.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1924.65,63,,1539.72,percent of total billed charges,63% of total billed charges,2359.07,77.22,,1887.26,percent of total billed charges,77.22% of total billed charges,2019.36,66.1,,1615.49,percent of total billed charges,66.1% of total billed charges,2535.65,83,,2028.52,percent of total billed charges,83% of total,2902.25,95,,2321.8,percent of total billed charges ,95% of total billed charges,2444,80,,1955.2,percent of total billed charges,78% of total billed charges,2382.9,78,,1906.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1924.65,63,,1539.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2749.5,90,,2199.6,percent of total billed charges,90% of total billed charges,2444,80,,1955.2,percent of total billed charges,80% of total billed charges,1924.65,63,,1539.72,percent of total billed charges,63% of total billed charges,2596.75,85,,2077.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2413.45,79,,1930.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2902.25,
DRILL PIN 1.5 x 100MM,278217199,CDM,272,RC,,,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,425.25,641.25,
BIO EYE 24MM,278217788,CDM,272,RC,C1781,HCPCS,outpatient,,,1564,1094.8,,1235.56,79,,988.45,percent of total billed charges,79% of total billed charges,1407.6,90,,1126.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,985.32,63,,788.26,percent of total billed charges,63% of total billed charges,1207.72,77.22,,966.18,percent of total billed charges,77.22% of total billed charges,1033.8,66.1,,827.04,percent of total billed charges,66.1% of total billed charges,1298.12,83,,1038.5,percent of total billed charges,83% of total,1485.8,95,,1188.64,percent of total billed charges ,95% of total billed charges,1251.2,80,,1000.96,percent of total billed charges,78% of total billed charges,1219.92,78,,975.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,985.32,63,,788.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1407.6,90,,1126.08,percent of total billed charges,90% of total billed charges,1251.2,80,,1000.96,percent of total billed charges,80% of total billed charges,985.32,63,,788.26,percent of total billed charges,63% of total billed charges,1329.4,85,,1063.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1235.56,79,,988.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1485.8,
BIO EYE 18MM,278220283,CDM,272,RC,C1781,HCPCS,outpatient,,,1789,1252.3,,1413.31,79,,1130.65,percent of total billed charges,79% of total billed charges,1610.1,90,,1288.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1127.07,63,,901.66,percent of total billed charges,63% of total billed charges,1381.47,77.22,,1105.18,percent of total billed charges,77.22% of total billed charges,1182.53,66.1,,946.02,percent of total billed charges,66.1% of total billed charges,1484.87,83,,1187.9,percent of total billed charges,83% of total,1699.55,95,,1359.64,percent of total billed charges ,95% of total billed charges,1431.2,80,,1144.96,percent of total billed charges,78% of total billed charges,1395.42,78,,1116.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1127.07,63,,901.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1610.1,90,,1288.08,percent of total billed charges,90% of total billed charges,1431.2,80,,1144.96,percent of total billed charges,80% of total billed charges,1127.07,63,,901.66,percent of total billed charges,63% of total billed charges,1520.65,85,,1216.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1413.31,79,,1130.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1699.55,
BIO EYE 20MM,278220305,CDM,272,RC,C1781,HCPCS,outpatient,,,1856,1299.2,,1466.24,79,,1172.99,percent of total billed charges,79% of total billed charges,1670.4,90,,1336.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1169.28,63,,935.42,percent of total billed charges,63% of total billed charges,1433.2,77.22,,1146.56,percent of total billed charges,77.22% of total billed charges,1226.82,66.1,,981.46,percent of total billed charges,66.1% of total billed charges,1540.48,83,,1232.38,percent of total billed charges,83% of total,1763.2,95,,1410.56,percent of total billed charges ,95% of total billed charges,1484.8,80,,1187.84,percent of total billed charges,78% of total billed charges,1447.68,78,,1158.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1169.28,63,,935.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1670.4,90,,1336.32,percent of total billed charges,90% of total billed charges,1484.8,80,,1187.84,percent of total billed charges,80% of total billed charges,1169.28,63,,935.42,percent of total billed charges,63% of total billed charges,1577.6,85,,1262.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1466.24,79,,1172.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1763.2,
TIBIAL TRAY,278222367,CDM,272,RC,,,outpatient,,,3037,2125.9,,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2345.17,77.22,,1876.14,percent of total billed charges,77.22% of total billed charges,2007.46,66.1,,1605.97,percent of total billed charges,66.1% of total billed charges,2520.71,83,,2016.57,percent of total billed charges,83% of total,2885.15,95,,2308.12,percent of total billed charges ,95% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,78% of total billed charges,2368.86,78,,1895.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,80% of total billed charges,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2581.45,85,,2065.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2885.15,
PARIETEX PROGRIP MESH L-14X9CM,278226235,CDM,272,RC,C1781,HCPCS,outpatient,,,6140,4298,,4850.6,79,,3880.48,percent of total billed charges,79% of total billed charges,5526,90,,4420.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3868.2,63,,3094.56,percent of total billed charges,63% of total billed charges,4741.31,77.22,,3793.05,percent of total billed charges,77.22% of total billed charges,4058.54,66.1,,3246.83,percent of total billed charges,66.1% of total billed charges,5096.2,83,,4076.96,percent of total billed charges,83% of total,5833,95,,4666.4,percent of total billed charges ,95% of total billed charges,4912,80,,3929.6,percent of total billed charges,78% of total billed charges,4789.2,78,,3831.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3868.2,63,,3094.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5526,90,,4420.8,percent of total billed charges,90% of total billed charges,4912,80,,3929.6,percent of total billed charges,80% of total billed charges,3868.2,63,,3094.56,percent of total billed charges,63% of total billed charges,5219,85,,4175.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4850.6,79,,3880.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5833,
PEELE SUTURE,278226280,CDM,272,RC,,,outpatient,,,821,574.7,,648.59,79,,518.87,percent of total billed charges,79% of total billed charges,738.9,90,,591.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,633.98,77.22,,507.18,percent of total billed charges,77.22% of total billed charges,542.68,66.1,,434.14,percent of total billed charges,66.1% of total billed charges,681.43,83,,545.14,percent of total billed charges,83% of total,779.95,95,,623.96,percent of total billed charges ,95% of total billed charges,656.8,80,,525.44,percent of total billed charges,78% of total billed charges,640.38,78,,512.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,697.85,85,,558.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,648.59,79,,518.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,779.95,
DRILL BIT 1.8 X 90,278226654,CDM,272,RC,,,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
MENISCAL CINCH II,278227744,CDM,272,RC,,,outpatient,,,1271,889.7,,1004.09,79,,803.27,percent of total billed charges,79% of total billed charges,1143.9,90,,915.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800.73,63,,640.58,percent of total billed charges,63% of total billed charges,981.47,77.22,,785.18,percent of total billed charges,77.22% of total billed charges,840.13,66.1,,672.1,percent of total billed charges,66.1% of total billed charges,1054.93,83,,843.94,percent of total billed charges,83% of total,1207.45,95,,965.96,percent of total billed charges ,95% of total billed charges,1016.8,80,,813.44,percent of total billed charges,78% of total billed charges,991.38,78,,793.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,800.73,63,,640.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1143.9,90,,915.12,percent of total billed charges,90% of total billed charges,1016.8,80,,813.44,percent of total billed charges,80% of total billed charges,800.73,63,,640.58,percent of total billed charges,63% of total billed charges,1080.35,85,,864.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1004.09,79,,803.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1207.45,
SYNDESMOSIS TIGHT ROPE XP,278229311,CDM,272,RC,,,outpatient,,,4806,3364.2,,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,3711.19,77.22,,2968.95,percent of total billed charges,77.22% of total billed charges,3176.77,66.1,,2541.42,percent of total billed charges,66.1% of total billed charges,3988.98,83,,3191.18,percent of total billed charges,83% of total,4565.7,95,,3652.56,percent of total billed charges ,95% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,78% of total billed charges,3748.68,78,,2998.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,80% of total billed charges,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,4085.1,85,,3268.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4565.7,
"BRACE, CLAVICLE SMALL",270002131,CDM,274,RC,L3650,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
BRACE CLAVICLE MEDIUM,270002132,CDM,274,RC,L3650,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
"BRACE, CLAVICAL LARGE",270002133,CDM,274,RC,L3650,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
"BRACE, CLAVICLE X-LARGE",270002134,CDM,274,RC,L3650,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,25.12,66.1,,20.1,percent of total billed charges,66.1% of total billed charges,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.94,63,,19.15,percent of total billed charges,63% of total billed charges,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.94,450,
"COLLAR, CERVICAL 2""""",270002156,CDM,274,RC,L0120,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"COLLAR, CERVICAL 2 1/2""""",270002157,CDM,274,RC,L0120,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"COLLAR, CERVICAL 3 3/4""""",270002159,CDM,274,RC,L0120,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"COLLAR, CERVICAL 4 1/4""""",270002160,CDM,274,RC,L0120,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,8.59,66.1,,6.87,percent of total billed charges,66.1% of total billed charges,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,8.19,63,,6.55,percent of total billed charges,63% of total billed charges,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.19,450,
"COLLAR, PHILADELPHIA FOAM SM",270002161,CDM,274,RC,L0172,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
"COLLAR, PHILADELPHIA FOAM MED",270002162,CDM,274,RC,L0172,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
"COLLAR, PHILADELPHIA FOAM LG",270002163,CDM,274,RC,L0172,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
"IMMOBILIZER, KNEE 16""""",270002175,CDM,274,RC,L1830,HCPCS,outpatient,,,312,218.4,,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,153.87,160,,,fee schedule,160% of CMS fee schedule,125.02,130,,,fee schedule,130% of CMS fee schedule,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,240.93,77.22,,192.74,percent of total billed charges,77.22% of total billed charges,206.23,66.1,,164.98,percent of total billed charges,66.1% of total billed charges,258.96,83,,207.17,percent of total billed charges,83% of total,296.4,95,,237.12,percent of total billed charges ,95% of total billed charges,249.6,80,,199.68,percent of total billed charges,78% of total billed charges,243.36,78,,194.688,percent of total billed charges,78% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,96.17,100,,,fee schedule,100% of CMS 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,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,89.44,93,,,fee schedule,93% of CMS fee schedule,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,96.17,100,,,fee schedule,100% of CMS fee schedule,89.44,450,
"IMMOBILIZER, KNEE 20""""",270002176,CDM,274,RC,L1830,HCPCS,outpatient,,,312,218.4,,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,153.87,160,,,fee schedule,160% of CMS fee schedule,125.02,130,,,fee schedule,130% of CMS fee schedule,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,240.93,77.22,,192.74,percent of total billed charges,77.22% of total billed charges,206.23,66.1,,164.98,percent of total billed charges,66.1% of total billed charges,258.96,83,,207.17,percent of total billed charges,83% of total,296.4,95,,237.12,percent of total billed charges ,95% of total billed charges,249.6,80,,199.68,percent of total billed charges,78% of total billed charges,243.36,78,,194.688,percent of total billed charges,78% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,96.17,100,,,fee schedule,100% of CMS 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,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,89.44,93,,,fee schedule,93% of CMS fee schedule,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,96.17,100,,,fee schedule,100% of CMS fee schedule,89.44,450,
"IMMOBILIZER, KNEE 24""""",270002177,CDM,274,RC,L1830,HCPCS,outpatient,,,312,218.4,,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,153.87,160,,,fee schedule,160% of CMS fee schedule,125.02,130,,,fee schedule,130% of CMS fee schedule,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,240.93,77.22,,192.74,percent of total billed charges,77.22% of total billed charges,206.23,66.1,,164.98,percent of total billed charges,66.1% of total billed charges,258.96,83,,207.17,percent of total billed charges,83% of total,296.4,95,,237.12,percent of total billed charges ,95% of total billed charges,249.6,80,,199.68,percent of total billed charges,78% of total billed charges,243.36,78,,194.688,percent of total billed charges,78% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,96.17,100,,,fee schedule,100% of CMS 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,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,89.44,93,,,fee schedule,93% of CMS fee schedule,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,96.17,100,,,fee schedule,100% of CMS fee schedule,96.17,100,,,fee schedule,100% of CMS fee schedule,89.44,450,
"IMMOBILIZER, ARM SMALL",270002178,CDM,274,RC,L3660,HCPCS,outpatient,,,64,44.8,,50.56,79,,40.45,percent of total billed charges,79% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,63,,32.26,percent of total billed charges,63% of total billed charges,49.42,77.22,,39.54,percent of total billed charges,77.22% of total billed charges,42.3,66.1,,33.84,percent of total billed charges,66.1% of total billed charges,53.12,83,,42.5,percent of total billed charges,83% of total,60.8,95,,48.64,percent of total billed charges ,95% of total billed charges,51.2,80,,40.96,percent of total billed charges,78% of total billed charges,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.32,63,,32.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.32,63,,32.26,percent of total billed charges,63% of total billed charges,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,50.56,79,,40.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.32,450,
"IMMOBILIZER, ARM MEDIUM",270002179,CDM,274,RC,L3660,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
"IMMOBILIZER, ARM LARGE",270002180,CDM,274,RC,L3660,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
"IMMOBILIZER, ARM EX-LARGE",270002181,CDM,274,RC,L3660,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40.95,450,
"SLING, ARM PEDIATRIC",270002208,CDM,274,RC,A4565,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.36,450,
"SLING, ARM SMALL",270002209,CDM,274,RC,A4565,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.36,450,
"SLING, ARM LARGE",270002211,CDM,274,RC,A4565,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.36,450,
"SLING, ARM X-LARGE",270002212,CDM,274,RC,A4565,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,47.59,66.1,,38.07,percent of total billed charges,66.1% of total billed charges,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.36,63,,36.29,percent of total billed charges,63% of total billed charges,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.36,450,
SPLINT WRIST UNIVERSAL LARGE,270002213,CDM,274,RC,L3908,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"SPLINT, WRIST PEDIATRIC RIGHT",270002220,CDM,274,RC,L3908,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"SPLINT, WRIST SMALL RIGHT",270002221,CDM,274,RC,L3908,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
"SPLINT, WRIST MEDIUM RIGHT",270002222,CDM,274,RC,L3908,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
"SPLINT, WRIST X-LARGE RIGHT",270002224,CDM,274,RC,L3908,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
"SPLINT, WRIST PEDIATRIC LEFT",270002225,CDM,274,RC,L3908,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
"SPLINT, WRIST MEDIUM LEFT",270002227,CDM,274,RC,L3908,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
SPLINT WRIST XLARGE LEFT,270002229,CDM,274,RC,L3908,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
ANKLE STIRRUP RIGHT,270002231,CDM,274,RC,L4350,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,28.42,66.1,,22.74,percent of total billed charges,66.1% of total billed charges,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.09,450,
"SPLINT,WRIST METAL PED RIGHT",270005025,CDM,274,RC,L3908,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
"SPLINT,WRIST METAL SML RIGHT",270005026,CDM,274,RC,L3908,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"SPLINT,WRIST METAL MED RIGHT",270005027,CDM,274,RC,L3908,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"SPLINT,WRIST METAL LRG RIGHT",270005028,CDM,274,RC,L3908,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"SPLINT,WRIST METAL PED LEFT",270005029,CDM,274,RC,L3908,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.27,450,
"SPLINT,WRIST METAL SML LEFT",270005030,CDM,274,RC,L3908,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"SPLINT,WRIST METAL MED LEFT",270005031,CDM,274,RC,L3908,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"SPLINT, WRIST METAL LRG LEFT",270005032,CDM,274,RC,L3908,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
"ELBOW SPLINT, METAL, SMALL",270005033,CDM,274,RC,L3710,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
"ELBOW SPLINT, METAL, MEDIUM",270005034,CDM,274,RC,L3710,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61.11,450,
PLASTALUME FINGER SPLINT 3 1/4,270005062,CDM,274,RC,L3901,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
PLASTALUME FINGER SPLINT 4 1/4,270005063,CDM,274,RC,L3901,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
PLASTALUME FINGER SPLINT 5 1/4,270005064,CDM,274,RC,L3901,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
PLASTALUME FINGER SPLINT 6 1/4,270005065,CDM,274,RC,L3901,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
PLASTALUME FINGER SPLINT 7 1/4,270005066,CDM,274,RC,L3901,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"STANDARD ANKLE BRACE, LEFT",270005700,CDM,274,RC,L4350,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,28.42,66.1,,22.74,percent of total billed charges,66.1% of total billed charges,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.09,450,
"STANDARD ANKLE BRACE, RIGHT",270005702,CDM,274,RC,L4350,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,28.42,66.1,,22.74,percent of total billed charges,66.1% of total billed charges,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.09,450,
"SMALL ANKLE BRACE, LEFT",270005704,CDM,274,RC,L4396,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"SMALL ANKLE BRACE, RIGHT",270005706,CDM,274,RC,L4396,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.13,450,
"TRAINING ANKLE BRACE, RIGHT",270005708,CDM,274,RC,L4350,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,28.42,66.1,,22.74,percent of total billed charges,66.1% of total billed charges,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.09,63,,21.67,percent of total billed charges,63% of total billed charges,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.09,450,
"TRAINING ANKLE BRACE, LEFT",270005710,CDM,274,RC,L4396,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,84.61,66.1,,67.69,percent of total billed charges,66.1% of total billed charges,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.64,450,
"KNEE BRACE,POST OP LITE,SHORT",270202076,CDM,274,RC,L1832,HCPCS,outpatient,,,306,214.2,,241.74,79,,193.39,percent of total billed charges,79% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.78,63,,154.22,percent of total billed charges,63% of total billed charges,236.29,77.22,,189.03,percent of total billed charges,77.22% of total billed charges,202.27,66.1,,161.82,percent of total billed charges,66.1% of total billed charges,253.98,83,,203.18,percent of total billed charges,83% of total,290.7,95,,232.56,percent of total billed charges ,95% of total billed charges,244.8,80,,195.84,percent of total billed charges,78% of total billed charges,238.68,78,,190.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,192.78,63,,154.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,192.78,63,,154.22,percent of total billed charges,63% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,241.74,79,,193.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,192.78,450,
LATERAL PATELLA SUPPORT- RT,27205493,CDM,274,RC,L1820,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
SUTURE ANCHOR 4.75 X 19.1 MM,278226525,CDM,275,RC,C1713,HCPCS,outpatient,,,1368,957.6,,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1056.37,77.22,,845.1,percent of total billed charges,77.22% of total billed charges,904.25,66.1,,723.4,percent of total billed charges,66.1% of total billed charges,1135.44,83,,908.35,percent of total billed charges,83% of total,1299.6,95,,1039.68,percent of total billed charges ,95% of total billed charges,1094.4,80,,875.52,percent of total billed charges,78% of total billed charges,1067.04,78,,853.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,1094.4,80,,875.52,percent of total billed charges,80% of total billed charges,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1162.8,85,,930.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1299.6,
"LENS, INTRAOCULAR ALCON SA60WF",276007500,CDM,276,RC,V2632,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
"LENS, INTRAOCULAR ALCON SN6AT6",276226045,CDM,276,RC,V2787,HCPCS,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
"LENS, INTRAOCULAR ABBOTT ZCB00",276226046,CDM,276,RC,V2632,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
"LENS, INTRAOCULAR ABBOTT ZKB00",276226047,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ABBOTT ZLB00",276226048,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SN6AT3",276226049,CDM,276,RC,V2787,HCPCS,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
"LENS, INTRAOCULAR ALCON MTA4U0",276226302,CDM,276,RC,V2630,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,450,
"LENS, INTRAOCULAR ABBOTT ZXR00",276226351,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SN6AT4",276226363,CDM,276,RC,V2787,HCPCS,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
"LENS, INTRAOCULAR ALCON MA60AC",276226382,CDM,276,RC,V2632,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
"LENS, INTRAOCULAR ALCON SN6AT5",276226385,CDM,276,RC,V2787,HCPCS,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
"LENS, INTRAOCULAR ALCON SV25T4",276226416,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SN6AT7",276226423,CDM,276,RC,V2787,HCPCS,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
"LENS, INTRAOCULAR ALCON SN6AT8",276226424,CDM,276,RC,V2787,HCPCS,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
"LENS, INTRAOCULAR ALCON SN6AT9",276226425,CDM,276,RC,V2787,HCPCS,outpatient,,,800,560,,632,79,,505.6,percent of total billed charges,79% of total billed charges,720,90,,576,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,617.76,77.22,,494.21,percent of total billed charges,77.22% of total billed charges,528.8,66.1,,423.04,percent of total billed charges,66.1% of total billed charges,664,83,,531.2,percent of total billed charges,83% of total,760,95,,608,percent of total billed charges ,95% of total billed charges,640,80,,512,percent of total billed charges,78% of total billed charges,624,78,,499.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504,63,,403.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,504,63,,403.2,percent of total billed charges,63% of total billed charges,680,85,,544,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632,79,,505.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760,
"LENS, INTRAOCULAR ALCON SV25T3",276226426,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SV25T5",276226427,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SV25T6",276226428,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ABBOTT ZMB00",276226429,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SV25T7",276226430,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SV25T8",276226431,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SV25T9",276226432,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SND1T3",276226434,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SND1T4",276226435,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SND1T5",276226436,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SND1T6",276226437,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SN6AD1",276226447,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON MTA5U0",276226612,CDM,276,RC,,,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,450,
LENS INTRAOCULAR SV25T0,276226863,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
LENS ZA9003,276227636,CDM,276,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
"LENS, INTRAOCULAR ALCON TFAT00",276227637,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS,INTRAOCULAR ALCON TFAT40",276227739,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS,INTRAOCULAR ALCON TFAT30",276227751,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS,INTRAOCULAR ALCON TFNT30",276228136,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
LENS TFNT00,276228224,CDM,276,RC,,,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS, INTRAOCULAR ALCON SN60WF",276228264,CDM,276,RC,V2632,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
"LENS, MONOFOCAL ALCON SN60AT",276229151,CDM,276,RC,V2632,HCPCS,outpatient,,,637,445.9,,503.23,79,,402.58,percent of total billed charges,79% of total billed charges,573.3,90,,458.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401.31,63,,321.05,percent of total billed charges,63% of total billed charges,491.89,77.22,,393.51,percent of total billed charges,77.22% of total billed charges,421.06,66.1,,336.85,percent of total billed charges,66.1% of total billed charges,528.71,83,,422.97,percent of total billed charges,83% of total,605.15,95,,484.12,percent of total billed charges ,95% of total billed charges,509.6,80,,407.68,percent of total billed charges,78% of total billed charges,496.86,78,,397.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,401.31,63,,321.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,401.31,63,,321.05,percent of total billed charges,63% of total billed charges,541.45,85,,433.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,503.23,79,,402.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,401.31,605.15,
"LENS,INTRAOCULAR TECHNIS DCB00",276229241,CDM,276,RC,V2632,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
CLAREON IOL LENS 20.0D,276229519,CDM,276,RC,C1780,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
"LENS,INTRAOCULAR ALCON DFT015",276229949,CDM,276,RC,V2788,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
"LENS,INTRAOCULAR ALCON CNWTT0",276229996,CDM,276,RC,V2788,HCPCS,outpatient,,,1095,766.5,,865.05,79,,692.04,percent of total billed charges,79% of total billed charges,985.5,90,,788.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,689.85,63,,551.88,percent of total billed charges,63% of total billed charges,845.56,77.22,,676.45,percent of total billed charges,77.22% of total billed charges,723.8,66.1,,579.04,percent of total billed charges,66.1% of total billed charges,908.85,83,,727.08,percent of total billed charges,83% of total,1040.25,95,,832.2,percent of total billed charges ,95% of total billed charges,876,80,,700.8,percent of total billed charges,78% of total billed charges,854.1,78,,683.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,689.85,63,,551.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,985.5,90,,788.4,percent of total billed charges,90% of total billed charges,876,80,,700.8,percent of total billed charges,80% of total billed charges,689.85,63,,551.88,percent of total billed charges,63% of total billed charges,930.75,85,,744.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,865.05,79,,692.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1040.25,
ORTHOSORB 1.3MM TAPERED PIN,270000382,CDM,278,RC,C1713,HCPCS,outpatient,,,630,441,,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,567,90,,453.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,486.49,77.22,,389.19,percent of total billed charges,77.22% of total billed charges,416.43,66.1,,333.14,percent of total billed charges,66.1% of total billed charges,522.9,83,,418.32,percent of total billed charges,83% of total,598.5,95,,478.8,percent of total billed charges ,95% of total billed charges,504,80,,403.2,percent of total billed charges,78% of total billed charges,491.4,78,,393.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,396.9,598.5,
"CATHETER, ROBINSON 14FR",270002320,CDM,278,RC,C1758,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.47,450,
"CATHETER, ROBINSON 16FR",270002321,CDM,278,RC,C1758,HCPCS,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
"CATHETER, ROBINSON 12FR",270002323,CDM,278,RC,C1758,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
"CATHETER, ROBINSON 10FR",270002324,CDM,278,RC,C1758,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
MESH 1 X 4,270014440,CDM,278,RC,C1781,HCPCS,outpatient,,,79,55.3,,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,61,77.22,,48.8,percent of total billed charges,77.22% of total billed charges,52.22,66.1,,41.78,percent of total billed charges,66.1% of total billed charges,65.57,83,,52.46,percent of total billed charges,83% of total,75.05,95,,60.04,percent of total billed charges ,95% of total billed charges,63.2,80,,50.56,percent of total billed charges,78% of total billed charges,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.77,450,
PROLENE MESH PLUG MED,270201112,CDM,278,RC,C1781,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
PEZZER 18FR CATH,270202039,CDM,278,RC,C1729,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
PEZZER 24 FR CATHETER,270202040,CDM,278,RC,C1729,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
PEZZER 26 FR CATH,270202041,CDM,278,RC,C1729,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
PEZZER 28 FR CATH,270202042,CDM,278,RC,C1729,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
2.8 GUIDE WIRE,270202712,CDM,278,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
STEINMEN PINS,270203851,CDM,278,RC,C1713,HCPCS,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.65,450,
223.57 PLATE,270204246,CDM,278,RC,C1713,HCPCS,outpatient,,,1417,991.9,,1119.43,79,,895.54,percent of total billed charges,79% of total billed charges,1275.3,90,,1020.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,892.71,63,,714.17,percent of total billed charges,63% of total billed charges,1094.21,77.22,,875.37,percent of total billed charges,77.22% of total billed charges,936.64,66.1,,749.31,percent of total billed charges,66.1% of total billed charges,1176.11,83,,940.89,percent of total billed charges,83% of total,1346.15,95,,1076.92,percent of total billed charges ,95% of total billed charges,1133.6,80,,906.88,percent of total billed charges,78% of total billed charges,1105.26,78,,884.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,892.71,63,,714.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1275.3,90,,1020.24,percent of total billed charges,90% of total billed charges,1133.6,80,,906.88,percent of total billed charges,80% of total billed charges,892.71,63,,714.17,percent of total billed charges,63% of total billed charges,1204.45,85,,963.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1119.43,79,,895.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1346.15,
PEZZER 16FR CATHETER,270205221,CDM,278,RC,C1729,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
P3DPM PROLENE MESH PATCH,270205672,CDM,278,RC,C1781,HCPCS,outpatient,,,1124,786.8,,887.96,79,,710.37,percent of total billed charges,79% of total billed charges,1011.6,90,,809.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,708.12,63,,566.5,percent of total billed charges,63% of total billed charges,867.95,77.22,,694.36,percent of total billed charges,77.22% of total billed charges,742.96,66.1,,594.37,percent of total billed charges,66.1% of total billed charges,932.92,83,,746.34,percent of total billed charges,83% of total,1067.8,95,,854.24,percent of total billed charges ,95% of total billed charges,899.2,80,,719.36,percent of total billed charges,78% of total billed charges,876.72,78,,701.376,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,708.12,63,,566.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1011.6,90,,809.28,percent of total billed charges,90% of total billed charges,899.2,80,,719.36,percent of total billed charges,80% of total billed charges,708.12,63,,566.5,percent of total billed charges,63% of total billed charges,955.4,85,,764.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,887.96,79,,710.37,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1067.8,
CRE BALLOON DILATOR 10-11-12MM,270207428,CDM,278,RC,C1726,HCPCS,outpatient,,,506,354.2,,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,390.73,77.22,,312.58,percent of total billed charges,77.22% of total billed charges,334.47,66.1,,267.58,percent of total billed charges,66.1% of total billed charges,419.98,83,,335.98,percent of total billed charges,83% of total,480.7,95,,384.56,percent of total billed charges ,95% of total billed charges,404.8,80,,323.84,percent of total billed charges,78% of total billed charges,394.68,78,,315.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,318.78,480.7,
CRE BALLOON DIL.12-13.5-15MM,270207429,CDM,278,RC,C1726,HCPCS,outpatient,,,506,354.2,,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,390.73,77.22,,312.58,percent of total billed charges,77.22% of total billed charges,334.47,66.1,,267.58,percent of total billed charges,66.1% of total billed charges,419.98,83,,335.98,percent of total billed charges,83% of total,480.7,95,,384.56,percent of total billed charges ,95% of total billed charges,404.8,80,,323.84,percent of total billed charges,78% of total billed charges,394.68,78,,315.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,318.78,480.7,
CRE BALLOON DILATOR 6-7-8,270207727,CDM,278,RC,C1726,HCPCS,outpatient,,,506,354.2,,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,390.73,77.22,,312.58,percent of total billed charges,77.22% of total billed charges,334.47,66.1,,267.58,percent of total billed charges,66.1% of total billed charges,419.98,83,,335.98,percent of total billed charges,83% of total,480.7,95,,384.56,percent of total billed charges ,95% of total billed charges,404.8,80,,323.84,percent of total billed charges,78% of total billed charges,394.68,78,,315.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,318.78,480.7,
CRE BALLOON DILATOR 8-9-10,270207728,CDM,278,RC,C1726,HCPCS,outpatient,,,506,354.2,,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,390.73,77.22,,312.58,percent of total billed charges,77.22% of total billed charges,334.47,66.1,,267.58,percent of total billed charges,66.1% of total billed charges,419.98,83,,335.98,percent of total billed charges,83% of total,480.7,95,,384.56,percent of total billed charges ,95% of total billed charges,404.8,80,,323.84,percent of total billed charges,78% of total billed charges,394.68,78,,315.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,318.78,480.7,
TUTOPLAST PERICARDIUM,270211526,CDM,278,RC,Q4128,HCPCS,outpatient,,,937,655.9,,740.23,79,,592.18,percent of total billed charges,79% of total billed charges,843.3,90,,674.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,590.31,63,,472.25,percent of total billed charges,63% of total billed charges,723.55,77.22,,578.84,percent of total billed charges,77.22% of total billed charges,619.36,66.1,,495.49,percent of total billed charges,66.1% of total billed charges,777.71,83,,622.17,percent of total billed charges,83% of total,890.15,95,,712.12,percent of total billed charges ,95% of total billed charges,749.6,80,,599.68,percent of total billed charges,78% of total billed charges,730.86,78,,584.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,590.31,63,,472.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,843.3,90,,674.64,percent of total billed charges,90% of total billed charges,749.6,80,,599.68,percent of total billed charges,80% of total billed charges,590.31,63,,472.25,percent of total billed charges,63% of total billed charges,796.45,85,,637.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,740.23,79,,592.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,890.15,
UNIVERSAL DRAINAGE CATHETER,270212458,CDM,278,RC,C1729,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,207.72,77.22,,166.18,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,169.47,450,
GYNECARE TVT SYSTEM WITH SLING,270214115,CDM,278,RC,C1771,HCPCS,outpatient,,,3360,2352,,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2594.59,77.22,,2075.67,percent of total billed charges,77.22% of total billed charges,2220.96,66.1,,1776.77,percent of total billed charges,66.1% of total billed charges,2788.8,83,,2231.04,percent of total billed charges,83% of total,3192,95,,2553.6,percent of total billed charges ,95% of total billed charges,2688,80,,2150.4,percent of total billed charges,78% of total billed charges,2620.8,78,,2096.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,2688,80,,2150.4,percent of total billed charges,80% of total billed charges,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2856,85,,2284.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3192,
PERFIX PLUG,270215485,CDM,278,RC,C1781,HCPCS,outpatient,,,687,480.9,,542.73,79,,434.18,percent of total billed charges,79% of total billed charges,618.3,90,,494.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,432.81,63,,346.25,percent of total billed charges,63% of total billed charges,530.5,77.22,,424.4,percent of total billed charges,77.22% of total billed charges,454.11,66.1,,363.29,percent of total billed charges,66.1% of total billed charges,570.21,83,,456.17,percent of total billed charges,83% of total,652.65,95,,522.12,percent of total billed charges ,95% of total billed charges,549.6,80,,439.68,percent of total billed charges,78% of total billed charges,535.86,78,,428.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,432.81,63,,346.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,618.3,90,,494.64,percent of total billed charges,90% of total billed charges,549.6,80,,439.68,percent of total billed charges,80% of total billed charges,432.81,63,,346.25,percent of total billed charges,63% of total billed charges,583.95,85,,467.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,542.73,79,,434.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,432.81,652.65,
PERFIX PLUG,270215486,CDM,278,RC,C1781,HCPCS,outpatient,,,624,436.8,,492.96,79,,394.37,percent of total billed charges,79% of total billed charges,561.6,90,,449.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.12,63,,314.5,percent of total billed charges,63% of total billed charges,481.85,77.22,,385.48,percent of total billed charges,77.22% of total billed charges,412.46,66.1,,329.97,percent of total billed charges,66.1% of total billed charges,517.92,83,,414.34,percent of total billed charges,83% of total,592.8,95,,474.24,percent of total billed charges ,95% of total billed charges,499.2,80,,399.36,percent of total billed charges,78% of total billed charges,486.72,78,,389.376,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.12,63,,314.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,393.12,63,,314.5,percent of total billed charges,63% of total billed charges,530.4,85,,424.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,492.96,79,,394.37,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.12,592.8,
PERFIX PLUG  X LARGE,270215487,CDM,278,RC,C1781,HCPCS,outpatient,,,655,458.5,,517.45,79,,413.96,percent of total billed charges,79% of total billed charges,589.5,90,,471.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.65,63,,330.12,percent of total billed charges,63% of total billed charges,505.79,77.22,,404.63,percent of total billed charges,77.22% of total billed charges,432.96,66.1,,346.37,percent of total billed charges,66.1% of total billed charges,543.65,83,,434.92,percent of total billed charges,83% of total,622.25,95,,497.8,percent of total billed charges ,95% of total billed charges,524,80,,419.2,percent of total billed charges,78% of total billed charges,510.9,78,,408.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,412.65,63,,330.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,412.65,63,,330.12,percent of total billed charges,63% of total billed charges,556.75,85,,445.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,517.45,79,,413.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,412.65,622.25,
LOW PROFILE IMPLANTED PORT,270215798,CDM,278,RC,C1788,HCPCS,outpatient,,,1357,949.9,,1072.03,79,,857.62,percent of total billed charges,79% of total billed charges,1221.3,90,,977.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,854.91,63,,683.93,percent of total billed charges,63% of total billed charges,1047.88,77.22,,838.3,percent of total billed charges,77.22% of total billed charges,896.98,66.1,,717.58,percent of total billed charges,66.1% of total billed charges,1126.31,83,,901.05,percent of total billed charges,83% of total,1289.15,95,,1031.32,percent of total billed charges ,95% of total billed charges,1085.6,80,,868.48,percent of total billed charges,78% of total billed charges,1058.46,78,,846.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,854.91,63,,683.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,854.91,63,,683.93,percent of total billed charges,63% of total billed charges,1153.45,85,,922.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1072.03,79,,857.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1289.15,
PINS HOLDING 3.2 MM,270215960,CDM,278,RC,C1713,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FIBERWIRE REFND (AR-7250),270216330,CDM,278,RC,C1713,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.22,450,
PROLEN MESH HERNIA SYSTEM,270216368,CDM,278,RC,C1781,HCPCS,outpatient,,,1026,718.2,,810.54,79,,648.43,percent of total billed charges,79% of total billed charges,923.4,90,,738.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,646.38,63,,517.1,percent of total billed charges,63% of total billed charges,792.28,77.22,,633.82,percent of total billed charges,77.22% of total billed charges,678.19,66.1,,542.55,percent of total billed charges,66.1% of total billed charges,851.58,83,,681.26,percent of total billed charges,83% of total,974.7,95,,779.76,percent of total billed charges ,95% of total billed charges,820.8,80,,656.64,percent of total billed charges,78% of total billed charges,800.28,78,,640.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,646.38,63,,517.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,923.4,90,,738.72,percent of total billed charges,90% of total billed charges,820.8,80,,656.64,percent of total billed charges,80% of total billed charges,646.38,63,,517.1,percent of total billed charges,63% of total billed charges,872.1,85,,697.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,810.54,79,,648.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,974.7,
FIBERTAPE #2,270216834,CDM,278,RC,C1713,HCPCS,outpatient,,,438,306.6,,346.02,79,,276.82,percent of total billed charges,79% of total billed charges,394.2,90,,315.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.94,63,,220.75,percent of total billed charges,63% of total billed charges,338.22,77.22,,270.58,percent of total billed charges,77.22% of total billed charges,289.52,66.1,,231.62,percent of total billed charges,66.1% of total billed charges,363.54,83,,290.83,percent of total billed charges,83% of total,416.1,95,,332.88,percent of total billed charges ,95% of total billed charges,350.4,80,,280.32,percent of total billed charges,78% of total billed charges,341.64,78,,273.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,275.94,63,,220.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,275.94,63,,220.75,percent of total billed charges,63% of total billed charges,372.3,85,,297.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,346.02,79,,276.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,275.94,450,
FIBERWIRE #2,270216835,CDM,278,RC,C1713,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
ESOPHAGEL BALLOON DILATOR,270217438,CDM,278,RC,C1726,HCPCS,outpatient,,,506,354.2,,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,455.4,90,,364.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,390.73,77.22,,312.58,percent of total billed charges,77.22% of total billed charges,334.47,66.1,,267.58,percent of total billed charges,66.1% of total billed charges,419.98,83,,335.98,percent of total billed charges,83% of total,480.7,95,,384.56,percent of total billed charges ,95% of total billed charges,404.8,80,,323.84,percent of total billed charges,78% of total billed charges,394.68,78,,315.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,318.78,63,,255.02,percent of total billed charges,63% of total billed charges,430.1,85,,344.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,399.74,79,,319.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,318.78,480.7,
KIRSCHNER WIRE .045,270218418,CDM,278,RC,C1713,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
KIRSCHNER WIRE .028,270218419,CDM,278,RC,C1713,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
FIBERWIRE SUTURE 2-0,270219174,CDM,278,RC,C1713,HCPCS,outpatient,,,144,100.8,,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,111.2,77.22,,88.96,percent of total billed charges,77.22% of total billed charges,95.18,66.1,,76.14,percent of total billed charges,66.1% of total billed charges,119.52,83,,95.62,percent of total billed charges,83% of total,136.8,95,,109.44,percent of total billed charges ,95% of total billed charges,115.2,80,,92.16,percent of total billed charges,78% of total billed charges,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,90.72,450,
COBAL CEMENT W/GENTAMICIN,270219417,CDM,278,RC,C1763,HCPCS,outpatient,,,1276,893.2,,1008.04,79,,806.43,percent of total billed charges,79% of total billed charges,1148.4,90,,918.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,985.33,77.22,,788.26,percent of total billed charges,77.22% of total billed charges,843.44,66.1,,674.75,percent of total billed charges,66.1% of total billed charges,1059.08,83,,847.26,percent of total billed charges,83% of total,1212.2,95,,969.76,percent of total billed charges ,95% of total billed charges,1020.8,80,,816.64,percent of total billed charges,78% of total billed charges,995.28,78,,796.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1148.4,90,,918.72,percent of total billed charges,90% of total billed charges,1020.8,80,,816.64,percent of total billed charges,80% of total billed charges,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,1084.6,85,,867.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1008.04,79,,806.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1212.2,
TIGERLOOP,270219441,CDM,278,RC,C1713,HCPCS,outpatient,,,197,137.9,,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,152.12,77.22,,121.7,percent of total billed charges,77.22% of total billed charges,130.22,66.1,,104.18,percent of total billed charges,66.1% of total billed charges,163.51,83,,130.81,percent of total billed charges,83% of total,187.15,95,,149.72,percent of total billed charges ,95% of total billed charges,157.6,80,,126.08,percent of total billed charges,78% of total billed charges,153.66,78,,122.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.11,63,,99.29,percent of total billed charges,63% of total billed charges,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.11,450,
BAERVELDT SHUNT,270220304,CDM,278,RC,L8612,HCPCS,outpatient,,,3656,2559.2,,2888.24,79,,2310.59,percent of total billed charges,79% of total billed charges,3290.4,90,,2632.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,2823.16,77.22,,2258.53,percent of total billed charges,77.22% of total billed charges,2416.62,66.1,,1933.3,percent of total billed charges,66.1% of total billed charges,3034.48,83,,2427.58,percent of total billed charges,83% of total,3473.2,95,,2778.56,percent of total billed charges ,95% of total billed charges,2924.8,80,,2339.84,percent of total billed charges,78% of total billed charges,2851.68,78,,2281.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3290.4,90,,2632.32,percent of total billed charges,90% of total billed charges,2924.8,80,,2339.84,percent of total billed charges,80% of total billed charges,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,3107.6,85,,2486.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2888.24,79,,2310.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3473.2,
CATHETER 20 FRENCH PEZZER,270220360,CDM,278,RC,C1729,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
PEZZER 22FR CATHETER,270220361,CDM,278,RC,C1729,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
ARTHEX METAL ANCHORS,270220829,CDM,278,RC,C1713,HCPCS,outpatient,,,575,402.5,,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,444.02,77.22,,355.22,percent of total billed charges,77.22% of total billed charges,380.08,66.1,,304.06,percent of total billed charges,66.1% of total billed charges,477.25,83,,381.8,percent of total billed charges,83% of total,546.25,95,,437,percent of total billed charges ,95% of total billed charges,460,80,,368,percent of total billed charges,78% of total billed charges,448.5,78,,358.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,362.25,546.25,
DISPOSABLE KIT 2.9 MM PUSHLOCK,270220853,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
MICRO SUTURE LASSO,270220857,CDM,278,RC,C1713,HCPCS,outpatient,,,500,350,,395,79,,316,percent of total billed charges,79% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,386.1,77.22,,308.88,percent of total billed charges,77.22% of total billed charges,330.5,66.1,,264.4,percent of total billed charges,66.1% of total billed charges,415,83,,332,percent of total billed charges,83% of total,475,95,,380,percent of total billed charges ,95% of total billed charges,400,80,,320,percent of total billed charges,78% of total billed charges,390,78,,312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,315,63,,252,percent of total billed charges,63% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,395,79,,316,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315,475,
"FIBERWIRE #2  38""",270221058,CDM,278,RC,C1713,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
TIGERSTICK #2,270221381,CDM,278,RC,C1713,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.66,450,
ACL WIRE KIT,270221527,CDM,278,RC,C1713,HCPCS,outpatient,,,520,364,,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,401.54,77.22,,321.23,percent of total billed charges,77.22% of total billed charges,343.72,66.1,,274.98,percent of total billed charges,66.1% of total billed charges,431.6,83,,345.28,percent of total billed charges,83% of total,494,95,,395.2,percent of total billed charges ,95% of total billed charges,416,80,,332.8,percent of total billed charges,78% of total billed charges,405.6,78,,324.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,327.6,494,
NICORE NITINOL GUIDEWIRE,270221629,CDM,278,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
FIBERWIRE 5,270221818,CDM,278,RC,C1713,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,104.44,66.1,,83.55,percent of total billed charges,66.1% of total billed charges,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.54,450,
STIMUBLAST DBM 1CC,270222161,CDM,278,RC,C9539,HCPCS,outpatient,,,552,386.4,,436.08,79,,348.86,percent of total billed charges,79% of total billed charges,496.8,90,,397.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,347.76,63,,278.21,percent of total billed charges,63% of total billed charges,426.25,77.22,,341,percent of total billed charges,77.22% of total billed charges,364.87,66.1,,291.9,percent of total billed charges,66.1% of total billed charges,458.16,83,,366.53,percent of total billed charges,83% of total,524.4,95,,419.52,percent of total billed charges ,95% of total billed charges,441.6,80,,353.28,percent of total billed charges,78% of total billed charges,430.56,78,,344.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,347.76,63,,278.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,496.8,90,,397.44,percent of total billed charges,90% of total billed charges,441.6,80,,353.28,percent of total billed charges,80% of total billed charges,347.76,63,,278.21,percent of total billed charges,63% of total billed charges,469.2,85,,375.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,436.08,79,,348.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,347.76,524.4,
KWIRE 1.5 X 127 MM,270222693,CDM,278,RC,C1713,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.49,450,
FIBERLOOP,270223814,CDM,278,RC,C1713,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
KWIRE 1.6MM,270224140,CDM,278,RC,C1713,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
K WIRE 1.6MM,270225318,CDM,278,RC,C1713,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
#0 FIBERLOOP SUTURE,270225479,CDM,278,RC,C1713,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,70.73,66.1,,56.58,percent of total billed charges,66.1% of total billed charges,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67.41,450,
4 HOLD LEFT PLATE,270225783,CDM,278,RC,C1713,HCPCS,outpatient,,,5017,3511.9,,3963.43,79,,3170.74,percent of total billed charges,79% of total billed charges,4515.3,90,,3612.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3160.71,63,,2528.57,percent of total billed charges,63% of total billed charges,3874.13,77.22,,3099.3,percent of total billed charges,77.22% of total billed charges,3316.24,66.1,,2652.99,percent of total billed charges,66.1% of total billed charges,4164.11,83,,3331.29,percent of total billed charges,83% of total,4766.15,95,,3812.92,percent of total billed charges ,95% of total billed charges,4013.6,80,,3210.88,percent of total billed charges,78% of total billed charges,3913.26,78,,3130.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3160.71,63,,2528.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4515.3,90,,3612.24,percent of total billed charges,90% of total billed charges,4013.6,80,,3210.88,percent of total billed charges,80% of total billed charges,3160.71,63,,2528.57,percent of total billed charges,63% of total billed charges,4264.45,85,,3411.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3963.43,79,,3170.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4766.15,
2-0 FIBER LOOP,270225835,CDM,278,RC,C1713,HCPCS,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,130.88,66.1,,104.7,percent of total billed charges,66.1% of total billed charges,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,124.74,63,,99.79,percent of total billed charges,63% of total billed charges,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,124.74,450,
FIBERWIRE #5,270225946,CDM,278,RC,C1713,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,71.82,450,
MESH PROLITE 2.5 X 5.5,270226060,CDM,278,RC,C1781,HCPCS,outpatient,,,130,91,,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,100.39,77.22,,80.31,percent of total billed charges,77.22% of total billed charges,85.93,66.1,,68.74,percent of total billed charges,66.1% of total billed charges,107.9,83,,86.32,percent of total billed charges,83% of total,123.5,95,,98.8,percent of total billed charges ,95% of total billed charges,104,80,,83.2,percent of total billed charges,78% of total billed charges,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.9,450,
MESH PROLITE 2 X 4,270226064,CDM,278,RC,C1781,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,98.75,79,,79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.75,450,
C QUR TACSHIELD 4 X 6,270226073,CDM,278,RC,C1781,HCPCS,outpatient,,,1133,793.1,,895.07,79,,716.06,percent of total billed charges,79% of total billed charges,1019.7,90,,815.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,713.79,63,,571.03,percent of total billed charges,63% of total billed charges,874.9,77.22,,699.92,percent of total billed charges,77.22% of total billed charges,748.91,66.1,,599.13,percent of total billed charges,66.1% of total billed charges,940.39,83,,752.31,percent of total billed charges,83% of total,1076.35,95,,861.08,percent of total billed charges ,95% of total billed charges,906.4,80,,725.12,percent of total billed charges,78% of total billed charges,883.74,78,,706.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,713.79,63,,571.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,713.79,63,,571.03,percent of total billed charges,63% of total billed charges,963.05,85,,770.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,895.07,79,,716.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1076.35,
C QUR V-PATCH 2.5 X 2.5 MED,270226075,CDM,278,RC,C1781,HCPCS,outpatient,,,995,696.5,,786.05,79,,628.84,percent of total billed charges,79% of total billed charges,895.5,90,,716.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,626.85,63,,501.48,percent of total billed charges,63% of total billed charges,768.34,77.22,,614.67,percent of total billed charges,77.22% of total billed charges,657.7,66.1,,526.16,percent of total billed charges,66.1% of total billed charges,825.85,83,,660.68,percent of total billed charges,83% of total,945.25,95,,756.2,percent of total billed charges ,95% of total billed charges,796,80,,636.8,percent of total billed charges,78% of total billed charges,776.1,78,,620.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,626.85,63,,501.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,895.5,90,,716.4,percent of total billed charges,90% of total billed charges,796,80,,636.8,percent of total billed charges,80% of total billed charges,626.85,63,,501.48,percent of total billed charges,63% of total billed charges,845.75,85,,676.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,786.05,79,,628.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,945.25,
C QUR V-PATCH 1.7 X 1.7 SMALL,270226076,CDM,278,RC,C1781,HCPCS,outpatient,,,791,553.7,,624.89,79,,499.91,percent of total billed charges,79% of total billed charges,711.9,90,,569.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,498.33,63,,398.66,percent of total billed charges,63% of total billed charges,610.81,77.22,,488.65,percent of total billed charges,77.22% of total billed charges,522.85,66.1,,418.28,percent of total billed charges,66.1% of total billed charges,656.53,83,,525.22,percent of total billed charges,83% of total,751.45,95,,601.16,percent of total billed charges ,95% of total billed charges,632.8,80,,506.24,percent of total billed charges,78% of total billed charges,616.98,78,,493.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,498.33,63,,398.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,711.9,90,,569.52,percent of total billed charges,90% of total billed charges,632.8,80,,506.24,percent of total billed charges,80% of total billed charges,498.33,63,,398.66,percent of total billed charges,63% of total billed charges,672.35,85,,537.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,624.89,79,,499.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,751.45,
PROLOOP MESH SMALL,270226080,CDM,278,RC,C1781,HCPCS,outpatient,,,327,228.9,,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,252.51,77.22,,202.01,percent of total billed charges,77.22% of total billed charges,216.15,66.1,,172.92,percent of total billed charges,66.1% of total billed charges,271.41,83,,217.13,percent of total billed charges,83% of total,310.65,95,,248.52,percent of total billed charges ,95% of total billed charges,261.6,80,,209.28,percent of total billed charges,78% of total billed charges,255.06,78,,204.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.01,450,
C QUR TACSHIELD 4.5 X 4.5,270226226,CDM,278,RC,C1781,HCPCS,outpatient,,,1295,906.5,,1023.05,79,,818.44,percent of total billed charges,79% of total billed charges,1165.5,90,,932.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,815.85,63,,652.68,percent of total billed charges,63% of total billed charges,1000,77.22,,800,percent of total billed charges,77.22% of total billed charges,856,66.1,,684.8,percent of total billed charges,66.1% of total billed charges,1074.85,83,,859.88,percent of total billed charges,83% of total,1230.25,95,,984.2,percent of total billed charges ,95% of total billed charges,1036,80,,828.8,percent of total billed charges,78% of total billed charges,1010.1,78,,808.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,815.85,63,,652.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,815.85,63,,652.68,percent of total billed charges,63% of total billed charges,1100.75,85,,880.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1023.05,79,,818.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1230.25,
C QUR TACSHIELD 3 X 6,270226227,CDM,278,RC,C1781,HCPCS,outpatient,,,1168,817.6,,922.72,79,,738.18,percent of total billed charges,79% of total billed charges,1051.2,90,,840.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,735.84,63,,588.67,percent of total billed charges,63% of total billed charges,901.93,77.22,,721.54,percent of total billed charges,77.22% of total billed charges,772.05,66.1,,617.64,percent of total billed charges,66.1% of total billed charges,969.44,83,,775.55,percent of total billed charges,83% of total,1109.6,95,,887.68,percent of total billed charges ,95% of total billed charges,934.4,80,,747.52,percent of total billed charges,78% of total billed charges,911.04,78,,728.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,735.84,63,,588.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1051.2,90,,840.96,percent of total billed charges,90% of total billed charges,934.4,80,,747.52,percent of total billed charges,80% of total billed charges,735.84,63,,588.67,percent of total billed charges,63% of total billed charges,992.8,85,,794.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,922.72,79,,738.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1109.6,
BARD VENTRALEX SMALL CIRCLE,270226237,CDM,278,RC,C1781,HCPCS,outpatient,,,747,522.9,,590.13,79,,472.1,percent of total billed charges,79% of total billed charges,672.3,90,,537.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,470.61,63,,376.49,percent of total billed charges,63% of total billed charges,576.83,77.22,,461.46,percent of total billed charges,77.22% of total billed charges,493.77,66.1,,395.02,percent of total billed charges,66.1% of total billed charges,620.01,83,,496.01,percent of total billed charges,83% of total,709.65,95,,567.72,percent of total billed charges ,95% of total billed charges,597.6,80,,478.08,percent of total billed charges,78% of total billed charges,582.66,78,,466.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,470.61,63,,376.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,470.61,63,,376.49,percent of total billed charges,63% of total billed charges,634.95,85,,507.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,590.13,79,,472.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,709.65,
PATCH VENTRALEX ST LARGE,270226264,CDM,278,RC,C1781,HCPCS,outpatient,,,1937,1355.9,,1530.23,79,,1224.18,percent of total billed charges,79% of total billed charges,1743.3,90,,1394.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1220.31,63,,976.25,percent of total billed charges,63% of total billed charges,1495.75,77.22,,1196.6,percent of total billed charges,77.22% of total billed charges,1280.36,66.1,,1024.29,percent of total billed charges,66.1% of total billed charges,1607.71,83,,1286.17,percent of total billed charges,83% of total,1840.15,95,,1472.12,percent of total billed charges ,95% of total billed charges,1549.6,80,,1239.68,percent of total billed charges,78% of total billed charges,1510.86,78,,1208.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1220.31,63,,976.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1743.3,90,,1394.64,percent of total billed charges,90% of total billed charges,1549.6,80,,1239.68,percent of total billed charges,80% of total billed charges,1220.31,63,,976.25,percent of total billed charges,63% of total billed charges,1646.45,85,,1317.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1530.23,79,,1224.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1840.15,
PATCH MEDIUM VENTRALEX MESH,270226265,CDM,278,RC,C1781,HCPCS,outpatient,,,1646,1152.2,,1300.34,79,,1040.27,percent of total billed charges,79% of total billed charges,1481.4,90,,1185.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1036.98,63,,829.58,percent of total billed charges,63% of total billed charges,1271.04,77.22,,1016.83,percent of total billed charges,77.22% of total billed charges,1088.01,66.1,,870.41,percent of total billed charges,66.1% of total billed charges,1366.18,83,,1092.94,percent of total billed charges,83% of total,1563.7,95,,1250.96,percent of total billed charges ,95% of total billed charges,1316.8,80,,1053.44,percent of total billed charges,78% of total billed charges,1283.88,78,,1027.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1036.98,63,,829.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1036.98,63,,829.58,percent of total billed charges,63% of total billed charges,1399.1,85,,1119.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1300.34,79,,1040.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1563.7,
PATCH VENTRALEX ST SMALL,270226266,CDM,278,RC,C1781,HCPCS,outpatient,,,887,620.9,,700.73,79,,560.58,percent of total billed charges,79% of total billed charges,798.3,90,,638.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,558.81,63,,447.05,percent of total billed charges,63% of total billed charges,684.94,77.22,,547.95,percent of total billed charges,77.22% of total billed charges,586.31,66.1,,469.05,percent of total billed charges,66.1% of total billed charges,736.21,83,,588.97,percent of total billed charges,83% of total,842.65,95,,674.12,percent of total billed charges ,95% of total billed charges,709.6,80,,567.68,percent of total billed charges,78% of total billed charges,691.86,78,,553.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,558.81,63,,447.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,798.3,90,,638.64,percent of total billed charges,90% of total billed charges,709.6,80,,567.68,percent of total billed charges,80% of total billed charges,558.81,63,,447.05,percent of total billed charges,63% of total billed charges,753.95,85,,603.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,700.73,79,,560.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,842.65,
FIBER WIRE,270226532,CDM,278,RC,C1713,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
2.8 GUIDE WIRE,270226539,CDM,278,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
1.6 KWIRES,270226547,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
KWIRE DBL END TRO 1.4X9,270226649,CDM,278,RC,C1713,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
3 MM RETRO PIN,270226684,CDM,278,RC,C1713,HCPCS,outpatient,,,274,191.8,,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,211.58,77.22,,169.26,percent of total billed charges,77.22% of total billed charges,181.11,66.1,,144.89,percent of total billed charges,66.1% of total billed charges,227.42,83,,181.94,percent of total billed charges,83% of total,260.3,95,,208.24,percent of total billed charges ,95% of total billed charges,219.2,80,,175.36,percent of total billed charges,78% of total billed charges,213.72,78,,170.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,172.62,63,,138.1,percent of total billed charges,63% of total billed charges,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,172.62,450,
4 MM PIN,270226685,CDM,278,RC,C1713,HCPCS,outpatient,,,447,312.9,,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,345.17,77.22,,276.14,percent of total billed charges,77.22% of total billed charges,295.47,66.1,,236.38,percent of total billed charges,66.1% of total billed charges,371.01,83,,296.81,percent of total billed charges,83% of total,424.65,95,,339.72,percent of total billed charges ,95% of total billed charges,357.6,80,,286.08,percent of total billed charges,78% of total billed charges,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,281.61,450,
#2 FIBERLOOP,270226689,CDM,278,RC,C1713,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
FIBERLOOP,270226758,CDM,278,RC,C1713,HCPCS,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.86,450,
TIGERLOOP,270226759,CDM,278,RC,C1713,HCPCS,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,202.86,450,
K WIRE DBL END TROCAR TIP 1.6,270226854,CDM,278,RC,C1713,HCPCS,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,14.54,66.1,,11.63,percent of total billed charges,66.1% of total billed charges,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,13.86,63,,11.09,percent of total billed charges,63% of total billed charges,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.86,450,
KWIRE DBL ENDED TRO 0.62X6,270226855,CDM,278,RC,C1713,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
K WIRE 1.6 SING SIDED,270226931,CDM,278,RC,C1713,HCPCS,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.98,450,
GPS THREADED SHOULDER PIN KIT,270226956,CDM,278,RC,C1713,HCPCS,outpatient,,,500,350,,395,79,,316,percent of total billed charges,79% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,386.1,77.22,,308.88,percent of total billed charges,77.22% of total billed charges,330.5,66.1,,264.4,percent of total billed charges,66.1% of total billed charges,415,83,,332,percent of total billed charges,83% of total,475,95,,380,percent of total billed charges ,95% of total billed charges,400,80,,320,percent of total billed charges,78% of total billed charges,390,78,,312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,315,63,,252,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,315,63,,252,percent of total billed charges,63% of total billed charges,425,85,,340,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,395,79,,316,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315,475,
FIXED ANG TORQUE SCREW KIT,270226957,CDM,278,RC,C1713,HCPCS,outpatient,,,792,554.4,,625.68,79,,500.54,percent of total billed charges,79% of total billed charges,712.8,90,,570.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,498.96,63,,399.17,percent of total billed charges,63% of total billed charges,611.58,77.22,,489.26,percent of total billed charges,77.22% of total billed charges,523.51,66.1,,418.81,percent of total billed charges,66.1% of total billed charges,657.36,83,,525.89,percent of total billed charges,83% of total,752.4,95,,601.92,percent of total billed charges ,95% of total billed charges,633.6,80,,506.88,percent of total billed charges,78% of total billed charges,617.76,78,,494.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,498.96,63,,399.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,498.96,63,,399.17,percent of total billed charges,63% of total billed charges,673.2,85,,538.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,625.68,79,,500.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,752.4,
HERNIA PATCH 11CM X 14 CM,270226992,CDM,278,RC,C1781,HCPCS,outpatient,,,2891,2023.7,,2283.89,79,,1827.11,percent of total billed charges,79% of total billed charges,2601.9,90,,2081.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1821.33,63,,1457.06,percent of total billed charges,63% of total billed charges,2232.43,77.22,,1785.94,percent of total billed charges,77.22% of total billed charges,1910.95,66.1,,1528.76,percent of total billed charges,66.1% of total billed charges,2399.53,83,,1919.62,percent of total billed charges,83% of total,2746.45,95,,2197.16,percent of total billed charges ,95% of total billed charges,2312.8,80,,1850.24,percent of total billed charges,78% of total billed charges,2254.98,78,,1803.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1821.33,63,,1457.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2601.9,90,,2081.52,percent of total billed charges,90% of total billed charges,2312.8,80,,1850.24,percent of total billed charges,80% of total billed charges,1821.33,63,,1457.06,percent of total billed charges,63% of total billed charges,2457.35,85,,1965.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2283.89,79,,1827.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2746.45,
FIBER TAPE DIS KIT,270227038,CDM,278,RC,C1713,HCPCS,outpatient,,,884,618.8,,698.36,79,,558.69,percent of total billed charges,79% of total billed charges,795.6,90,,636.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,556.92,63,,445.54,percent of total billed charges,63% of total billed charges,682.62,77.22,,546.1,percent of total billed charges,77.22% of total billed charges,584.32,66.1,,467.46,percent of total billed charges,66.1% of total billed charges,733.72,83,,586.98,percent of total billed charges,83% of total,839.8,95,,671.84,percent of total billed charges ,95% of total billed charges,707.2,80,,565.76,percent of total billed charges,78% of total billed charges,689.52,78,,551.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,556.92,63,,445.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,795.6,90,,636.48,percent of total billed charges,90% of total billed charges,707.2,80,,565.76,percent of total billed charges,80% of total billed charges,556.92,63,,445.54,percent of total billed charges,63% of total billed charges,751.4,85,,601.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,698.36,79,,558.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,839.8,
FIBERLOOP,270227070,CDM,278,RC,C1713,HCPCS,outpatient,,,296,207.2,,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,228.57,77.22,,182.86,percent of total billed charges,77.22% of total billed charges,195.66,66.1,,156.53,percent of total billed charges,66.1% of total billed charges,245.68,83,,196.54,percent of total billed charges,83% of total,281.2,95,,224.96,percent of total billed charges ,95% of total billed charges,236.8,80,,189.44,percent of total billed charges,78% of total billed charges,230.88,78,,184.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,186.48,450,
VENTRALIGHT ST ECHO 2.0,270227109,CDM,278,RC,C1781,HCPCS,outpatient,,,1470,1029,,1161.3,79,,929.04,percent of total billed charges,79% of total billed charges,1323,90,,1058.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,926.1,63,,740.88,percent of total billed charges,63% of total billed charges,1135.13,77.22,,908.1,percent of total billed charges,77.22% of total billed charges,971.67,66.1,,777.34,percent of total billed charges,66.1% of total billed charges,1220.1,83,,976.08,percent of total billed charges,83% of total,1396.5,95,,1117.2,percent of total billed charges ,95% of total billed charges,1176,80,,940.8,percent of total billed charges,78% of total billed charges,1146.6,78,,917.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,926.1,63,,740.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1323,90,,1058.4,percent of total billed charges,90% of total billed charges,1176,80,,940.8,percent of total billed charges,80% of total billed charges,926.1,63,,740.88,percent of total billed charges,63% of total billed charges,1249.5,85,,999.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1161.3,79,,929.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1396.5,
FIBERLOOP,270227125,CDM,278,RC,C1713,HCPCS,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
HERNIA PATCH 13.8CM X 17.8CM,270227332,CDM,278,RC,C1781,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
2.0 K WIRE,270227933,CDM,278,RC,C1713,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
ECHO 2 CIRCLE 15 CM,270228555,CDM,278,RC,,,outpatient,,,1928,1349.6,,1523.12,79,,1218.5,percent of total billed charges,79% of total billed charges,1735.2,90,,1388.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1214.64,63,,971.71,percent of total billed charges,63% of total billed charges,1488.8,77.22,,1191.04,percent of total billed charges,77.22% of total billed charges,1274.41,66.1,,1019.53,percent of total billed charges,66.1% of total billed charges,1600.24,83,,1280.19,percent of total billed charges,83% of total,1831.6,95,,1465.28,percent of total billed charges ,95% of total billed charges,1542.4,80,,1233.92,percent of total billed charges,78% of total billed charges,1503.84,78,,1203.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1214.64,63,,971.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1214.64,63,,971.71,percent of total billed charges,63% of total billed charges,1638.8,85,,1311.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1523.12,79,,1218.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1831.6,
KWIRE 1.6MM,270229167,CDM,278,RC,C1713,HCPCS,outpatient,,,192,134.4,,151.68,79,,121.34,percent of total billed charges,79% of total billed charges,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,63,,96.77,percent of total billed charges,63% of total billed charges,148.26,77.22,,118.61,percent of total billed charges,77.22% of total billed charges,126.91,66.1,,101.53,percent of total billed charges,66.1% of total billed charges,159.36,83,,127.49,percent of total billed charges,83% of total,182.4,95,,145.92,percent of total billed charges ,95% of total billed charges,153.6,80,,122.88,percent of total billed charges,78% of total billed charges,149.76,78,,119.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,120.96,63,,96.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,120.96,63,,96.77,percent of total billed charges,63% of total billed charges,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,151.68,79,,121.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120.96,450,
GUIDEWIRE 1.4,270229284,CDM,278,RC,C1769,HCPCS,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,97.17,66.1,,77.74,percent of total billed charges,66.1% of total billed charges,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.61,450,
1.35 K-WIRE,270229357,CDM,278,RC,C1713,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
5 HOLE STRAIGHT PLATE 243.15,27210030,CDM,278,RC,C1713,HCPCS,outpatient,,,184,128.8,,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,165.6,90,,132.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,142.08,77.22,,113.66,percent of total billed charges,77.22% of total billed charges,121.62,66.1,,97.3,percent of total billed charges,66.1% of total billed charges,152.72,83,,122.18,percent of total billed charges,83% of total,174.8,95,,139.84,percent of total billed charges ,95% of total billed charges,147.2,80,,117.76,percent of total billed charges,78% of total billed charges,143.52,78,,114.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.92,63,,92.74,percent of total billed charges,63% of total billed charges,156.4,85,,125.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,145.36,79,,116.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.92,450,
TRULIANT FEM COMP CRP 1.5,278000002,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIB TRAY PRS1.5F/1.5T,278000003,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
ACTIVIT-E TRLT CRC TIB 3.2/3,278000004,CDM,278,RC,C1713,HCPCS,outpatient,,,2025,1417.5,,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1563.71,77.22,,1250.97,percent of total billed charges,77.22% of total billed charges,1338.53,66.1,,1070.82,percent of total billed charges,66.1% of total billed charges,1680.75,83,,1344.6,percent of total billed charges,83% of total,1923.75,95,,1539,percent of total billed charges ,95% of total billed charges,1620,80,,1296,percent of total billed charges,78% of total billed charges,1579.5,78,,1263.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,1620,80,,1296,percent of total billed charges,80% of total billed charges,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1721.25,85,,1377,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1923.75,
TRULIANT FEM COMP CCR SZ 1,278000076,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
"ACTIVIT-E CRC TIB INS 1, 12MM",278000077,CDM,278,RC,C1713,HCPCS,outpatient,,,2025,1417.5,,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1563.71,77.22,,1250.97,percent of total billed charges,77.22% of total billed charges,1338.53,66.1,,1070.82,percent of total billed charges,66.1% of total billed charges,1680.75,83,,1344.6,percent of total billed charges,83% of total,1923.75,95,,1539,percent of total billed charges ,95% of total billed charges,1620,80,,1296,percent of total billed charges,78% of total billed charges,1579.5,78,,1263.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,1620,80,,1296,percent of total billed charges,80% of total billed charges,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1721.25,85,,1377,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1923.75,
ALTEON FEMRL STEM PF SZ7 107MM,278000080,CDM,278,RC,C1776,HCPCS,outpatient,,,4500,3150,,3555,79,,2844,percent of total billed charges,79% of total billed charges,4050,90,,3240,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,3474.9,77.22,,2779.92,percent of total billed charges,77.22% of total billed charges,2974.5,66.1,,2379.6,percent of total billed charges,66.1% of total billed charges,3735,83,,2988,percent of total billed charges,83% of total,4275,95,,3420,percent of total billed charges ,95% of total billed charges,3600,80,,2880,percent of total billed charges,78% of total billed charges,3510,78,,2808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4050,90,,3240,percent of total billed charges,90% of total billed charges,3600,80,,2880,percent of total billed charges,80% of total billed charges,2835,63,,2268,percent of total billed charges,63% of total billed charges,3825,85,,3060,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3555,79,,2844,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4275,
TRULIANT FEM COMP RET SZ 4 RT,278000081,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIB TRAY PRS 4F/4T,278000082,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
"ACTIVIT-E CRC TIB INS 4, 11MM",278000083,CDM,278,RC,C1713,HCPCS,outpatient,,,2025,1417.5,,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1563.71,77.22,,1250.97,percent of total billed charges,77.22% of total billed charges,1338.53,66.1,,1070.82,percent of total billed charges,66.1% of total billed charges,1680.75,83,,1344.6,percent of total billed charges,83% of total,1923.75,95,,1539,percent of total billed charges ,95% of total billed charges,1620,80,,1296,percent of total billed charges,78% of total billed charges,1579.5,78,,1263.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,1620,80,,1296,percent of total billed charges,80% of total billed charges,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1721.25,85,,1377,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1923.75,
CANNULATED SCREW 7.3 MM,278202692,CDM,278,RC,C1713,HCPCS,outpatient,,,985,689.5,,778.15,79,,622.52,percent of total billed charges,79% of total billed charges,886.5,90,,709.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,620.55,63,,496.44,percent of total billed charges,63% of total billed charges,760.62,77.22,,608.5,percent of total billed charges,77.22% of total billed charges,651.09,66.1,,520.87,percent of total billed charges,66.1% of total billed charges,817.55,83,,654.04,percent of total billed charges,83% of total,935.75,95,,748.6,percent of total billed charges ,95% of total billed charges,788,80,,630.4,percent of total billed charges,78% of total billed charges,768.3,78,,614.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,620.55,63,,496.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,886.5,90,,709.2,percent of total billed charges,90% of total billed charges,788,80,,630.4,percent of total billed charges,80% of total billed charges,620.55,63,,496.44,percent of total billed charges,63% of total billed charges,837.25,85,,669.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,778.15,79,,622.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,935.75,
"SCREW, CANNULATED 7X20 MM",278203003,CDM,278,RC,C1713,HCPCS,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,199.08,450,
CANNULATED SCREW 7.33MM 70MM,278203167,CDM,278,RC,C1713,HCPCS,outpatient,,,985,689.5,,778.15,79,,622.52,percent of total billed charges,79% of total billed charges,886.5,90,,709.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,620.55,63,,496.44,percent of total billed charges,63% of total billed charges,760.62,77.22,,608.5,percent of total billed charges,77.22% of total billed charges,651.09,66.1,,520.87,percent of total billed charges,66.1% of total billed charges,817.55,83,,654.04,percent of total billed charges,83% of total,935.75,95,,748.6,percent of total billed charges ,95% of total billed charges,788,80,,630.4,percent of total billed charges,78% of total billed charges,768.3,78,,614.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,620.55,63,,496.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,886.5,90,,709.2,percent of total billed charges,90% of total billed charges,788,80,,630.4,percent of total billed charges,80% of total billed charges,620.55,63,,496.44,percent of total billed charges,63% of total billed charges,837.25,85,,669.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,778.15,79,,622.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,935.75,
SCREW CORTEX 4.5MM 214.852,278206167,CDM,278,RC,C1713,HCPCS,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.71,450,
SCREW TIBIAL STEM EXTENSION,278214112,CDM,278,RC,C1713,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
PATELLA 3.5MM JOINT DEVICE IMP,278214113,CDM,278,RC,C1776,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,425.25,641.25,
PATELLA  38MM,278214230,CDM,278,RC,C1776,HCPCS,outpatient,,,709,496.3,,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,547.49,77.22,,437.99,percent of total billed charges,77.22% of total billed charges,468.65,66.1,,374.92,percent of total billed charges,66.1% of total billed charges,588.47,83,,470.78,percent of total billed charges,83% of total,673.55,95,,538.84,percent of total billed charges ,95% of total billed charges,567.2,80,,453.76,percent of total billed charges,78% of total billed charges,553.02,78,,442.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,446.67,673.55,
PATELLA 32MM,278214454,CDM,278,RC,C1776,HCPCS,outpatient,,,709,496.3,,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,547.49,77.22,,437.99,percent of total billed charges,77.22% of total billed charges,468.65,66.1,,374.92,percent of total billed charges,66.1% of total billed charges,588.47,83,,470.78,percent of total billed charges,83% of total,673.55,95,,538.84,percent of total billed charges ,95% of total billed charges,567.2,80,,453.76,percent of total billed charges,78% of total billed charges,553.02,78,,442.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,446.67,673.55,
ARGON HAWKINS III 5.0 NEEDLE,278214503,CDM,278,RC,C1819,HCPCS,outpatient,,,96,67.2,,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,74.13,77.22,,59.3,percent of total billed charges,77.22% of total billed charges,63.46,66.1,,50.77,percent of total billed charges,66.1% of total billed charges,79.68,83,,63.74,percent of total billed charges,83% of total,91.2,95,,72.96,percent of total billed charges ,95% of total billed charges,76.8,80,,61.44,percent of total billed charges,78% of total billed charges,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60.48,450,
ARGON HAWKINS III 7.5 NEEDLE,278214504,CDM,278,RC,C1819,HCPCS,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.71,450,
PATELLA 41 MM,278214751,CDM,278,RC,C1776,HCPCS,outpatient,,,709,496.3,,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,547.49,77.22,,437.99,percent of total billed charges,77.22% of total billed charges,468.65,66.1,,374.92,percent of total billed charges,66.1% of total billed charges,588.47,83,,470.78,percent of total billed charges,83% of total,673.55,95,,538.84,percent of total billed charges ,95% of total billed charges,567.2,80,,453.76,percent of total billed charges,78% of total billed charges,553.02,78,,442.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,446.67,673.55,
FEMORAL STEM SIZE 5 150MM,278217744,CDM,278,RC,C1776,HCPCS,outpatient,,,15329,10730.3,,12109.91,79,,9687.93,percent of total billed charges,79% of total billed charges,13796.1,90,,11036.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9657.27,63,,7725.82,percent of total billed charges,63% of total billed charges,11837.05,77.22,,9469.64,percent of total billed charges,77.22% of total billed charges,10132.47,66.1,,8105.98,percent of total billed charges,66.1% of total billed charges,12723.07,83,,10178.46,percent of total billed charges,83% of total,14562.55,95,,11650.04,percent of total billed charges ,95% of total billed charges,12263.2,80,,9810.56,percent of total billed charges,78% of total billed charges,11956.62,78,,9565.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9657.27,63,,7725.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,13796.1,90,,11036.88,percent of total billed charges,90% of total billed charges,12263.2,80,,9810.56,percent of total billed charges,80% of total billed charges,9657.27,63,,7725.82,percent of total billed charges,63% of total billed charges,13029.65,85,,10423.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12109.91,79,,9687.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,14562.55,
SCREW CORTEX 28 X 2.4,278218049,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SUTURE ANCHOR 5.5 x 24.5MM,278219525,CDM,278,RC,C1713,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
CORKSCREW ANCHOR NEEDLES,278219667,CDM,278,RC,C1713,HCPCS,outpatient,,,821,574.7,,648.59,79,,518.87,percent of total billed charges,79% of total billed charges,738.9,90,,591.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,633.98,77.22,,507.18,percent of total billed charges,77.22% of total billed charges,542.68,66.1,,434.14,percent of total billed charges,66.1% of total billed charges,681.43,83,,545.14,percent of total billed charges,83% of total,779.95,95,,623.96,percent of total billed charges ,95% of total billed charges,656.8,80,,525.44,percent of total billed charges,78% of total billed charges,640.38,78,,512.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,697.85,85,,558.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,648.59,79,,518.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,779.95,
PIN RETRO 3MM,278219906,CDM,278,RC,C1713,HCPCS,outpatient,,,457,319.9,,361.03,79,,288.82,percent of total billed charges,79% of total billed charges,411.3,90,,329.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,352.9,77.22,,282.32,percent of total billed charges,77.22% of total billed charges,302.08,66.1,,241.66,percent of total billed charges,66.1% of total billed charges,379.31,83,,303.45,percent of total billed charges,83% of total,434.15,95,,347.32,percent of total billed charges ,95% of total billed charges,365.6,80,,292.48,percent of total billed charges,78% of total billed charges,356.46,78,,285.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,411.3,90,,329.04,percent of total billed charges,90% of total billed charges,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,388.45,85,,310.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,361.03,79,,288.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,287.91,450,
SCREW LOCKING 3.5 x 14,278220399,CDM,278,RC,C1713,HCPCS,outpatient,,,413,289.1,,326.27,79,,261.02,percent of total billed charges,79% of total billed charges,371.7,90,,297.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.19,63,,208.15,percent of total billed charges,63% of total billed charges,318.92,77.22,,255.14,percent of total billed charges,77.22% of total billed charges,272.99,66.1,,218.39,percent of total billed charges,66.1% of total billed charges,342.79,83,,274.23,percent of total billed charges,83% of total,392.35,95,,313.88,percent of total billed charges ,95% of total billed charges,330.4,80,,264.32,percent of total billed charges,78% of total billed charges,322.14,78,,257.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,260.19,63,,208.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,371.7,90,,297.36,percent of total billed charges,90% of total billed charges,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,260.19,63,,208.15,percent of total billed charges,63% of total billed charges,351.05,85,,280.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,326.27,79,,261.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,260.19,450,
SCREW CANCELLOUS 3.5 x 12,278220405,CDM,278,RC,C1713,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
CORTICAL SCREW 3.5 x 14MM,278220575,CDM,278,RC,,,outpatient,,,161,112.7,,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,124.32,77.22,,99.46,percent of total billed charges,77.22% of total billed charges,106.42,66.1,,85.14,percent of total billed charges,66.1% of total billed charges,133.63,83,,106.9,percent of total billed charges,83% of total,152.95,95,,122.36,percent of total billed charges ,95% of total billed charges,128.8,80,,103.04,percent of total billed charges,78% of total billed charges,125.58,78,,100.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.43,450,
BIOCOMPOSITE SWIVELOCK,278220588,CDM,278,RC,C1713,HCPCS,outpatient,,,1501,1050.7,,1185.79,79,,948.63,percent of total billed charges,79% of total billed charges,1350.9,90,,1080.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,945.63,63,,756.5,percent of total billed charges,63% of total billed charges,1159.07,77.22,,927.26,percent of total billed charges,77.22% of total billed charges,992.16,66.1,,793.73,percent of total billed charges,66.1% of total billed charges,1245.83,83,,996.66,percent of total billed charges,83% of total,1425.95,95,,1140.76,percent of total billed charges ,95% of total billed charges,1200.8,80,,960.64,percent of total billed charges,78% of total billed charges,1170.78,78,,936.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,945.63,63,,756.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1350.9,90,,1080.72,percent of total billed charges,90% of total billed charges,1200.8,80,,960.64,percent of total billed charges,80% of total billed charges,945.63,63,,756.5,percent of total billed charges,63% of total billed charges,1275.85,85,,1020.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1185.79,79,,948.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1425.95,
SCREW INTERFERENCE 8 x 28MM,278221091,CDM,278,RC,C1713,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
SCREW LOW PROF LOCKNG 2.7x10MM,278221209,CDM,278,RC,C1713,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
LOCK SCREW 2.7 x 16MM,278221382,CDM,278,RC,C1713,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
SUTURE ANCHOR 4.75 x 19.1MM,278221512,CDM,278,RC,C1713,HCPCS,outpatient,,,1206,844.2,,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,1085.4,90,,868.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,931.27,77.22,,745.02,percent of total billed charges,77.22% of total billed charges,797.17,66.1,,637.74,percent of total billed charges,66.1% of total billed charges,1000.98,83,,800.78,percent of total billed charges,83% of total,1145.7,95,,916.56,percent of total billed charges ,95% of total billed charges,964.8,80,,771.84,percent of total billed charges,78% of total billed charges,940.68,78,,752.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,1025.1,85,,820.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1145.7,
ACL TIGHTROPE  RT,278221861,CDM,278,RC,C1713,HCPCS,outpatient,,,1125,787.5,,888.75,79,,711,percent of total billed charges,79% of total billed charges,1012.5,90,,810,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,868.73,77.22,,694.98,percent of total billed charges,77.22% of total billed charges,743.63,66.1,,594.9,percent of total billed charges,66.1% of total billed charges,933.75,83,,747,percent of total billed charges,83% of total,1068.75,95,,855,percent of total billed charges ,95% of total billed charges,900,80,,720,percent of total billed charges,78% of total billed charges,877.5,78,,702,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1012.5,90,,810,percent of total billed charges,90% of total billed charges,900,80,,720,percent of total billed charges,80% of total billed charges,708.75,63,,567,percent of total billed charges,63% of total billed charges,956.25,85,,765,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,888.75,79,,711,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1068.75,
SUTURE ANCHOR 2.4 X 8.5 MM,278221875,CDM,278,RC,C1713,HCPCS,outpatient,,,1046,732.2,,826.34,79,,661.07,percent of total billed charges,79% of total billed charges,941.4,90,,753.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658.98,63,,527.18,percent of total billed charges,63% of total billed charges,807.72,77.22,,646.18,percent of total billed charges,77.22% of total billed charges,691.41,66.1,,553.13,percent of total billed charges,66.1% of total billed charges,868.18,83,,694.54,percent of total billed charges,83% of total,993.7,95,,794.96,percent of total billed charges ,95% of total billed charges,836.8,80,,669.44,percent of total billed charges,78% of total billed charges,815.88,78,,652.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,658.98,63,,527.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,941.4,90,,753.12,percent of total billed charges,90% of total billed charges,836.8,80,,669.44,percent of total billed charges,80% of total billed charges,658.98,63,,527.18,percent of total billed charges,63% of total billed charges,889.1,85,,711.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,826.34,79,,661.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,993.7,
INTRAMEDULLARY BONE PLUG/SMALL,278221932,CDM,278,RC,C1713,HCPCS,outpatient,,,367,256.9,,289.93,79,,231.94,percent of total billed charges,79% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,283.4,77.22,,226.72,percent of total billed charges,77.22% of total billed charges,242.59,66.1,,194.07,percent of total billed charges,66.1% of total billed charges,304.61,83,,243.69,percent of total billed charges,83% of total,348.65,95,,278.92,percent of total billed charges ,95% of total billed charges,293.6,80,,234.88,percent of total billed charges,78% of total billed charges,286.26,78,,229.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,289.93,79,,231.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,231.21,450,
SURTUE ANCHOR 5.5 x 19.1MM,278221935,CDM,278,RC,C1713,HCPCS,outpatient,,,1206,844.2,,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,1085.4,90,,868.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,931.27,77.22,,745.02,percent of total billed charges,77.22% of total billed charges,797.17,66.1,,637.74,percent of total billed charges,66.1% of total billed charges,1000.98,83,,800.78,percent of total billed charges,83% of total,1145.7,95,,916.56,percent of total billed charges ,95% of total billed charges,964.8,80,,771.84,percent of total billed charges,78% of total billed charges,940.68,78,,752.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,1025.1,85,,820.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1145.7,
SUTURE ANCHOR 4.75 x 19.1MM,278222037,CDM,278,RC,C1713,HCPCS,outpatient,,,1341,938.7,,1059.39,79,,847.51,percent of total billed charges,79% of total billed charges,1206.9,90,,965.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,844.83,63,,675.86,percent of total billed charges,63% of total billed charges,1035.52,77.22,,828.42,percent of total billed charges,77.22% of total billed charges,886.4,66.1,,709.12,percent of total billed charges,66.1% of total billed charges,1113.03,83,,890.42,percent of total billed charges,83% of total,1273.95,95,,1019.16,percent of total billed charges ,95% of total billed charges,1072.8,80,,858.24,percent of total billed charges,78% of total billed charges,1045.98,78,,836.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,844.83,63,,675.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1206.9,90,,965.52,percent of total billed charges,90% of total billed charges,1072.8,80,,858.24,percent of total billed charges,80% of total billed charges,844.83,63,,675.86,percent of total billed charges,63% of total billed charges,1139.85,85,,911.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1059.39,79,,847.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1273.95,
"TIBIAL INSERT SIZE 3, 9MM",278222368,CDM,278,RC,C1776,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
THREADED PEG LOCKING 2.3X18MM,278222688,CDM,278,RC,C1713,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,249.86,66.1,,199.89,percent of total billed charges,66.1% of total billed charges,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,238.14,450,
SCREW PEG 2.3 x 20MM,278222689,CDM,278,RC,C1713,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,249.86,66.1,,199.89,percent of total billed charges,66.1% of total billed charges,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,238.14,450,
HIGH COMP LOCKING PEG 2.7X18MM,278222690,CDM,278,RC,C1713,HCPCS,outpatient,,,380,266,,300.2,79,,240.16,percent of total billed charges,79% of total billed charges,342,90,,273.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.4,63,,191.52,percent of total billed charges,63% of total billed charges,293.44,77.22,,234.75,percent of total billed charges,77.22% of total billed charges,251.18,66.1,,200.94,percent of total billed charges,66.1% of total billed charges,315.4,83,,252.32,percent of total billed charges,83% of total,361,95,,288.8,percent of total billed charges ,95% of total billed charges,304,80,,243.2,percent of total billed charges,78% of total billed charges,296.4,78,,237.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,239.4,63,,191.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,239.4,63,,191.52,percent of total billed charges,63% of total billed charges,323,85,,258.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,300.2,79,,240.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,239.4,450,
SCREW POLYAXIAL 3.5 x 10MM,278222691,CDM,278,RC,C1713,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
ALMINING GUIDE 1.5MM,278222692,CDM,278,RC,,,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.49,450,
SCREW CORTICAL 3.5 x 10MM,278222698,CDM,278,RC,C1713,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
SCREW CORTICAL 3.5 x 12MM,278222699,CDM,278,RC,C1713,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
PIN TIGHTROPE,278222847,CDM,278,RC,C1713,HCPCS,outpatient,,,447,312.9,,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,345.17,77.22,,276.14,percent of total billed charges,77.22% of total billed charges,295.47,66.1,,236.38,percent of total billed charges,66.1% of total billed charges,371.01,83,,296.81,percent of total billed charges,83% of total,424.65,95,,339.72,percent of total billed charges ,95% of total billed charges,357.6,80,,286.08,percent of total billed charges,78% of total billed charges,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,281.61,450,
SCREW CORTICAL 3.5 x 18,278223076,CDM,278,RC,,,outpatient,,,161,112.7,,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,124.32,77.22,,99.46,percent of total billed charges,77.22% of total billed charges,106.42,66.1,,85.14,percent of total billed charges,66.1% of total billed charges,133.63,83,,106.9,percent of total billed charges,83% of total,152.95,95,,122.36,percent of total billed charges ,95% of total billed charges,128.8,80,,103.04,percent of total billed charges,78% of total billed charges,125.58,78,,100.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101.43,450,
2.3 X 16 M THREADED PEG,278223099,CDM,278,RC,C1713,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,249.86,66.1,,199.89,percent of total billed charges,66.1% of total billed charges,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,238.14,450,
SCREW CORT LOCKING 3.5X11MM,278223101,CDM,278,RC,C1713,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
SCREW POLYAXIAL 3.5 x 12MM,278223102,CDM,278,RC,C1713,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
SCREW CORTIAL 3.5MMX13MM,278223103,CDM,278,RC,C1713,HCPCS,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,198.45,450,
SCREW CORTICAL 3.5 x 11MM,278223280,CDM,278,RC,C1713,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
SCREW LOCKING 2.7 x 14,278223300,CDM,278,RC,C1713,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
FEMORAL COMPONENT SIZE 4,278223761,CDM,278,RC,C1776,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
LOW PROF CANN SCREW SHT 40MM,278223808,CDM,278,RC,C1713,HCPCS,outpatient,,,590,413,,466.1,79,,372.88,percent of total billed charges,79% of total billed charges,531,90,,424.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.7,63,,297.36,percent of total billed charges,63% of total billed charges,455.6,77.22,,364.48,percent of total billed charges,77.22% of total billed charges,389.99,66.1,,311.99,percent of total billed charges,66.1% of total billed charges,489.7,83,,391.76,percent of total billed charges,83% of total,560.5,95,,448.4,percent of total billed charges ,95% of total billed charges,472,80,,377.6,percent of total billed charges,78% of total billed charges,460.2,78,,368.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,371.7,63,,297.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,371.7,63,,297.36,percent of total billed charges,63% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,466.1,79,,372.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,371.7,560.5,
3.5 POLYAXIAL 14MM,278223818,CDM,278,RC,C1713,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
3.5 LOCKY 14MM,278223819,CDM,278,RC,C1713,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
26MM LOCKING SCREW,278224020,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
30MM LOCKING SCREW,278224022,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
3.5 LOCK SCREW 32MM,278224023,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
3.5 LOCK SCREW 42MM,278224026,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
48MM LOCKING SCREW,278224028,CDM,278,RC,C1713,HCPCS,outpatient,,,502,351.4,,396.58,79,,317.26,percent of total billed charges,79% of total billed charges,451.8,90,,361.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,387.64,77.22,,310.11,percent of total billed charges,77.22% of total billed charges,331.82,66.1,,265.46,percent of total billed charges,66.1% of total billed charges,416.66,83,,333.33,percent of total billed charges,83% of total,476.9,95,,381.52,percent of total billed charges ,95% of total billed charges,401.6,80,,321.28,percent of total billed charges,78% of total billed charges,391.56,78,,313.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,426.7,85,,341.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,396.58,79,,317.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,316.26,476.9,
SCREW 18MM CORTICAL,278224141,CDM,278,RC,C1713,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
SCREW 20MM CORTICAL,278224142,CDM,278,RC,C1713,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
SCREW CANCELLOUS 4.0X24MM,278224148,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
SCREW LOCKING 2.7 x 14,278224201,CDM,278,RC,C1713,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
SCREW 16MM LOCKING,278224288,CDM,278,RC,C1713,HCPCS,outpatient,,,600,420,,474,79,,379.2,percent of total billed charges,79% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,463.32,77.22,,370.66,percent of total billed charges,77.22% of total billed charges,396.6,66.1,,317.28,percent of total billed charges,66.1% of total billed charges,498,83,,398.4,percent of total billed charges,83% of total,570,95,,456,percent of total billed charges ,95% of total billed charges,480,80,,384,percent of total billed charges,78% of total billed charges,468,78,,374.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,378,63,,302.4,percent of total billed charges,63% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,474,79,,379.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,570,
TIBIAL BEARING 10MM x 79MM,278224315,CDM,278,RC,C1713,HCPCS,outpatient,,,6701,4690.7,,5293.79,79,,4235.03,percent of total billed charges,79% of total billed charges,6030.9,90,,4824.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4221.63,63,,3377.3,percent of total billed charges,63% of total billed charges,5174.51,77.22,,4139.61,percent of total billed charges,77.22% of total billed charges,4429.36,66.1,,3543.49,percent of total billed charges,66.1% of total billed charges,5561.83,83,,4449.46,percent of total billed charges,83% of total,6365.95,95,,5092.76,percent of total billed charges ,95% of total billed charges,5360.8,80,,4288.64,percent of total billed charges,78% of total billed charges,5226.78,78,,4181.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4221.63,63,,3377.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6030.9,90,,4824.72,percent of total billed charges,90% of total billed charges,5360.8,80,,4288.64,percent of total billed charges,80% of total billed charges,4221.63,63,,3377.3,percent of total billed charges,63% of total billed charges,5695.85,85,,4556.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5293.79,79,,4235.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,6365.95,
SUTURE ANCHOR 2.9 x 15.5MM,278224337,CDM,278,RC,C1713,HCPCS,outpatient,,,1159,811.3,,915.61,79,,732.49,percent of total billed charges,79% of total billed charges,1043.1,90,,834.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,894.98,77.22,,715.98,percent of total billed charges,77.22% of total billed charges,766.1,66.1,,612.88,percent of total billed charges,66.1% of total billed charges,961.97,83,,769.58,percent of total billed charges,83% of total,1101.05,95,,880.84,percent of total billed charges ,95% of total billed charges,927.2,80,,741.76,percent of total billed charges,78% of total billed charges,904.02,78,,723.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,985.15,85,,788.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,915.61,79,,732.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1101.05,
SCREW CORTICAL 16MM,278224634,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CANCELLOUS 18MM,278224636,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
4MM CANCELLOUS SCREW,278224659,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
BASEPLATE 25MM W TAPER ADAPTER,278224734,CDM,278,RC,C1713,HCPCS,outpatient,,,3566,2496.2,,2817.14,79,,2253.71,percent of total billed charges,79% of total billed charges,3209.4,90,,2567.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2246.58,63,,1797.26,percent of total billed charges,63% of total billed charges,2753.67,77.22,,2202.94,percent of total billed charges,77.22% of total billed charges,2357.13,66.1,,1885.7,percent of total billed charges,66.1% of total billed charges,2959.78,83,,2367.82,percent of total billed charges,83% of total,3387.7,95,,2710.16,percent of total billed charges ,95% of total billed charges,2852.8,80,,2282.24,percent of total billed charges,78% of total billed charges,2781.48,78,,2225.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2246.58,63,,1797.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3209.4,90,,2567.52,percent of total billed charges,90% of total billed charges,2852.8,80,,2282.24,percent of total billed charges,80% of total billed charges,2246.58,63,,1797.26,percent of total billed charges,63% of total billed charges,3031.1,85,,2424.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2817.14,79,,2253.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3387.7,
LOCKING SCREW 25MM,278224736,CDM,278,RC,C1713,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,199.71,450,
LOCKING SCREW 4.75MM x 15MM,278224737,CDM,278,RC,C1713,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,199.71,450,
LOCKING SCREW 2.75MM x 20MM,278224738,CDM,278,RC,C1713,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,199.71,450,
HUMERAL BEARING CURVE STD,278224739,CDM,278,RC,C1713,HCPCS,outpatient,,,3341,2338.7,,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2579.92,77.22,,2063.94,percent of total billed charges,77.22% of total billed charges,2208.4,66.1,,1766.72,percent of total billed charges,66.1% of total billed charges,2773.03,83,,2218.42,percent of total billed charges,83% of total,3173.95,95,,2539.16,percent of total billed charges ,95% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,78% of total billed charges,2605.98,78,,2084.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,80% of total billed charges,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2839.85,85,,2271.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3173.95,
TRAY HUMERAL 44MM STD LOC RING,278224740,CDM,278,RC,C1713,HCPCS,outpatient,,,3341,2338.7,,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2579.92,77.22,,2063.94,percent of total billed charges,77.22% of total billed charges,2208.4,66.1,,1766.72,percent of total billed charges,66.1% of total billed charges,2773.03,83,,2218.42,percent of total billed charges,83% of total,3173.95,95,,2539.16,percent of total billed charges ,95% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,78% of total billed charges,2605.98,78,,2084.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,80% of total billed charges,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2839.85,85,,2271.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3173.95,
HUMERAL BEARING 44MM DIA CURVE,278224741,CDM,278,RC,C1713,HCPCS,outpatient,,,2450,1715,,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,2205,90,,1764,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1543.5,63,,1234.8,percent of total billed charges,63% of total billed charges,1891.89,77.22,,1513.51,percent of total billed charges,77.22% of total billed charges,1619.45,66.1,,1295.56,percent of total billed charges,66.1% of total billed charges,2033.5,83,,1626.8,percent of total billed charges,83% of total,2327.5,95,,1862,percent of total billed charges ,95% of total billed charges,1960,80,,1568,percent of total billed charges,78% of total billed charges,1911,78,,1528.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1543.5,63,,1234.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2205,90,,1764,percent of total billed charges,90% of total billed charges,1960,80,,1568,percent of total billed charges,80% of total billed charges,1543.5,63,,1234.8,percent of total billed charges,63% of total billed charges,2082.5,85,,1666,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2327.5,
SUTURE ANCHOR 5.5 x 16.3MM,278224746,CDM,278,RC,C1713,HCPCS,outpatient,,,821,574.7,,648.59,79,,518.87,percent of total billed charges,79% of total billed charges,738.9,90,,591.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,633.98,77.22,,507.18,percent of total billed charges,77.22% of total billed charges,542.68,66.1,,434.14,percent of total billed charges,66.1% of total billed charges,681.43,83,,545.14,percent of total billed charges,83% of total,779.95,95,,623.96,percent of total billed charges ,95% of total billed charges,656.8,80,,525.44,percent of total billed charges,78% of total billed charges,640.38,78,,512.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,517.23,63,,413.78,percent of total billed charges,63% of total billed charges,697.85,85,,558.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,648.59,79,,518.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,779.95,
SCREW CANNULATED 4.0 x 40,278224770,CDM,278,RC,C1713,HCPCS,outpatient,,,590,413,,466.1,79,,372.88,percent of total billed charges,79% of total billed charges,531,90,,424.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371.7,63,,297.36,percent of total billed charges,63% of total billed charges,455.6,77.22,,364.48,percent of total billed charges,77.22% of total billed charges,389.99,66.1,,311.99,percent of total billed charges,66.1% of total billed charges,489.7,83,,391.76,percent of total billed charges,83% of total,560.5,95,,448.4,percent of total billed charges ,95% of total billed charges,472,80,,377.6,percent of total billed charges,78% of total billed charges,460.2,78,,368.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,371.7,63,,297.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,371.7,63,,297.36,percent of total billed charges,63% of total billed charges,501.5,85,,401.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,466.1,79,,372.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,371.7,560.5,
SCREW COMPRESSION 2.5 x 18MM,278224805,CDM,278,RC,C1713,HCPCS,outpatient,,,949,664.3,,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,732.82,77.22,,586.26,percent of total billed charges,77.22% of total billed charges,627.29,66.1,,501.83,percent of total billed charges,66.1% of total billed charges,787.67,83,,630.14,percent of total billed charges,83% of total,901.55,95,,721.24,percent of total billed charges ,95% of total billed charges,759.2,80,,607.36,percent of total billed charges,78% of total billed charges,740.22,78,,592.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,759.2,80,,607.36,percent of total billed charges,80% of total billed charges,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,806.65,85,,645.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,901.55,
SCREW LOCKING TITAN 3.5 x 14MM,278224964,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
CENTRAL SCREW 25 x 6.5,278224966,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
SCREW LOCKING 35MM,278224967,CDM,278,RC,C1713,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,199.71,450,
SCREW LOCKING 30MM,278224968,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
GLENOSPHERE 36MM,278224969,CDM,278,RC,C1713,HCPCS,outpatient,,,4016,2811.2,,3172.64,79,,2538.11,percent of total billed charges,79% of total billed charges,3614.4,90,,2891.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2530.08,63,,2024.06,percent of total billed charges,63% of total billed charges,3101.16,77.22,,2480.93,percent of total billed charges,77.22% of total billed charges,2654.58,66.1,,2123.66,percent of total billed charges,66.1% of total billed charges,3333.28,83,,2666.62,percent of total billed charges,83% of total,3815.2,95,,3052.16,percent of total billed charges ,95% of total billed charges,3212.8,80,,2570.24,percent of total billed charges,78% of total billed charges,3132.48,78,,2505.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2530.08,63,,2024.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3614.4,90,,2891.52,percent of total billed charges,90% of total billed charges,3212.8,80,,2570.24,percent of total billed charges,80% of total billed charges,2530.08,63,,2024.06,percent of total billed charges,63% of total billed charges,3413.6,85,,2730.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3172.64,79,,2538.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3815.2,
BEARING E POLY,278224970,CDM,278,RC,C1713,HCPCS,outpatient,,,2450,1715,,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,2205,90,,1764,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1543.5,63,,1234.8,percent of total billed charges,63% of total billed charges,1891.89,77.22,,1513.51,percent of total billed charges,77.22% of total billed charges,1619.45,66.1,,1295.56,percent of total billed charges,66.1% of total billed charges,2033.5,83,,1626.8,percent of total billed charges,83% of total,2327.5,95,,1862,percent of total billed charges ,95% of total billed charges,1960,80,,1568,percent of total billed charges,78% of total billed charges,1911,78,,1528.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1543.5,63,,1234.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2205,90,,1764,percent of total billed charges,90% of total billed charges,1960,80,,1568,percent of total billed charges,80% of total billed charges,1543.5,63,,1234.8,percent of total billed charges,63% of total billed charges,2082.5,85,,1666,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1935.5,79,,1548.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2327.5,
SUTURE ANCHOR 4.75 x 19.1MM,278224974,CDM,278,RC,C1713,HCPCS,outpatient,,,1368,957.6,,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1056.37,77.22,,845.1,percent of total billed charges,77.22% of total billed charges,904.25,66.1,,723.4,percent of total billed charges,66.1% of total billed charges,1135.44,83,,908.35,percent of total billed charges,83% of total,1299.6,95,,1039.68,percent of total billed charges ,95% of total billed charges,1094.4,80,,875.52,percent of total billed charges,78% of total billed charges,1067.04,78,,853.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,1094.4,80,,875.52,percent of total billed charges,80% of total billed charges,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1162.8,85,,930.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1299.6,
SUTURE ANCHOR 4.75 x 19MM,278224975,CDM,278,RC,C1713,HCPCS,outpatient,,,1368,957.6,,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1056.37,77.22,,845.1,percent of total billed charges,77.22% of total billed charges,904.25,66.1,,723.4,percent of total billed charges,66.1% of total billed charges,1135.44,83,,908.35,percent of total billed charges,83% of total,1299.6,95,,1039.68,percent of total billed charges ,95% of total billed charges,1094.4,80,,875.52,percent of total billed charges,78% of total billed charges,1067.04,78,,853.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,1094.4,80,,875.52,percent of total billed charges,80% of total billed charges,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1162.8,85,,930.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1299.6,
SCREW COMPRESSION 2.5 x 16MM,278225010,CDM,278,RC,C1713,HCPCS,outpatient,,,949,664.3,,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,732.82,77.22,,586.26,percent of total billed charges,77.22% of total billed charges,627.29,66.1,,501.83,percent of total billed charges,66.1% of total billed charges,787.67,83,,630.14,percent of total billed charges,83% of total,901.55,95,,721.24,percent of total billed charges ,95% of total billed charges,759.2,80,,607.36,percent of total billed charges,78% of total billed charges,740.22,78,,592.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,759.2,80,,607.36,percent of total billed charges,80% of total billed charges,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,806.65,85,,645.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,901.55,
ISTENT GTS100L,278225049,CDM,278,RC,C1783,HCPCS,outpatient,,,3663,2564.1,,2893.77,79,,2315.02,percent of total billed charges,79% of total billed charges,3296.7,90,,2637.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2307.69,63,,1846.15,percent of total billed charges,63% of total billed charges,2828.57,77.22,,2262.86,percent of total billed charges,77.22% of total billed charges,2421.24,66.1,,1936.99,percent of total billed charges,66.1% of total billed charges,3040.29,83,,2432.23,percent of total billed charges,83% of total,3479.85,95,,2783.88,percent of total billed charges ,95% of total billed charges,2930.4,80,,2344.32,percent of total billed charges,78% of total billed charges,2857.14,78,,2285.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2307.69,63,,1846.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3296.7,90,,2637.36,percent of total billed charges,90% of total billed charges,2930.4,80,,2344.32,percent of total billed charges,80% of total billed charges,2307.69,63,,1846.15,percent of total billed charges,63% of total billed charges,3113.55,85,,2490.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2893.77,79,,2315.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3479.85,
HUMERAL TRAY W LOCK RING 44MM,278225076,CDM,278,RC,C1713,HCPCS,outpatient,,,3341,2338.7,,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2579.92,77.22,,2063.94,percent of total billed charges,77.22% of total billed charges,2208.4,66.1,,1766.72,percent of total billed charges,66.1% of total billed charges,2773.03,83,,2218.42,percent of total billed charges,83% of total,3173.95,95,,2539.16,percent of total billed charges ,95% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,78% of total billed charges,2605.98,78,,2084.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,80% of total billed charges,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2839.85,85,,2271.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3173.95,
CORTICAL SCREW 3.5 X 42MM,278225121,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
SHOULDER SYS STD LENGTH STEM,278225144,CDM,278,RC,C1776,HCPCS,outpatient,,,7875,5512.5,,6221.25,79,,4977,percent of total billed charges,79% of total billed charges,7087.5,90,,5670,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4961.25,63,,3969,percent of total billed charges,63% of total billed charges,6081.08,77.22,,4864.86,percent of total billed charges,77.22% of total billed charges,5205.38,66.1,,4164.3,percent of total billed charges,66.1% of total billed charges,6536.25,83,,5229,percent of total billed charges,83% of total,7481.25,95,,5985,percent of total billed charges ,95% of total billed charges,6300,80,,5040,percent of total billed charges,78% of total billed charges,6142.5,78,,4914,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4961.25,63,,3969,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7087.5,90,,5670,percent of total billed charges,90% of total billed charges,6300,80,,5040,percent of total billed charges,80% of total billed charges,4961.25,63,,3969,percent of total billed charges,63% of total billed charges,6693.75,85,,5355,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6221.25,79,,4977,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7481.25,
"TIGHTROPE ABS, BUTTON 14 MM",278225146,CDM,278,RC,C1713,HCPCS,outpatient,,,688,481.6,,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,531.27,77.22,,425.02,percent of total billed charges,77.22% of total billed charges,454.77,66.1,,363.82,percent of total billed charges,66.1% of total billed charges,571.04,83,,456.83,percent of total billed charges,83% of total,653.6,95,,522.88,percent of total billed charges ,95% of total billed charges,550.4,80,,440.32,percent of total billed charges,78% of total billed charges,536.64,78,,429.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,433.44,653.6,
SCREW,278225148,CDM,278,RC,C1713,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
IMPLANT SYSTEM MPFL BIOCOMP,278225165,CDM,278,RC,C1713,HCPCS,outpatient,,,4781,3346.7,,3776.99,79,,3021.59,percent of total billed charges,79% of total billed charges,4302.9,90,,3442.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3012.03,63,,2409.62,percent of total billed charges,63% of total billed charges,3691.89,77.22,,2953.51,percent of total billed charges,77.22% of total billed charges,3160.24,66.1,,2528.19,percent of total billed charges,66.1% of total billed charges,3968.23,83,,3174.58,percent of total billed charges,83% of total,4541.95,95,,3633.56,percent of total billed charges ,95% of total billed charges,3824.8,80,,3059.84,percent of total billed charges,78% of total billed charges,3729.18,78,,2983.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3012.03,63,,2409.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4302.9,90,,3442.32,percent of total billed charges,90% of total billed charges,3824.8,80,,3059.84,percent of total billed charges,80% of total billed charges,3012.03,63,,2409.62,percent of total billed charges,63% of total billed charges,4063.85,85,,3251.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3776.99,79,,3021.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4541.95,
DISTAL BICEP IMPLANT SYSTEM,278225206,CDM,278,RC,C1713,HCPCS,outpatient,,,2734,1913.8,,2159.86,79,,1727.89,percent of total billed charges,79% of total billed charges,2460.6,90,,1968.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1722.42,63,,1377.94,percent of total billed charges,63% of total billed charges,2111.19,77.22,,1688.95,percent of total billed charges,77.22% of total billed charges,1807.17,66.1,,1445.74,percent of total billed charges,66.1% of total billed charges,2269.22,83,,1815.38,percent of total billed charges,83% of total,2597.3,95,,2077.84,percent of total billed charges ,95% of total billed charges,2187.2,80,,1749.76,percent of total billed charges,78% of total billed charges,2132.52,78,,1706.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1722.42,63,,1377.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2460.6,90,,1968.48,percent of total billed charges,90% of total billed charges,2187.2,80,,1749.76,percent of total billed charges,80% of total billed charges,1722.42,63,,1377.94,percent of total billed charges,63% of total billed charges,2323.9,85,,1859.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2159.86,79,,1727.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2597.3,
SCREW COMPRESSION 4.0 x 44MM,278225222,CDM,278,RC,C1713,HCPCS,outpatient,,,949,664.3,,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,732.82,77.22,,586.26,percent of total billed charges,77.22% of total billed charges,627.29,66.1,,501.83,percent of total billed charges,66.1% of total billed charges,787.67,83,,630.14,percent of total billed charges,83% of total,901.55,95,,721.24,percent of total billed charges ,95% of total billed charges,759.2,80,,607.36,percent of total billed charges,78% of total billed charges,740.22,78,,592.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,759.2,80,,607.36,percent of total billed charges,80% of total billed charges,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,806.65,85,,645.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,901.55,
DISTAL RADIUS PLATE 3 HOLE R,278225285,CDM,278,RC,C1713,HCPCS,outpatient,,,2876,2013.2,,2272.04,79,,1817.63,percent of total billed charges,79% of total billed charges,2588.4,90,,2070.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1811.88,63,,1449.5,percent of total billed charges,63% of total billed charges,2220.85,77.22,,1776.68,percent of total billed charges,77.22% of total billed charges,1901.04,66.1,,1520.83,percent of total billed charges,66.1% of total billed charges,2387.08,83,,1909.66,percent of total billed charges,83% of total,2732.2,95,,2185.76,percent of total billed charges ,95% of total billed charges,2300.8,80,,1840.64,percent of total billed charges,78% of total billed charges,2243.28,78,,1794.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1811.88,63,,1449.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2588.4,90,,2070.72,percent of total billed charges,90% of total billed charges,2300.8,80,,1840.64,percent of total billed charges,80% of total billed charges,1811.88,63,,1449.5,percent of total billed charges,63% of total billed charges,2444.6,85,,1955.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2272.04,79,,1817.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2732.2,
CORTICAL SCREW 3.5 X 14 MM,278225291,CDM,278,RC,C1713,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,220.5,450,
SCREW CORTICAL 3.5 X 22 MM,278225292,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
TUBULAR PLATE 7 HOLE,278225299,CDM,278,RC,C1713,HCPCS,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,328.19,77.22,,262.55,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.75,450,
DVR NARROW RIGHT,278225301,CDM,278,RC,C1713,HCPCS,outpatient,,,3082,2157.4,,2434.78,79,,1947.82,percent of total billed charges,79% of total billed charges,2773.8,90,,2219.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1941.66,63,,1553.33,percent of total billed charges,63% of total billed charges,2379.92,77.22,,1903.94,percent of total billed charges,77.22% of total billed charges,2037.2,66.1,,1629.76,percent of total billed charges,66.1% of total billed charges,2558.06,83,,2046.45,percent of total billed charges,83% of total,2927.9,95,,2342.32,percent of total billed charges ,95% of total billed charges,2465.6,80,,1972.48,percent of total billed charges,78% of total billed charges,2403.96,78,,1923.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1941.66,63,,1553.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2773.8,90,,2219.04,percent of total billed charges,90% of total billed charges,2465.6,80,,1972.48,percent of total billed charges,80% of total billed charges,1941.66,63,,1553.33,percent of total billed charges,63% of total billed charges,2619.7,85,,2095.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2434.78,79,,1947.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2927.9,
DVR NARROW LEFT,278225302,CDM,278,RC,C1713,HCPCS,outpatient,,,3082,2157.4,,2434.78,79,,1947.82,percent of total billed charges,79% of total billed charges,2773.8,90,,2219.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1941.66,63,,1553.33,percent of total billed charges,63% of total billed charges,2379.92,77.22,,1903.94,percent of total billed charges,77.22% of total billed charges,2037.2,66.1,,1629.76,percent of total billed charges,66.1% of total billed charges,2558.06,83,,2046.45,percent of total billed charges,83% of total,2927.9,95,,2342.32,percent of total billed charges ,95% of total billed charges,2465.6,80,,1972.48,percent of total billed charges,78% of total billed charges,2403.96,78,,1923.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1941.66,63,,1553.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2773.8,90,,2219.04,percent of total billed charges,90% of total billed charges,2465.6,80,,1972.48,percent of total billed charges,80% of total billed charges,1941.66,63,,1553.33,percent of total billed charges,63% of total billed charges,2619.7,85,,2095.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2434.78,79,,1947.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2927.9,
CORTICAL SCREW 2.7 X 13 MM,278225303,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
CORTICAL SCREW 2.7 X 14 MM,278225304,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
CORTICAL SCREW 2.7 X 15 MM,278225305,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
CORTICAL SCREW 2.7 X 22 MM,278225307,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
CORTICAL SCREW 2.7 X 12 MM,278225308,CDM,278,RC,C1713,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
CORTICAL SCREW 2.7 X 14 MM,278225310,CDM,278,RC,C1713,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
CORTICAL SCREW 2.7 X 16 MM,278225311,CDM,278,RC,C1713,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
LOCK SCREW 2.7 X 18 MM,278225312,CDM,278,RC,C1713,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
LOCK SCREW 2.7 X 20 MM,278225313,CDM,278,RC,C1713,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
LOCK SCREW 2.7 X 24 MM,278225314,CDM,278,RC,C1713,HCPCS,outpatient,,,372,260.4,,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,287.26,77.22,,229.81,percent of total billed charges,77.22% of total billed charges,245.89,66.1,,196.71,percent of total billed charges,66.1% of total billed charges,308.76,83,,247.01,percent of total billed charges,83% of total,353.4,95,,282.72,percent of total billed charges ,95% of total billed charges,297.6,80,,238.08,percent of total billed charges,78% of total billed charges,290.16,78,,232.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,234.36,450,
LOCK SCREW 2.7 X 18 MM MD,278225315,CDM,278,RC,C1713,HCPCS,outpatient,,,650,455,,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,501.93,77.22,,401.54,percent of total billed charges,77.22% of total billed charges,429.65,66.1,,343.72,percent of total billed charges,66.1% of total billed charges,539.5,83,,431.6,percent of total billed charges,83% of total,617.5,95,,494,percent of total billed charges ,95% of total billed charges,520,80,,416,percent of total billed charges,78% of total billed charges,507,78,,405.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,409.5,617.5,
LOCK SCREW 2.7 X 27 MM MD,278225316,CDM,278,RC,C1713,HCPCS,outpatient,,,650,455,,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,501.93,77.22,,401.54,percent of total billed charges,77.22% of total billed charges,429.65,66.1,,343.72,percent of total billed charges,66.1% of total billed charges,539.5,83,,431.6,percent of total billed charges,83% of total,617.5,95,,494,percent of total billed charges ,95% of total billed charges,520,80,,416,percent of total billed charges,78% of total billed charges,507,78,,405.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,409.5,617.5,
SCREW QF 2.0 X 13 MM,278225322,CDM,278,RC,C1713,HCPCS,outpatient,,,772,540.4,,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,596.14,77.22,,476.91,percent of total billed charges,77.22% of total billed charges,510.29,66.1,,408.23,percent of total billed charges,66.1% of total billed charges,640.76,83,,512.61,percent of total billed charges,83% of total,733.4,95,,586.72,percent of total billed charges ,95% of total billed charges,617.6,80,,494.08,percent of total billed charges,78% of total billed charges,602.16,78,,481.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,733.4,
GRACILIS TENDON,278225332,CDM,278,RC,C1762,HCPCS,outpatient,,,3110,2177,,2456.9,79,,1965.52,percent of total billed charges,79% of total billed charges,2799,90,,2239.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1959.3,63,,1567.44,percent of total billed charges,63% of total billed charges,2401.54,77.22,,1921.23,percent of total billed charges,77.22% of total billed charges,2055.71,66.1,,1644.57,percent of total billed charges,66.1% of total billed charges,2581.3,83,,2065.04,percent of total billed charges,83% of total,2954.5,95,,2363.6,percent of total billed charges ,95% of total billed charges,2488,80,,1990.4,percent of total billed charges,78% of total billed charges,2425.8,78,,1940.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1959.3,63,,1567.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2799,90,,2239.2,percent of total billed charges,90% of total billed charges,2488,80,,1990.4,percent of total billed charges,80% of total billed charges,1959.3,63,,1567.44,percent of total billed charges,63% of total billed charges,2643.5,85,,2114.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2456.9,79,,1965.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2954.5,
LOCK SCREW 22 X 2.7MM,278225428,CDM,278,RC,C1713,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
CORTICAL SCREW 16 X 2.7 MM,278225429,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
FEMORAL HEAD 36MM OD -3.5MM,278225433,CDM,278,RC,,,outpatient,,,1890,1323,,1493.1,79,,1194.48,percent of total billed charges,79% of total billed charges,1701,90,,1360.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1190.7,63,,952.56,percent of total billed charges,63% of total billed charges,1459.46,77.22,,1167.57,percent of total billed charges,77.22% of total billed charges,1249.29,66.1,,999.43,percent of total billed charges,66.1% of total billed charges,1568.7,83,,1254.96,percent of total billed charges,83% of total,1795.5,95,,1436.4,percent of total billed charges ,95% of total billed charges,1512,80,,1209.6,percent of total billed charges,78% of total billed charges,1474.2,78,,1179.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1190.7,63,,952.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1190.7,63,,952.56,percent of total billed charges,63% of total billed charges,1606.5,85,,1285.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1493.1,79,,1194.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1795.5,
DISTAL CLAVICLE BUTTON,278225437,CDM,278,RC,C1713,HCPCS,outpatient,,,1125,787.5,,888.75,79,,711,percent of total billed charges,79% of total billed charges,1012.5,90,,810,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,868.73,77.22,,694.98,percent of total billed charges,77.22% of total billed charges,743.63,66.1,,594.9,percent of total billed charges,66.1% of total billed charges,933.75,83,,747,percent of total billed charges,83% of total,1068.75,95,,855,percent of total billed charges ,95% of total billed charges,900,80,,720,percent of total billed charges,78% of total billed charges,877.5,78,,702,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1012.5,90,,810,percent of total billed charges,90% of total billed charges,900,80,,720,percent of total billed charges,80% of total billed charges,708.75,63,,567,percent of total billed charges,63% of total billed charges,956.25,85,,765,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,888.75,79,,711,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1068.75,
"TIBIAL INSERT SIZE 3, 9MM",278225586,CDM,278,RC,C1713,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
4.0 CANNULATEK SCREW 42 MM,278225623,CDM,278,RC,C1713,HCPCS,outpatient,,,652,456.4,,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,503.47,77.22,,402.78,percent of total billed charges,77.22% of total billed charges,430.97,66.1,,344.78,percent of total billed charges,66.1% of total billed charges,541.16,83,,432.93,percent of total billed charges,83% of total,619.4,95,,495.52,percent of total billed charges ,95% of total billed charges,521.6,80,,417.28,percent of total billed charges,78% of total billed charges,508.56,78,,406.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,521.6,80,,417.28,percent of total billed charges,80% of total billed charges,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,554.2,85,,443.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,410.76,619.4,
CLUSTERHOLE SHELL GROUP 4 62MM,278225680,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
CROWN CUP CONNEXION 40 MM,278225681,CDM,278,RC,C1776,HCPCS,outpatient,,,1181,826.7,,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,911.97,77.22,,729.58,percent of total billed charges,77.22% of total billed charges,780.64,66.1,,624.51,percent of total billed charges,66.1% of total billed charges,980.23,83,,784.18,percent of total billed charges,83% of total,1121.95,95,,897.56,percent of total billed charges ,95% of total billed charges,944.8,80,,755.84,percent of total billed charges,78% of total billed charges,921.18,78,,736.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,944.8,80,,755.84,percent of total billed charges,80% of total billed charges,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,1003.85,85,,803.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1121.95,
FEMORAL HEAD 40MM,278225682,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
DUR STD PLATE RIGHT,278225715,CDM,278,RC,C1713,HCPCS,outpatient,,,2842,1989.4,,2245.18,79,,1796.14,percent of total billed charges,79% of total billed charges,2557.8,90,,2046.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1790.46,63,,1432.37,percent of total billed charges,63% of total billed charges,2194.59,77.22,,1755.67,percent of total billed charges,77.22% of total billed charges,1878.56,66.1,,1502.85,percent of total billed charges,66.1% of total billed charges,2358.86,83,,1887.09,percent of total billed charges,83% of total,2699.9,95,,2159.92,percent of total billed charges ,95% of total billed charges,2273.6,80,,1818.88,percent of total billed charges,78% of total billed charges,2216.76,78,,1773.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1790.46,63,,1432.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2557.8,90,,2046.24,percent of total billed charges,90% of total billed charges,2273.6,80,,1818.88,percent of total billed charges,80% of total billed charges,1790.46,63,,1432.37,percent of total billed charges,63% of total billed charges,2415.7,85,,1932.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2245.18,79,,1796.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2699.9,
2.7 CORTICAL SCREW 18 MM,278225717,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
2.7 CORTICAL SCREW 20 MM,278225718,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
2.7 CORTICAL SCREW 24 MM,278225719,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
2.7 CORTICAL SCREW 26 MM,278225720,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
2.7 LOCKING SCREW 18 MM,278225721,CDM,278,RC,C1713,HCPCS,outpatient,,,372,260.4,,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,287.26,77.22,,229.81,percent of total billed charges,77.22% of total billed charges,245.89,66.1,,196.71,percent of total billed charges,66.1% of total billed charges,308.76,83,,247.01,percent of total billed charges,83% of total,353.4,95,,282.72,percent of total billed charges ,95% of total billed charges,297.6,80,,238.08,percent of total billed charges,78% of total billed charges,290.16,78,,232.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,234.36,450,
2.7 LOCKING SCREW 26 MM,278225722,CDM,278,RC,C1713,HCPCS,outpatient,,,372,260.4,,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,334.8,90,,267.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,287.26,77.22,,229.81,percent of total billed charges,77.22% of total billed charges,245.89,66.1,,196.71,percent of total billed charges,66.1% of total billed charges,308.76,83,,247.01,percent of total billed charges,83% of total,353.4,95,,282.72,percent of total billed charges ,95% of total billed charges,297.6,80,,238.08,percent of total billed charges,78% of total billed charges,290.16,78,,232.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,234.36,63,,187.49,percent of total billed charges,63% of total billed charges,316.2,85,,252.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,293.88,79,,235.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,234.36,450,
2.7 MULTIDIRECTION SCREW 20MM,278225723,CDM,278,RC,C1713,HCPCS,outpatient,,,622,435.4,,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,480.31,77.22,,384.25,percent of total billed charges,77.22% of total billed charges,411.14,66.1,,328.91,percent of total billed charges,66.1% of total billed charges,516.26,83,,413.01,percent of total billed charges,83% of total,590.9,95,,472.72,percent of total billed charges ,95% of total billed charges,497.6,80,,398.08,percent of total billed charges,78% of total billed charges,485.16,78,,388.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,528.7,85,,422.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,391.86,590.9,
TIGHTROPE ABS IMPLANT,278225725,CDM,278,RC,C1713,HCPCS,outpatient,,,658,460.6,,519.82,79,,415.86,percent of total billed charges,79% of total billed charges,592.2,90,,473.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,508.11,77.22,,406.49,percent of total billed charges,77.22% of total billed charges,434.94,66.1,,347.95,percent of total billed charges,66.1% of total billed charges,546.14,83,,436.91,percent of total billed charges,83% of total,625.1,95,,500.08,percent of total billed charges ,95% of total billed charges,526.4,80,,421.12,percent of total billed charges,78% of total billed charges,513.24,78,,410.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,592.2,90,,473.76,percent of total billed charges,90% of total billed charges,526.4,80,,421.12,percent of total billed charges,80% of total billed charges,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,559.3,85,,447.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,519.82,79,,415.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,414.54,625.1,
SCREW QUICKFIX 2.0,278225739,CDM,278,RC,C1713,HCPCS,outpatient,,,1543,1080.1,,1218.97,79,,975.18,percent of total billed charges,79% of total billed charges,1388.7,90,,1110.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,972.09,63,,777.67,percent of total billed charges,63% of total billed charges,1191.5,77.22,,953.2,percent of total billed charges,77.22% of total billed charges,1019.92,66.1,,815.94,percent of total billed charges,66.1% of total billed charges,1280.69,83,,1024.55,percent of total billed charges,83% of total,1465.85,95,,1172.68,percent of total billed charges ,95% of total billed charges,1234.4,80,,987.52,percent of total billed charges,78% of total billed charges,1203.54,78,,962.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,972.09,63,,777.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1388.7,90,,1110.96,percent of total billed charges,90% of total billed charges,1234.4,80,,987.52,percent of total billed charges,80% of total billed charges,972.09,63,,777.67,percent of total billed charges,63% of total billed charges,1311.55,85,,1049.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1218.97,79,,975.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1465.85,
SUTURE ANCHOR 3 X 12.7 MM,278225765,CDM,278,RC,C1713,HCPCS,outpatient,,,1237,865.9,,977.23,79,,781.78,percent of total billed charges,79% of total billed charges,1113.3,90,,890.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,779.31,63,,623.45,percent of total billed charges,63% of total billed charges,955.21,77.22,,764.17,percent of total billed charges,77.22% of total billed charges,817.66,66.1,,654.13,percent of total billed charges,66.1% of total billed charges,1026.71,83,,821.37,percent of total billed charges,83% of total,1175.15,95,,940.12,percent of total billed charges ,95% of total billed charges,989.6,80,,791.68,percent of total billed charges,78% of total billed charges,964.86,78,,771.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,779.31,63,,623.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1113.3,90,,890.64,percent of total billed charges,90% of total billed charges,989.6,80,,791.68,percent of total billed charges,80% of total billed charges,779.31,63,,623.45,percent of total billed charges,63% of total billed charges,1051.45,85,,841.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,977.23,79,,781.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1175.15,
"TIBIAL INSERT SIZE 2, 9MM",278225778,CDM,278,RC,C1713,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
TIBIAL INSERT 3.5 11MM,278225779,CDM,278,RC,C1713,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
4 HOLE LEFT PLATE,278225783,CDM,278,RC,C1713,HCPCS,outpatient,,,5018,3512.6,,3964.22,79,,3171.38,percent of total billed charges,79% of total billed charges,4516.2,90,,3612.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3161.34,63,,2529.07,percent of total billed charges,63% of total billed charges,3874.9,77.22,,3099.92,percent of total billed charges,77.22% of total billed charges,3316.9,66.1,,2653.52,percent of total billed charges,66.1% of total billed charges,4164.94,83,,3331.95,percent of total billed charges,83% of total,4767.1,95,,3813.68,percent of total billed charges ,95% of total billed charges,4014.4,80,,3211.52,percent of total billed charges,78% of total billed charges,3914.04,78,,3131.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3161.34,63,,2529.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4516.2,90,,3612.96,percent of total billed charges,90% of total billed charges,4014.4,80,,3211.52,percent of total billed charges,80% of total billed charges,3161.34,63,,2529.07,percent of total billed charges,63% of total billed charges,4265.3,85,,3412.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3964.22,79,,3171.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4767.1,
24MM SCREW,278225784,CDM,278,RC,C1713,HCPCS,outpatient,,,402,281.4,,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,310.42,77.22,,248.34,percent of total billed charges,77.22% of total billed charges,265.72,66.1,,212.58,percent of total billed charges,66.1% of total billed charges,333.66,83,,266.93,percent of total billed charges,83% of total,381.9,95,,305.52,percent of total billed charges ,95% of total billed charges,321.6,80,,257.28,percent of total billed charges,78% of total billed charges,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,253.26,450,
26MM SCREW,278225785,CDM,278,RC,C1713,HCPCS,outpatient,,,402,281.4,,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,310.42,77.22,,248.34,percent of total billed charges,77.22% of total billed charges,265.72,66.1,,212.58,percent of total billed charges,66.1% of total billed charges,333.66,83,,266.93,percent of total billed charges,83% of total,381.9,95,,305.52,percent of total billed charges ,95% of total billed charges,321.6,80,,257.28,percent of total billed charges,78% of total billed charges,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,253.26,450,
22MM LOCKING SCREW,278225786,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
34MM LOCKING SCREW,278225787,CDM,278,RC,C1713,HCPCS,outpatient,,,502,351.4,,396.58,79,,317.26,percent of total billed charges,79% of total billed charges,451.8,90,,361.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,387.64,77.22,,310.11,percent of total billed charges,77.22% of total billed charges,331.82,66.1,,265.46,percent of total billed charges,66.1% of total billed charges,416.66,83,,333.33,percent of total billed charges,83% of total,476.9,95,,381.52,percent of total billed charges ,95% of total billed charges,401.6,80,,321.28,percent of total billed charges,78% of total billed charges,391.56,78,,313.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,426.7,85,,341.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,396.58,79,,317.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,316.26,476.9,
36MM LOCKING SCREW,278225788,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
COMPREHENSIVE SHOULDER SYSTEM,278225810,CDM,278,RC,C1776,HCPCS,outpatient,,,7875,5512.5,,6221.25,79,,4977,percent of total billed charges,79% of total billed charges,7087.5,90,,5670,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4961.25,63,,3969,percent of total billed charges,63% of total billed charges,6081.08,77.22,,4864.86,percent of total billed charges,77.22% of total billed charges,5205.38,66.1,,4164.3,percent of total billed charges,66.1% of total billed charges,6536.25,83,,5229,percent of total billed charges,83% of total,7481.25,95,,5985,percent of total billed charges ,95% of total billed charges,6300,80,,5040,percent of total billed charges,78% of total billed charges,6142.5,78,,4914,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4961.25,63,,3969,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7087.5,90,,5670,percent of total billed charges,90% of total billed charges,6300,80,,5040,percent of total billed charges,80% of total billed charges,4961.25,63,,3969,percent of total billed charges,63% of total billed charges,6693.75,85,,5355,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6221.25,79,,4977,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7481.25,
CENTRAL SCREW 6.5 MM,278225811,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
FLEXIGRAFT DBM FIBERS - 10 CC,278225825,CDM,278,RC,C1734,HCPCS,outpatient,,,2677,1873.9,,2114.83,79,,1691.86,percent of total billed charges,79% of total billed charges,2409.3,90,,1927.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,2067.18,77.22,,1653.74,percent of total billed charges,77.22% of total billed charges,1769.5,66.1,,1415.6,percent of total billed charges,66.1% of total billed charges,2221.91,83,,1777.53,percent of total billed charges,83% of total,2543.15,95,,2034.52,percent of total billed charges ,95% of total billed charges,2141.6,80,,1713.28,percent of total billed charges,78% of total billed charges,2088.06,78,,1670.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2409.3,90,,1927.44,percent of total billed charges,90% of total billed charges,2141.6,80,,1713.28,percent of total billed charges,80% of total billed charges,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,2275.45,85,,1820.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2114.83,79,,1691.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2543.15,
13X31 MM REVISION DOWELL,278225826,CDM,278,RC,C1734,HCPCS,outpatient,,,2677,1873.9,,2114.83,79,,1691.86,percent of total billed charges,79% of total billed charges,2409.3,90,,1927.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,2067.18,77.22,,1653.74,percent of total billed charges,77.22% of total billed charges,1769.5,66.1,,1415.6,percent of total billed charges,66.1% of total billed charges,2221.91,83,,1777.53,percent of total billed charges,83% of total,2543.15,95,,2034.52,percent of total billed charges ,95% of total billed charges,2141.6,80,,1713.28,percent of total billed charges,78% of total billed charges,2088.06,78,,1670.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2409.3,90,,1927.44,percent of total billed charges,90% of total billed charges,2141.6,80,,1713.28,percent of total billed charges,80% of total billed charges,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,2275.45,85,,1820.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2114.83,79,,1691.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2543.15,
11X32 MM REVISION DOWELL,278225827,CDM,278,RC,C1734,HCPCS,outpatient,,,2677,1873.9,,2114.83,79,,1691.86,percent of total billed charges,79% of total billed charges,2409.3,90,,1927.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,2067.18,77.22,,1653.74,percent of total billed charges,77.22% of total billed charges,1769.5,66.1,,1415.6,percent of total billed charges,66.1% of total billed charges,2221.91,83,,1777.53,percent of total billed charges,83% of total,2543.15,95,,2034.52,percent of total billed charges ,95% of total billed charges,2141.6,80,,1713.28,percent of total billed charges,78% of total billed charges,2088.06,78,,1670.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2409.3,90,,1927.44,percent of total billed charges,90% of total billed charges,2141.6,80,,1713.28,percent of total billed charges,80% of total billed charges,1686.51,63,,1349.21,percent of total billed charges,63% of total billed charges,2275.45,85,,1820.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2114.83,79,,1691.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2543.15,
6.5MM CENTRAL SCREW,278225829,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
2.7 MM LOCKING SCREW 15MM,278225866,CDM,278,RC,C1713,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
2.7MM MD LOCKING SCREW 20MM,278225867,CDM,278,RC,C1713,HCPCS,outpatient,,,650,455,,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,501.93,77.22,,401.54,percent of total billed charges,77.22% of total billed charges,429.65,66.1,,343.72,percent of total billed charges,66.1% of total billed charges,539.5,83,,431.6,percent of total billed charges,83% of total,617.5,95,,494,percent of total billed charges ,95% of total billed charges,520,80,,416,percent of total billed charges,78% of total billed charges,507,78,,405.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,409.5,617.5,
"SCREW,CANNULATED INT",278225873,CDM,278,RC,C1713,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
3.5 CIRTIAL SCREW 44MM,278225875,CDM,278,RC,C1713,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,129.78,450,
4.0 CANNULATED SCREW 46MM,278225876,CDM,278,RC,C1713,HCPCS,outpatient,,,650,455,,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,501.93,77.22,,401.54,percent of total billed charges,77.22% of total billed charges,429.65,66.1,,343.72,percent of total billed charges,66.1% of total billed charges,539.5,83,,431.6,percent of total billed charges,83% of total,617.5,95,,494,percent of total billed charges ,95% of total billed charges,520,80,,416,percent of total billed charges,78% of total billed charges,507,78,,405.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,409.5,617.5,
4.0 COMPRESSION SCREW 48MM,278225881,CDM,278,RC,C1713,HCPCS,outpatient,,,949,664.3,,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,732.82,77.22,,586.26,percent of total billed charges,77.22% of total billed charges,627.29,66.1,,501.83,percent of total billed charges,66.1% of total billed charges,787.67,83,,630.14,percent of total billed charges,83% of total,901.55,95,,721.24,percent of total billed charges ,95% of total billed charges,759.2,80,,607.36,percent of total billed charges,78% of total billed charges,740.22,78,,592.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,759.2,80,,607.36,percent of total billed charges,80% of total billed charges,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,806.65,85,,645.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,901.55,
4.0 COMPRESSIONS SCREW 46MM,278225882,CDM,278,RC,C1713,HCPCS,outpatient,,,949,664.3,,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,732.82,77.22,,586.26,percent of total billed charges,77.22% of total billed charges,627.29,66.1,,501.83,percent of total billed charges,66.1% of total billed charges,787.67,83,,630.14,percent of total billed charges,83% of total,901.55,95,,721.24,percent of total billed charges ,95% of total billed charges,759.2,80,,607.36,percent of total billed charges,78% of total billed charges,740.22,78,,592.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,759.2,80,,607.36,percent of total billed charges,80% of total billed charges,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,806.65,85,,645.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,901.55,
RETRO FUSION SCREW 20MM,278225883,CDM,278,RC,C1713,HCPCS,outpatient,,,2878,2014.6,,2273.62,79,,1818.9,percent of total billed charges,79% of total billed charges,2590.2,90,,2072.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1813.14,63,,1450.51,percent of total billed charges,63% of total billed charges,2222.39,77.22,,1777.91,percent of total billed charges,77.22% of total billed charges,1902.36,66.1,,1521.89,percent of total billed charges,66.1% of total billed charges,2388.74,83,,1910.99,percent of total billed charges,83% of total,2734.1,95,,2187.28,percent of total billed charges ,95% of total billed charges,2302.4,80,,1841.92,percent of total billed charges,78% of total billed charges,2244.84,78,,1795.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1813.14,63,,1450.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2590.2,90,,2072.16,percent of total billed charges,90% of total billed charges,2302.4,80,,1841.92,percent of total billed charges,80% of total billed charges,1813.14,63,,1450.51,percent of total billed charges,63% of total billed charges,2446.3,85,,1957.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2273.62,79,,1818.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2734.1,
SUTURE ANCHOR 4.75 X 24.5,278225944,CDM,278,RC,C1713,HCPCS,outpatient,,,1287,900.9,,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,1158.3,90,,926.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,993.82,77.22,,795.06,percent of total billed charges,77.22% of total billed charges,850.71,66.1,,680.57,percent of total billed charges,66.1% of total billed charges,1068.21,83,,854.57,percent of total billed charges,83% of total,1222.65,95,,978.12,percent of total billed charges ,95% of total billed charges,1029.6,80,,823.68,percent of total billed charges,78% of total billed charges,1003.86,78,,803.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,1093.95,85,,875.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1222.65,
7 X 20 METAL SCREW,278225945,CDM,278,RC,C1713,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
CANC REV. BONE DOWEL 10X25,278225948,CDM,278,RC,C1734,HCPCS,outpatient,,,2588,1811.6,,2044.52,79,,1635.62,percent of total billed charges,79% of total billed charges,2329.2,90,,1863.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1630.44,63,,1304.35,percent of total billed charges,63% of total billed charges,1998.45,77.22,,1598.76,percent of total billed charges,77.22% of total billed charges,1710.67,66.1,,1368.54,percent of total billed charges,66.1% of total billed charges,2148.04,83,,1718.43,percent of total billed charges,83% of total,2458.6,95,,1966.88,percent of total billed charges ,95% of total billed charges,2070.4,80,,1656.32,percent of total billed charges,78% of total billed charges,2018.64,78,,1614.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1630.44,63,,1304.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2329.2,90,,1863.36,percent of total billed charges,90% of total billed charges,2070.4,80,,1656.32,percent of total billed charges,80% of total billed charges,1630.44,63,,1304.35,percent of total billed charges,63% of total billed charges,2199.8,85,,1759.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2044.52,79,,1635.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2458.6,
CANCEL REV. BONE DOWEL 13X26,278225949,CDM,278,RC,C1734,HCPCS,outpatient,,,2588,1811.6,,2044.52,79,,1635.62,percent of total billed charges,79% of total billed charges,2329.2,90,,1863.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1630.44,63,,1304.35,percent of total billed charges,63% of total billed charges,1998.45,77.22,,1598.76,percent of total billed charges,77.22% of total billed charges,1710.67,66.1,,1368.54,percent of total billed charges,66.1% of total billed charges,2148.04,83,,1718.43,percent of total billed charges,83% of total,2458.6,95,,1966.88,percent of total billed charges ,95% of total billed charges,2070.4,80,,1656.32,percent of total billed charges,78% of total billed charges,2018.64,78,,1614.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1630.44,63,,1304.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2329.2,90,,1863.36,percent of total billed charges,90% of total billed charges,2070.4,80,,1656.32,percent of total billed charges,80% of total billed charges,1630.44,63,,1304.35,percent of total billed charges,63% of total billed charges,2199.8,85,,1759.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2044.52,79,,1635.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2458.6,
SUTURE ANCHOR 4.5x28 MM,278226024,CDM,278,RC,C1713,HCPCS,outpatient,,,1255,878.5,,991.45,79,,793.16,percent of total billed charges,79% of total billed charges,1129.5,90,,903.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,790.65,63,,632.52,percent of total billed charges,63% of total billed charges,969.11,77.22,,775.29,percent of total billed charges,77.22% of total billed charges,829.56,66.1,,663.65,percent of total billed charges,66.1% of total billed charges,1041.65,83,,833.32,percent of total billed charges,83% of total,1192.25,95,,953.8,percent of total billed charges ,95% of total billed charges,1004,80,,803.2,percent of total billed charges,78% of total billed charges,978.9,78,,783.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,790.65,63,,632.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,790.65,63,,632.52,percent of total billed charges,63% of total billed charges,1066.75,85,,853.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,991.45,79,,793.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1192.25,
GLENOSPHERE,278226058,CDM,278,RC,C1713,HCPCS,outpatient,,,3341,2338.7,,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2579.92,77.22,,2063.94,percent of total billed charges,77.22% of total billed charges,2208.4,66.1,,1766.72,percent of total billed charges,66.1% of total billed charges,2773.03,83,,2218.42,percent of total billed charges,83% of total,3173.95,95,,2539.16,percent of total billed charges ,95% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,78% of total billed charges,2605.98,78,,2084.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3006.9,90,,2405.52,percent of total billed charges,90% of total billed charges,2672.8,80,,2138.24,percent of total billed charges,80% of total billed charges,2104.83,63,,1683.86,percent of total billed charges,63% of total billed charges,2839.85,85,,2271.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2639.39,79,,2111.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3173.95,
MNIN HUMERAL STEM JOINT,278226059,CDM,278,RC,C1776,HCPCS,outpatient,,,8325,5827.5,,6576.75,79,,5261.4,percent of total billed charges,79% of total billed charges,7492.5,90,,5994,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5244.75,63,,4195.8,percent of total billed charges,63% of total billed charges,6428.57,77.22,,5142.86,percent of total billed charges,77.22% of total billed charges,5502.83,66.1,,4402.26,percent of total billed charges,66.1% of total billed charges,6909.75,83,,5527.8,percent of total billed charges,83% of total,7908.75,95,,6327,percent of total billed charges ,95% of total billed charges,6660,80,,5328,percent of total billed charges,78% of total billed charges,6493.5,78,,5194.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5244.75,63,,4195.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7492.5,90,,5994,percent of total billed charges,90% of total billed charges,6660,80,,5328,percent of total billed charges,80% of total billed charges,5244.75,63,,4195.8,percent of total billed charges,63% of total billed charges,7076.25,85,,5661,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6576.75,79,,5261.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7908.75,
HEADLESS COMP SCREWS,278226116,CDM,278,RC,C1713,HCPCS,outpatient,,,949,664.3,,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,732.82,77.22,,586.26,percent of total billed charges,77.22% of total billed charges,627.29,66.1,,501.83,percent of total billed charges,66.1% of total billed charges,787.67,83,,630.14,percent of total billed charges,83% of total,901.55,95,,721.24,percent of total billed charges ,95% of total billed charges,759.2,80,,607.36,percent of total billed charges,78% of total billed charges,740.22,78,,592.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,854.1,90,,683.28,percent of total billed charges,90% of total billed charges,759.2,80,,607.36,percent of total billed charges,80% of total billed charges,597.87,63,,478.3,percent of total billed charges,63% of total billed charges,806.65,85,,645.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,749.71,79,,599.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,901.55,
FLEXIGRAFT  BONE 13X34MM,278226163,CDM,278,RC,C1762,HCPCS,outpatient,,,3038,2126.6,,2400.02,79,,1920.02,percent of total billed charges,79% of total billed charges,2734.2,90,,2187.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.94,63,,1531.15,percent of total billed charges,63% of total billed charges,2345.94,77.22,,1876.75,percent of total billed charges,77.22% of total billed charges,2008.12,66.1,,1606.5,percent of total billed charges,66.1% of total billed charges,2521.54,83,,2017.23,percent of total billed charges,83% of total,2886.1,95,,2308.88,percent of total billed charges ,95% of total billed charges,2430.4,80,,1944.32,percent of total billed charges,78% of total billed charges,2369.64,78,,1895.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.94,63,,1531.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2734.2,90,,2187.36,percent of total billed charges,90% of total billed charges,2430.4,80,,1944.32,percent of total billed charges,80% of total billed charges,1913.94,63,,1531.15,percent of total billed charges,63% of total billed charges,2582.3,85,,2065.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2400.02,79,,1920.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2886.1,
SHORT PUSH LOCK,278226279,CDM,278,RC,C1713,HCPCS,outpatient,,,1159,811.3,,915.61,79,,732.49,percent of total billed charges,79% of total billed charges,1043.1,90,,834.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,894.98,77.22,,715.98,percent of total billed charges,77.22% of total billed charges,766.1,66.1,,612.88,percent of total billed charges,66.1% of total billed charges,961.97,83,,769.58,percent of total billed charges,83% of total,1101.05,95,,880.84,percent of total billed charges ,95% of total billed charges,927.2,80,,741.76,percent of total billed charges,78% of total billed charges,904.02,78,,723.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,985.15,85,,788.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,915.61,79,,732.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1101.05,
SCREW CORTICAL 2.7 X 18,278226345,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
"SCREW CORTIAL 3.5 22""",278226372,CDM,278,RC,C1713,HCPCS,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,328.19,77.22,,262.55,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.75,450,
"SCREW CORTIAL 3.5 28""",278226373,CDM,278,RC,C1713,HCPCS,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,328.19,77.22,,262.55,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.75,450,
"SCREW CORTIAL 3.5 16""",278226374,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
"SCREW LOCKING 3.5 24""",278226375,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
PLATE AR 2655CR,278226389,CDM,278,RC,C1713,HCPCS,outpatient,,,1769,1238.3,,1397.51,79,,1118.01,percent of total billed charges,79% of total billed charges,1592.1,90,,1273.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1114.47,63,,891.58,percent of total billed charges,63% of total billed charges,1366.02,77.22,,1092.82,percent of total billed charges,77.22% of total billed charges,1169.31,66.1,,935.45,percent of total billed charges,66.1% of total billed charges,1468.27,83,,1174.62,percent of total billed charges,83% of total,1680.55,95,,1344.44,percent of total billed charges ,95% of total billed charges,1415.2,80,,1132.16,percent of total billed charges,78% of total billed charges,1379.82,78,,1103.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1114.47,63,,891.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1592.1,90,,1273.68,percent of total billed charges,90% of total billed charges,1415.2,80,,1132.16,percent of total billed charges,80% of total billed charges,1114.47,63,,891.58,percent of total billed charges,63% of total billed charges,1503.65,85,,1202.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1397.51,79,,1118.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1680.55,
SCREW CORICAL 2.7 X 20 MM,278226391,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
SUTURE ANCHOR 4.75 X 19.1 MM,278226523,CDM,278,RC,C1713,HCPCS,outpatient,,,1368,957.6,,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1056.37,77.22,,845.1,percent of total billed charges,77.22% of total billed charges,904.25,66.1,,723.4,percent of total billed charges,66.1% of total billed charges,1135.44,83,,908.35,percent of total billed charges,83% of total,1299.6,95,,1039.68,percent of total billed charges ,95% of total billed charges,1094.4,80,,875.52,percent of total billed charges,78% of total billed charges,1067.04,78,,853.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,1094.4,80,,875.52,percent of total billed charges,80% of total billed charges,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1162.8,85,,930.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1299.6,
SUTURE ANCHOR 4.75 X 19.1 MM,278226524,CDM,278,RC,C1713,HCPCS,outpatient,,,1206,844.2,,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,1085.4,90,,868.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,931.27,77.22,,745.02,percent of total billed charges,77.22% of total billed charges,797.17,66.1,,637.74,percent of total billed charges,66.1% of total billed charges,1000.98,83,,800.78,percent of total billed charges,83% of total,1145.7,95,,916.56,percent of total billed charges ,95% of total billed charges,964.8,80,,771.84,percent of total billed charges,78% of total billed charges,940.68,78,,752.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,759.78,63,,607.82,percent of total billed charges,63% of total billed charges,1025.1,85,,820.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,952.74,79,,762.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1145.7,
DISTAL BICEPS IMPLANT SYSTEM,278226526,CDM,278,RC,11982,HCPCS,outpatient,,,2734,1913.8,,2159.86,79,,1727.89,percent of total billed charges,79% of total billed charges,2460.6,90,,1968.48,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,1722.42,63,,1377.94,percent of total billed charges,63% of total billed charges,2111.19,77.22,,1688.95,percent of total billed charges,77.22% of total billed charges,1807.17,66.1,,1445.74,percent of total billed charges,66.1% of total billed charges,2269.22,83,,1815.38,percent of total billed charges,83% of total,2597.3,95,,2077.84,percent of total billed charges ,95% of total billed charges,2187.2,80,,1749.76,percent of total billed charges,78% of total billed charges,2132.52,78,,1706.016,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,1722.42,63,,1377.94,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,2460.6,90,,1968.48,percent of total billed charges,90% of total billed charges,2187.2,80,,1749.76,percent of total billed charges,80% of total billed charges,1722.42,63,,1377.94,percent of total billed charges,63% of total billed charges,2323.9,85,,1859.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,2159.86,79,,1727.89,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,309.84,2597.3,
2.8 MM GUIDEWIRE,278226539,CDM,278,RC,C1769,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,145.42,66.1,,116.34,percent of total billed charges,66.1% of total billed charges,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,138.6,63,,110.88,percent of total billed charges,63% of total billed charges,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.6,450,
65MM X 16 MM TI 7.3 SCREW,278226540,CDM,278,RC,C1713,HCPCS,outpatient,,,1132,792.4,,894.28,79,,715.42,percent of total billed charges,79% of total billed charges,1018.8,90,,815.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,713.16,63,,570.53,percent of total billed charges,63% of total billed charges,874.13,77.22,,699.3,percent of total billed charges,77.22% of total billed charges,748.25,66.1,,598.6,percent of total billed charges,66.1% of total billed charges,939.56,83,,751.65,percent of total billed charges,83% of total,1075.4,95,,860.32,percent of total billed charges ,95% of total billed charges,905.6,80,,724.48,percent of total billed charges,78% of total billed charges,882.96,78,,706.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,713.16,63,,570.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1018.8,90,,815.04,percent of total billed charges,90% of total billed charges,905.6,80,,724.48,percent of total billed charges,80% of total billed charges,713.16,63,,570.53,percent of total billed charges,63% of total billed charges,962.2,85,,769.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,894.28,79,,715.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1075.4,
4.0x28 CANNULATED CAN,278226541,CDM,278,RC,C1713,HCPCS,outpatient,,,652,456.4,,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,503.47,77.22,,402.78,percent of total billed charges,77.22% of total billed charges,430.97,66.1,,344.78,percent of total billed charges,66.1% of total billed charges,541.16,83,,432.93,percent of total billed charges,83% of total,619.4,95,,495.52,percent of total billed charges ,95% of total billed charges,521.6,80,,417.28,percent of total billed charges,78% of total billed charges,508.56,78,,406.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,521.6,80,,417.28,percent of total billed charges,80% of total billed charges,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,554.2,85,,443.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,410.76,619.4,
4.0X32 CANNULATED CAN SCREW,278226542,CDM,278,RC,C1713,HCPCS,outpatient,,,652,456.4,,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,503.47,77.22,,402.78,percent of total billed charges,77.22% of total billed charges,430.97,66.1,,344.78,percent of total billed charges,66.1% of total billed charges,541.16,83,,432.93,percent of total billed charges,83% of total,619.4,95,,495.52,percent of total billed charges ,95% of total billed charges,521.6,80,,417.28,percent of total billed charges,78% of total billed charges,508.56,78,,406.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,521.6,80,,417.28,percent of total billed charges,80% of total billed charges,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,554.2,85,,443.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,410.76,619.4,
4.0X46 CANNULATED CAN SCREW,278226543,CDM,278,RC,C1713,HCPCS,outpatient,,,832,582.4,,657.28,79,,525.82,percent of total billed charges,79% of total billed charges,748.8,90,,599.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,524.16,63,,419.33,percent of total billed charges,63% of total billed charges,642.47,77.22,,513.98,percent of total billed charges,77.22% of total billed charges,549.95,66.1,,439.96,percent of total billed charges,66.1% of total billed charges,690.56,83,,552.45,percent of total billed charges,83% of total,790.4,95,,632.32,percent of total billed charges ,95% of total billed charges,665.6,80,,532.48,percent of total billed charges,78% of total billed charges,648.96,78,,519.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,524.16,63,,419.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,524.16,63,,419.33,percent of total billed charges,63% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,657.28,79,,525.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,790.4,
4.0X50 CANNULATED CAN SCREW,278226544,CDM,278,RC,C1713,HCPCS,outpatient,,,652,456.4,,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,503.47,77.22,,402.78,percent of total billed charges,77.22% of total billed charges,430.97,66.1,,344.78,percent of total billed charges,66.1% of total billed charges,541.16,83,,432.93,percent of total billed charges,83% of total,619.4,95,,495.52,percent of total billed charges ,95% of total billed charges,521.6,80,,417.28,percent of total billed charges,78% of total billed charges,508.56,78,,406.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,521.6,80,,417.28,percent of total billed charges,80% of total billed charges,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,554.2,85,,443.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,410.76,619.4,
4.0X60 CANNULATED CAN SCREW,278226545,CDM,278,RC,C1713,HCPCS,outpatient,,,652,456.4,,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,503.47,77.22,,402.78,percent of total billed charges,77.22% of total billed charges,430.97,66.1,,344.78,percent of total billed charges,66.1% of total billed charges,541.16,83,,432.93,percent of total billed charges,83% of total,619.4,95,,495.52,percent of total billed charges ,95% of total billed charges,521.6,80,,417.28,percent of total billed charges,78% of total billed charges,508.56,78,,406.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,586.8,90,,469.44,percent of total billed charges,90% of total billed charges,521.6,80,,417.28,percent of total billed charges,80% of total billed charges,410.76,63,,328.61,percent of total billed charges,63% of total billed charges,554.2,85,,443.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,515.08,79,,412.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,410.76,619.4,
MESH VENTRALEX 6.4CM 2.5 MED,278226584,CDM,278,RC,C1781,HCPCS,outpatient,,,1280,896,,1011.2,79,,808.96,percent of total billed charges,79% of total billed charges,1152,90,,921.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,806.4,63,,645.12,percent of total billed charges,63% of total billed charges,988.42,77.22,,790.74,percent of total billed charges,77.22% of total billed charges,846.08,66.1,,676.86,percent of total billed charges,66.1% of total billed charges,1062.4,83,,849.92,percent of total billed charges,83% of total,1216,95,,972.8,percent of total billed charges ,95% of total billed charges,1024,80,,819.2,percent of total billed charges,78% of total billed charges,998.4,78,,798.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,806.4,63,,645.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1152,90,,921.6,percent of total billed charges,90% of total billed charges,1024,80,,819.2,percent of total billed charges,80% of total billed charges,806.4,63,,645.12,percent of total billed charges,63% of total billed charges,1088,85,,870.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1011.2,79,,808.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1216,
SUTURE ANCHOR 2.9 X 12.5 MM,278226598,CDM,278,RC,C1713,HCPCS,outpatient,,,1159,811.3,,915.61,79,,732.49,percent of total billed charges,79% of total billed charges,1043.1,90,,834.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,894.98,77.22,,715.98,percent of total billed charges,77.22% of total billed charges,766.1,66.1,,612.88,percent of total billed charges,66.1% of total billed charges,961.97,83,,769.58,percent of total billed charges,83% of total,1101.05,95,,880.84,percent of total billed charges ,95% of total billed charges,927.2,80,,741.76,percent of total billed charges,78% of total billed charges,904.02,78,,723.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,730.17,63,,584.14,percent of total billed charges,63% of total billed charges,985.15,85,,788.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,915.61,79,,732.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1101.05,
PT SCREW 4.0 X 40,278226604,CDM,278,RC,C1713,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
WASHER,278226605,CDM,278,RC,C1713,HCPCS,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86.94,450,
PT SCREW 4.0 X 40,278226606,CDM,278,RC,C1713,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
SPEEDBRIDGE W/ PEEK SWIVELOCK,278226623,CDM,278,RC,C1713,HCPCS,outpatient,,,5143,3600.1,,4062.97,79,,3250.38,percent of total billed charges,79% of total billed charges,4628.7,90,,3702.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3240.09,63,,2592.07,percent of total billed charges,63% of total billed charges,3971.42,77.22,,3177.14,percent of total billed charges,77.22% of total billed charges,3399.52,66.1,,2719.62,percent of total billed charges,66.1% of total billed charges,4268.69,83,,3414.95,percent of total billed charges,83% of total,4885.85,95,,3908.68,percent of total billed charges ,95% of total billed charges,4114.4,80,,3291.52,percent of total billed charges,78% of total billed charges,4011.54,78,,3209.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3240.09,63,,2592.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4628.7,90,,3702.96,percent of total billed charges,90% of total billed charges,4114.4,80,,3291.52,percent of total billed charges,80% of total billed charges,3240.09,63,,2592.07,percent of total billed charges,63% of total billed charges,4371.55,85,,3497.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4062.97,79,,3250.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4885.85,
55 MM X 7.3 MM SCREW,278226651,CDM,278,RC,C1713,HCPCS,outpatient,,,1132,792.4,,894.28,79,,715.42,percent of total billed charges,79% of total billed charges,1018.8,90,,815.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,713.16,63,,570.53,percent of total billed charges,63% of total billed charges,874.13,77.22,,699.3,percent of total billed charges,77.22% of total billed charges,748.25,66.1,,598.6,percent of total billed charges,66.1% of total billed charges,939.56,83,,751.65,percent of total billed charges,83% of total,1075.4,95,,860.32,percent of total billed charges ,95% of total billed charges,905.6,80,,724.48,percent of total billed charges,78% of total billed charges,882.96,78,,706.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,713.16,63,,570.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1018.8,90,,815.04,percent of total billed charges,90% of total billed charges,905.6,80,,724.48,percent of total billed charges,80% of total billed charges,713.16,63,,570.53,percent of total billed charges,63% of total billed charges,962.2,85,,769.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,894.28,79,,715.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1075.4,
24 MM X 2.4 CORTEX SCREW,278226652,CDM,278,RC,C1713,HCPCS,outpatient,,,382,267.4,,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,294.98,77.22,,235.98,percent of total billed charges,77.22% of total billed charges,252.5,66.1,,202,percent of total billed charges,66.1% of total billed charges,317.06,83,,253.65,percent of total billed charges,83% of total,362.9,95,,290.32,percent of total billed charges ,95% of total billed charges,305.6,80,,244.48,percent of total billed charges,78% of total billed charges,297.96,78,,238.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,240.66,450,
18 MM CORTEX SCREW X 2.0,278226655,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
18 MM CORTEX SCREW X 2.0,278226656,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
16 MM X 2.0 MM CORTEX SCREW,278226659,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
3.5 POW PLATE,278226660,CDM,278,RC,C1713,HCPCS,outpatient,,,2878,2014.6,,2273.62,79,,1818.9,percent of total billed charges,79% of total billed charges,2590.2,90,,2072.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1813.14,63,,1450.51,percent of total billed charges,63% of total billed charges,2222.39,77.22,,1777.91,percent of total billed charges,77.22% of total billed charges,1902.36,66.1,,1521.89,percent of total billed charges,66.1% of total billed charges,2388.74,83,,1910.99,percent of total billed charges,83% of total,2734.1,95,,2187.28,percent of total billed charges ,95% of total billed charges,2302.4,80,,1841.92,percent of total billed charges,78% of total billed charges,2244.84,78,,1795.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1813.14,63,,1450.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2590.2,90,,2072.16,percent of total billed charges,90% of total billed charges,2302.4,80,,1841.92,percent of total billed charges,80% of total billed charges,1813.14,63,,1450.51,percent of total billed charges,63% of total billed charges,2446.3,85,,1957.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2273.62,79,,1818.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2734.1,
3.0 X 24 SCREW,278226661,CDM,278,RC,C1713,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,248.85,450,
3.0 X 28 SCREW,278226662,CDM,278,RC,C1713,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,248.85,450,
3.0 X 16 SCREW,278226663,CDM,278,RC,C1713,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,248.85,450,
3.0 X 22 LOCKING SCREW,278226664,CDM,278,RC,C1713,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,248.85,450,
3.0 X 15 QUICKFIX SCREW,278226668,CDM,278,RC,C1713,HCPCS,outpatient,,,772,540.4,,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,596.14,77.22,,476.91,percent of total billed charges,77.22% of total billed charges,510.29,66.1,,408.23,percent of total billed charges,66.1% of total billed charges,640.76,83,,512.61,percent of total billed charges,83% of total,733.4,95,,586.72,percent of total billed charges ,95% of total billed charges,617.6,80,,494.08,percent of total billed charges,78% of total billed charges,602.16,78,,481.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,486.36,63,,389.09,percent of total billed charges,63% of total billed charges,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,733.4,
18 X 18 X 6.5MM WEDGE,278226669,CDM,278,RC,C1763,HCPCS,outpatient,,,1276,893.2,,1008.04,79,,806.43,percent of total billed charges,79% of total billed charges,1148.4,90,,918.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,985.33,77.22,,788.26,percent of total billed charges,77.22% of total billed charges,843.44,66.1,,674.75,percent of total billed charges,66.1% of total billed charges,1059.08,83,,847.26,percent of total billed charges,83% of total,1212.2,95,,969.76,percent of total billed charges ,95% of total billed charges,1020.8,80,,816.64,percent of total billed charges,78% of total billed charges,995.28,78,,796.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1148.4,90,,918.72,percent of total billed charges,90% of total billed charges,1020.8,80,,816.64,percent of total billed charges,80% of total billed charges,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,1084.6,85,,867.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1008.04,79,,806.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1212.2,
20 6.5 MM COTTON WEDGE,278226670,CDM,278,RC,C1763,HCPCS,outpatient,,,1276,893.2,,1008.04,79,,806.43,percent of total billed charges,79% of total billed charges,1148.4,90,,918.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,985.33,77.22,,788.26,percent of total billed charges,77.22% of total billed charges,843.44,66.1,,674.75,percent of total billed charges,66.1% of total billed charges,1059.08,83,,847.26,percent of total billed charges,83% of total,1212.2,95,,969.76,percent of total billed charges ,95% of total billed charges,1020.8,80,,816.64,percent of total billed charges,78% of total billed charges,995.28,78,,796.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1148.4,90,,918.72,percent of total billed charges,90% of total billed charges,1020.8,80,,816.64,percent of total billed charges,80% of total billed charges,803.88,63,,643.1,percent of total billed charges,63% of total billed charges,1084.6,85,,867.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1008.04,79,,806.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1212.2,
2.4 X 34 CORTICAL SCREWS,278226671,CDM,278,RC,C1713,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,248.85,450,
7 X 20 SHEATH SCREW,278226690,CDM,278,RC,C1713,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
7 X 20 SCREW,278226691,CDM,278,RC,C1713,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
FORKTIP SWIVELLOCK,278226692,CDM,278,RC,C1713,HCPCS,outpatient,,,1399,979.3,,1105.21,79,,884.17,percent of total billed charges,79% of total billed charges,1259.1,90,,1007.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,881.37,63,,705.1,percent of total billed charges,63% of total billed charges,1080.31,77.22,,864.25,percent of total billed charges,77.22% of total billed charges,924.74,66.1,,739.79,percent of total billed charges,66.1% of total billed charges,1161.17,83,,928.94,percent of total billed charges,83% of total,1329.05,95,,1063.24,percent of total billed charges ,95% of total billed charges,1119.2,80,,895.36,percent of total billed charges,78% of total billed charges,1091.22,78,,872.976,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,881.37,63,,705.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1259.1,90,,1007.28,percent of total billed charges,90% of total billed charges,1119.2,80,,895.36,percent of total billed charges,80% of total billed charges,881.37,63,,705.1,percent of total billed charges,63% of total billed charges,1189.15,85,,951.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1105.21,79,,884.17,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1329.05,
SP SWIVELOCK 5.5,278226693,CDM,278,RC,C1713,HCPCS,outpatient,,,1287,900.9,,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,1158.3,90,,926.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,993.82,77.22,,795.06,percent of total billed charges,77.22% of total billed charges,850.71,66.1,,680.57,percent of total billed charges,66.1% of total billed charges,1068.21,83,,854.57,percent of total billed charges,83% of total,1222.65,95,,978.12,percent of total billed charges ,95% of total billed charges,1029.6,80,,823.68,percent of total billed charges,78% of total billed charges,1003.86,78,,803.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,1093.95,85,,875.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1222.65,
4.0 X 32 PT SCREW,278226744,CDM,278,RC,C1713,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
TIGHTROPE ABS BUTTON,278226756,CDM,278,RC,C1713,HCPCS,outpatient,,,688,481.6,,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,531.27,77.22,,425.02,percent of total billed charges,77.22% of total billed charges,454.77,66.1,,363.82,percent of total billed charges,66.1% of total billed charges,571.04,83,,456.83,percent of total billed charges,83% of total,653.6,95,,522.88,percent of total billed charges ,95% of total billed charges,550.4,80,,440.32,percent of total billed charges,78% of total billed charges,536.64,78,,429.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,433.44,653.6,
20 MM ABS BUTTON,278226757,CDM,278,RC,C1713,HCPCS,outpatient,,,720,504,,568.8,79,,455.04,percent of total billed charges,79% of total billed charges,648,90,,518.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,453.6,63,,362.88,percent of total billed charges,63% of total billed charges,555.98,77.22,,444.78,percent of total billed charges,77.22% of total billed charges,475.92,66.1,,380.74,percent of total billed charges,66.1% of total billed charges,597.6,83,,478.08,percent of total billed charges,83% of total,684,95,,547.2,percent of total billed charges ,95% of total billed charges,576,80,,460.8,percent of total billed charges,78% of total billed charges,561.6,78,,449.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,453.6,63,,362.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,453.6,63,,362.88,percent of total billed charges,63% of total billed charges,612,85,,489.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,568.8,79,,455.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,684,
FEMORAL COMP SZ 5 POSTERIOR,278226779,CDM,278,RC,C1776,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
FIT TIBIAL TRAY SZ 5F/FT,278226780,CDM,278,RC,C1713,HCPCS,outpatient,,,3037,2125.9,,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2345.17,77.22,,1876.14,percent of total billed charges,77.22% of total billed charges,2007.46,66.1,,1605.97,percent of total billed charges,66.1% of total billed charges,2520.71,83,,2016.57,percent of total billed charges,83% of total,2885.15,95,,2308.12,percent of total billed charges ,95% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,78% of total billed charges,2368.86,78,,1895.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,80% of total billed charges,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2581.45,85,,2065.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2885.15,
TIBIAL INSERT SZ 5 POSTERIOR,278226781,CDM,278,RC,C1713,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
3 PEG PATELLA 41MM,278226782,CDM,278,RC,C1776,HCPCS,outpatient,,,709,496.3,,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,547.49,77.22,,437.99,percent of total billed charges,77.22% of total billed charges,468.65,66.1,,374.92,percent of total billed charges,66.1% of total billed charges,588.47,83,,470.78,percent of total billed charges,83% of total,673.55,95,,538.84,percent of total billed charges ,95% of total billed charges,567.2,80,,453.76,percent of total billed charges,78% of total billed charges,553.02,78,,442.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,446.67,673.55,
FEMORAL COMP SZ 2.5 R POST,278226783,CDM,278,RC,C1713,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
FIT TIBIAL TRAY SZ 2.5F/2.5T,278226784,CDM,278,RC,C1713,HCPCS,outpatient,,,3037,2125.9,,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2345.17,77.22,,1876.14,percent of total billed charges,77.22% of total billed charges,2007.46,66.1,,1605.97,percent of total billed charges,66.1% of total billed charges,2520.71,83,,2016.57,percent of total billed charges,83% of total,2885.15,95,,2308.12,percent of total billed charges ,95% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,78% of total billed charges,2368.86,78,,1895.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,80% of total billed charges,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2581.45,85,,2065.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2885.15,
3 PEG PATELLA 32MM,278226785,CDM,278,RC,C1776,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,425.25,641.25,
PSC TIBIAL INSERT SZ 2.5 15MM,278226786,CDM,278,RC,C1713,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
SCREW CORTEX 2.0MM X 13MM,278226826,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
SCREW CORTEX 2.0MM X 13MM,278226827,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
SCREW CORTEX 2.0MM X 20MM,278226828,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
SCREW CORTEX 2.0MM X 22MM,278226829,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
SCREW CORTEX 2.0MM X 28MM,278226830,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
T PLATE 2 X 8,278226831,CDM,278,RC,C1713,HCPCS,outpatient,,,1631,1141.7,,1288.49,79,,1030.79,percent of total billed charges,79% of total billed charges,1467.9,90,,1174.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1027.53,63,,822.02,percent of total billed charges,63% of total billed charges,1259.46,77.22,,1007.57,percent of total billed charges,77.22% of total billed charges,1078.09,66.1,,862.47,percent of total billed charges,66.1% of total billed charges,1353.73,83,,1082.98,percent of total billed charges,83% of total,1549.45,95,,1239.56,percent of total billed charges ,95% of total billed charges,1304.8,80,,1043.84,percent of total billed charges,78% of total billed charges,1272.18,78,,1017.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1027.53,63,,822.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1027.53,63,,822.02,percent of total billed charges,63% of total billed charges,1386.35,85,,1109.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1288.49,79,,1030.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1549.45,
FEMORAL COMP SZ 5 LT,278226887,CDM,278,RC,C1776,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
FIT TIBIAL TRAY SZ 5F/4T,278226888,CDM,278,RC,C1713,HCPCS,outpatient,,,3037,2125.9,,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2345.17,77.22,,1876.14,percent of total billed charges,77.22% of total billed charges,2007.46,66.1,,1605.97,percent of total billed charges,66.1% of total billed charges,2520.71,83,,2016.57,percent of total billed charges,83% of total,2885.15,95,,2308.12,percent of total billed charges ,95% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,78% of total billed charges,2368.86,78,,1895.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,80% of total billed charges,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2581.45,85,,2065.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2885.15,
CRC TIBIAL INS SZ 5/11 MM,278226889,CDM,278,RC,C1776,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
FEMORAL COMP SZ 3 RIGHT,278226891,CDM,278,RC,C1776,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
FIT TIBIAL TRAY SZ 3F/2T,278226892,CDM,278,RC,C1713,HCPCS,outpatient,,,3037,2125.9,,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2345.17,77.22,,1876.14,percent of total billed charges,77.22% of total billed charges,2007.46,66.1,,1605.97,percent of total billed charges,66.1% of total billed charges,2520.71,83,,2016.57,percent of total billed charges,83% of total,2885.15,95,,2308.12,percent of total billed charges ,95% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,78% of total billed charges,2368.86,78,,1895.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,80% of total billed charges,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2581.45,85,,2065.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2885.15,
CRC TIBIAL INS SZ 3/12MM,278226893,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
SCREW CANNULATED 7.3 MM,278226898,CDM,278,RC,C1713,HCPCS,outpatient,,,1028,719.6,,812.12,79,,649.7,percent of total billed charges,79% of total billed charges,925.2,90,,740.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.64,63,,518.11,percent of total billed charges,63% of total billed charges,793.82,77.22,,635.06,percent of total billed charges,77.22% of total billed charges,679.51,66.1,,543.61,percent of total billed charges,66.1% of total billed charges,853.24,83,,682.59,percent of total billed charges,83% of total,976.6,95,,781.28,percent of total billed charges ,95% of total billed charges,822.4,80,,657.92,percent of total billed charges,78% of total billed charges,801.84,78,,641.472,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,647.64,63,,518.11,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,925.2,90,,740.16,percent of total billed charges,90% of total billed charges,822.4,80,,657.92,percent of total billed charges,80% of total billed charges,647.64,63,,518.11,percent of total billed charges,63% of total billed charges,873.8,85,,699.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,812.12,79,,649.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,976.6,
SCREW CANNULATED 7.3 MM,278226899,CDM,278,RC,C1713,HCPCS,outpatient,,,697,487.9,,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,627.3,90,,501.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,538.22,77.22,,430.58,percent of total billed charges,77.22% of total billed charges,460.72,66.1,,368.58,percent of total billed charges,66.1% of total billed charges,578.51,83,,462.81,percent of total billed charges,83% of total,662.15,95,,529.72,percent of total billed charges ,95% of total billed charges,557.6,80,,446.08,percent of total billed charges,78% of total billed charges,543.66,78,,434.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,439.11,662.15,
SCREW CORTICAL 3.5 MM,278226900,CDM,278,RC,C1713,HCPCS,outpatient,,,247,172.9,,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,190.73,77.22,,152.58,percent of total billed charges,77.22% of total billed charges,163.27,66.1,,130.62,percent of total billed charges,66.1% of total billed charges,205.01,83,,164.01,percent of total billed charges,83% of total,234.65,95,,187.72,percent of total billed charges ,95% of total billed charges,197.6,80,,158.08,percent of total billed charges,78% of total billed charges,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,155.61,63,,124.49,percent of total billed charges,63% of total billed charges,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,155.61,450,
FEMORAL COMP CEMENTED SZ 3 LT,278226904,CDM,278,RC,C1776,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
"TIBIAL INS CR SZ 3, 10MM",278226905,CDM,278,RC,C1776,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
SCREW CORTEX 2.4 X 12MM,278226922,CDM,278,RC,C1713,HCPCS,outpatient,,,236,165.2,,186.44,79,,149.15,percent of total billed charges,79% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.68,63,,118.94,percent of total billed charges,63% of total billed charges,182.24,77.22,,145.79,percent of total billed charges,77.22% of total billed charges,156,66.1,,124.8,percent of total billed charges,66.1% of total billed charges,195.88,83,,156.7,percent of total billed charges,83% of total,224.2,95,,179.36,percent of total billed charges ,95% of total billed charges,188.8,80,,151.04,percent of total billed charges,78% of total billed charges,184.08,78,,147.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,148.68,63,,118.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,148.68,63,,118.94,percent of total billed charges,63% of total billed charges,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,186.44,79,,149.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,148.68,450,
SCREW CORTEX 2.4 X 12MM,278226923,CDM,278,RC,C1713,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
SCREW CORTEX 2.4 X 14MM,278226924,CDM,278,RC,C1713,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
SCREW CORTEX 2.4 X 16MM,278226925,CDM,278,RC,C1713,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
SCREW CORTEX 2.4 X 18MM,278226926,CDM,278,RC,C1713,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
SCREW CORTEX 2.4 X 24MM,278226927,CDM,278,RC,C1713,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
PLATE 2.4MM STRAIGHT,278226929,CDM,278,RC,C1713,HCPCS,outpatient,,,3337,2335.9,,2636.23,79,,2108.98,percent of total billed charges,79% of total billed charges,3003.3,90,,2402.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2102.31,63,,1681.85,percent of total billed charges,63% of total billed charges,2576.83,77.22,,2061.46,percent of total billed charges,77.22% of total billed charges,2205.76,66.1,,1764.61,percent of total billed charges,66.1% of total billed charges,2769.71,83,,2215.77,percent of total billed charges,83% of total,3170.15,95,,2536.12,percent of total billed charges ,95% of total billed charges,2669.6,80,,2135.68,percent of total billed charges,78% of total billed charges,2602.86,78,,2082.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2102.31,63,,1681.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3003.3,90,,2402.64,percent of total billed charges,90% of total billed charges,2669.6,80,,2135.68,percent of total billed charges,80% of total billed charges,2102.31,63,,1681.85,percent of total billed charges,63% of total billed charges,2836.45,85,,2269.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2636.23,79,,2108.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3170.15,
SCREW CORTEX TITANIUM 2.4MM,278226930,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEX TITA 2.4 X 11,278226938,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEX TITA 2.4 X 14,278226939,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEX TITA 2.4 X 14,278226940,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEX TITA 2.4 X 16,278226941,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEX TITA 2.4 X 18,278226942,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
PLATE TITA 2.4 6 HOLE,278226943,CDM,278,RC,C1713,HCPCS,outpatient,,,1845,1291.5,,1457.55,79,,1166.04,percent of total billed charges,79% of total billed charges,1660.5,90,,1328.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.35,63,,929.88,percent of total billed charges,63% of total billed charges,1424.71,77.22,,1139.77,percent of total billed charges,77.22% of total billed charges,1219.55,66.1,,975.64,percent of total billed charges,66.1% of total billed charges,1531.35,83,,1225.08,percent of total billed charges,83% of total,1752.75,95,,1402.2,percent of total billed charges ,95% of total billed charges,1476,80,,1180.8,percent of total billed charges,78% of total billed charges,1439.1,78,,1151.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1162.35,63,,929.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1660.5,90,,1328.4,percent of total billed charges,90% of total billed charges,1476,80,,1180.8,percent of total billed charges,80% of total billed charges,1162.35,63,,929.88,percent of total billed charges,63% of total billed charges,1568.25,85,,1254.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1457.55,79,,1166.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1752.75,
GLENOSPHERE LOCKING SCREW,278226958,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
HUMERAL STEM PRESS FIT 15MM,278226959,CDM,278,RC,C1776,HCPCS,outpatient,,,5344,3740.8,,4221.76,79,,3377.41,percent of total billed charges,79% of total billed charges,4809.6,90,,3847.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3366.72,63,,2693.38,percent of total billed charges,63% of total billed charges,4126.64,77.22,,3301.31,percent of total billed charges,77.22% of total billed charges,3532.38,66.1,,2825.9,percent of total billed charges,66.1% of total billed charges,4435.52,83,,3548.42,percent of total billed charges,83% of total,5076.8,95,,4061.44,percent of total billed charges ,95% of total billed charges,4275.2,80,,3420.16,percent of total billed charges,78% of total billed charges,4168.32,78,,3334.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3366.72,63,,2693.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4809.6,90,,3847.68,percent of total billed charges,90% of total billed charges,4275.2,80,,3420.16,percent of total billed charges,80% of total billed charges,3366.72,63,,2693.38,percent of total billed charges,63% of total billed charges,4542.4,85,,3633.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4221.76,79,,3377.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5076.8,
HUMERAL ADAPTER TRAY +0MM,278226960,CDM,278,RC,C1713,HCPCS,outpatient,,,3971,2779.7,,3137.09,79,,2509.67,percent of total billed charges,79% of total billed charges,3573.9,90,,2859.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2501.73,63,,2001.38,percent of total billed charges,63% of total billed charges,3066.41,77.22,,2453.13,percent of total billed charges,77.22% of total billed charges,2624.83,66.1,,2099.86,percent of total billed charges,66.1% of total billed charges,3295.93,83,,2636.74,percent of total billed charges,83% of total,3772.45,95,,3017.96,percent of total billed charges ,95% of total billed charges,3176.8,80,,2541.44,percent of total billed charges,78% of total billed charges,3097.38,78,,2477.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2501.73,63,,2001.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3573.9,90,,2859.12,percent of total billed charges,90% of total billed charges,3176.8,80,,2541.44,percent of total billed charges,80% of total billed charges,2501.73,63,,2001.38,percent of total billed charges,63% of total billed charges,3375.35,85,,2700.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3137.09,79,,2509.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3772.45,
42MM HUMERAL LINER +0MM,278226961,CDM,278,RC,C1713,HCPCS,outpatient,,,1744,1220.8,,1377.76,79,,1102.21,percent of total billed charges,79% of total billed charges,1569.6,90,,1255.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1098.72,63,,878.98,percent of total billed charges,63% of total billed charges,1346.72,77.22,,1077.38,percent of total billed charges,77.22% of total billed charges,1152.78,66.1,,922.22,percent of total billed charges,66.1% of total billed charges,1447.52,83,,1158.02,percent of total billed charges,83% of total,1656.8,95,,1325.44,percent of total billed charges ,95% of total billed charges,1395.2,80,,1116.16,percent of total billed charges,78% of total billed charges,1360.32,78,,1088.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1098.72,63,,878.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1098.72,63,,878.98,percent of total billed charges,63% of total billed charges,1482.4,85,,1185.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1377.76,79,,1102.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1656.8,
REV SHOUL SUP/POST BASEPLATE R,278226962,CDM,278,RC,C1713,HCPCS,outpatient,,,3296,2307.2,,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,2545.17,77.22,,2036.14,percent of total billed charges,77.22% of total billed charges,2178.66,66.1,,1742.93,percent of total billed charges,66.1% of total billed charges,2735.68,83,,2188.54,percent of total billed charges,83% of total,3131.2,95,,2504.96,percent of total billed charges ,95% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,78% of total billed charges,2570.88,78,,2056.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,80% of total billed charges,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,2801.6,85,,2241.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3131.2,
SCREW COMPRESSION 4.5 X 30MM,278226963,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW COMPRESSION 4.5 X 30MM,278226964,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW COMPLRESSION 4.5 X 22MM,278226965,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW COMPRESSION 4.5 X 38MM,278226966,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
GLENOSPHERE 42MM,278226967,CDM,278,RC,C1713,HCPCS,outpatient,,,3060,2142,,2417.4,79,,1933.92,percent of total billed charges,79% of total billed charges,2754,90,,2203.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1927.8,63,,1542.24,percent of total billed charges,63% of total billed charges,2362.93,77.22,,1890.34,percent of total billed charges,77.22% of total billed charges,2022.66,66.1,,1618.13,percent of total billed charges,66.1% of total billed charges,2539.8,83,,2031.84,percent of total billed charges,83% of total,2907,95,,2325.6,percent of total billed charges ,95% of total billed charges,2448,80,,1958.4,percent of total billed charges,78% of total billed charges,2386.8,78,,1909.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1927.8,63,,1542.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2754,90,,2203.2,percent of total billed charges,90% of total billed charges,2448,80,,1958.4,percent of total billed charges,80% of total billed charges,1927.8,63,,1542.24,percent of total billed charges,63% of total billed charges,2601,85,,2080.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2417.4,79,,1933.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2907,
FIT TIBIAL TRAY CEMENT F4/3T,278226968,CDM,278,RC,C1713,HCPCS,outpatient,,,3037,2125.9,,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2345.17,77.22,,1876.14,percent of total billed charges,77.22% of total billed charges,2007.46,66.1,,1605.97,percent of total billed charges,66.1% of total billed charges,2520.71,83,,2016.57,percent of total billed charges,83% of total,2885.15,95,,2308.12,percent of total billed charges ,95% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,78% of total billed charges,2368.86,78,,1895.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,80% of total billed charges,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2581.45,85,,2065.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2885.15,
FEMORAL COMP POST SIZE 4,278226969,CDM,278,RC,C1713,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
PSC TIBIAL INSERT POST SIZE 4,278226970,CDM,278,RC,C1713,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
3PEG PATELLA CEMENTED 35MM,278226971,CDM,278,RC,C1776,HCPCS,outpatient,,,709,496.3,,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,547.49,77.22,,437.99,percent of total billed charges,77.22% of total billed charges,468.65,66.1,,374.92,percent of total billed charges,66.1% of total billed charges,588.47,83,,470.78,percent of total billed charges,83% of total,673.55,95,,538.84,percent of total billed charges ,95% of total billed charges,567.2,80,,453.76,percent of total billed charges,78% of total billed charges,553.02,78,,442.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,446.67,673.55,
AUTOGRAFT CONVENIENCE PACK,278226973,CDM,278,RC,C1768,HCPCS,outpatient,,,2750,1925,,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,2475,90,,1980,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2123.55,77.22,,1698.84,percent of total billed charges,77.22% of total billed charges,1817.75,66.1,,1454.2,percent of total billed charges,66.1% of total billed charges,2282.5,83,,1826,percent of total billed charges,83% of total,2612.5,95,,2090,percent of total billed charges ,95% of total billed charges,2200,80,,1760,percent of total billed charges,78% of total billed charges,2145,78,,1716,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2475,90,,1980,percent of total billed charges,90% of total billed charges,2200,80,,1760,percent of total billed charges,80% of total billed charges,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2337.5,85,,1870,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2612.5,
INJECATABLE MACRO CA PHOS,278226975,CDM,278,RC,C1713,HCPCS,outpatient,,,9619,6733.3,,7599.01,79,,6079.21,percent of total billed charges,79% of total billed charges,8657.1,90,,6925.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6059.97,63,,4847.98,percent of total billed charges,63% of total billed charges,7427.79,77.22,,5942.23,percent of total billed charges,77.22% of total billed charges,6358.16,66.1,,5086.53,percent of total billed charges,66.1% of total billed charges,7983.77,83,,6387.02,percent of total billed charges,83% of total,9138.05,95,,7310.44,percent of total billed charges ,95% of total billed charges,7695.2,80,,6156.16,percent of total billed charges,78% of total billed charges,7502.82,78,,6002.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6059.97,63,,4847.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,8657.1,90,,6925.68,percent of total billed charges,90% of total billed charges,7695.2,80,,6156.16,percent of total billed charges,80% of total billed charges,6059.97,63,,4847.98,percent of total billed charges,63% of total billed charges,8176.15,85,,6540.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7599.01,79,,6079.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,9138.05,
HERNIA PATCH VENTRIO ST,278226992,CDM,278,RC,C1781,HCPCS,outpatient,,,2891,2023.7,,2283.89,79,,1827.11,percent of total billed charges,79% of total billed charges,2601.9,90,,2081.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1821.33,63,,1457.06,percent of total billed charges,63% of total billed charges,2232.43,77.22,,1785.94,percent of total billed charges,77.22% of total billed charges,1910.95,66.1,,1528.76,percent of total billed charges,66.1% of total billed charges,2399.53,83,,1919.62,percent of total billed charges,83% of total,2746.45,95,,2197.16,percent of total billed charges ,95% of total billed charges,2312.8,80,,1850.24,percent of total billed charges,78% of total billed charges,2254.98,78,,1803.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1821.33,63,,1457.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2601.9,90,,2081.52,percent of total billed charges,90% of total billed charges,2312.8,80,,1850.24,percent of total billed charges,80% of total billed charges,1821.33,63,,1457.06,percent of total billed charges,63% of total billed charges,2457.35,85,,1965.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2283.89,79,,1827.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2746.45,
SCREW CORTEX 4.5MM,278226998,CDM,278,RC,C1713,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.49,450,
12 MM CORTICAL SCREW 3.5,278227015,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
4 HOLE TUBULAR PLATE,278227016,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
TITANIUM IMPLANT ANKLE SYND,278227017,CDM,278,RC,C1781,HCPCS,outpatient,,,3420,2394,,2701.8,79,,2161.44,percent of total billed charges,79% of total billed charges,3078,90,,2462.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2154.6,63,,1723.68,percent of total billed charges,63% of total billed charges,2640.92,77.22,,2112.74,percent of total billed charges,77.22% of total billed charges,2260.62,66.1,,1808.5,percent of total billed charges,66.1% of total billed charges,2838.6,83,,2270.88,percent of total billed charges,83% of total,3249,95,,2599.2,percent of total billed charges ,95% of total billed charges,2736,80,,2188.8,percent of total billed charges,78% of total billed charges,2667.6,78,,2134.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2154.6,63,,1723.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3078,90,,2462.4,percent of total billed charges,90% of total billed charges,2736,80,,2188.8,percent of total billed charges,80% of total billed charges,2154.6,63,,1723.68,percent of total billed charges,63% of total billed charges,2907,85,,2325.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2701.8,79,,2161.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3249,
1.3MM FIBERWIRE SUTURE TAPE,278227037,CDM,278,RC,C1713,HCPCS,outpatient,,,1496,1047.2,,1181.84,79,,945.47,percent of total billed charges,79% of total billed charges,1346.4,90,,1077.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,942.48,63,,753.98,percent of total billed charges,63% of total billed charges,1155.21,77.22,,924.17,percent of total billed charges,77.22% of total billed charges,988.86,66.1,,791.09,percent of total billed charges,66.1% of total billed charges,1241.68,83,,993.34,percent of total billed charges,83% of total,1421.2,95,,1136.96,percent of total billed charges ,95% of total billed charges,1196.8,80,,957.44,percent of total billed charges,78% of total billed charges,1166.88,78,,933.504,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,942.48,63,,753.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1346.4,90,,1077.12,percent of total billed charges,90% of total billed charges,1196.8,80,,957.44,percent of total billed charges,80% of total billed charges,942.48,63,,753.98,percent of total billed charges,63% of total billed charges,1271.6,85,,1017.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1181.84,79,,945.47,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1421.2,
IMPLANT SYSTEM ACL TIGHTROPE,278227039,CDM,278,RC,C1713,HCPCS,outpatient,,,5422,3795.4,,4283.38,79,,3426.7,percent of total billed charges,79% of total billed charges,4879.8,90,,3903.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3415.86,63,,2732.69,percent of total billed charges,63% of total billed charges,4186.87,77.22,,3349.5,percent of total billed charges,77.22% of total billed charges,3583.94,66.1,,2867.15,percent of total billed charges,66.1% of total billed charges,4500.26,83,,3600.21,percent of total billed charges,83% of total,5150.9,95,,4120.72,percent of total billed charges ,95% of total billed charges,4337.6,80,,3470.08,percent of total billed charges,78% of total billed charges,4229.16,78,,3383.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3415.86,63,,2732.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4879.8,90,,3903.84,percent of total billed charges,90% of total billed charges,4337.6,80,,3470.08,percent of total billed charges,80% of total billed charges,3415.86,63,,2732.69,percent of total billed charges,63% of total billed charges,4608.7,85,,3686.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4283.38,79,,3426.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5150.9,
TENODESIS SCREW 6.25 X 15,278227071,CDM,278,RC,C1713,HCPCS,outpatient,,,1013,709.1,,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,782.24,77.22,,625.79,percent of total billed charges,77.22% of total billed charges,669.59,66.1,,535.67,percent of total billed charges,66.1% of total billed charges,840.79,83,,672.63,percent of total billed charges,83% of total,962.35,95,,769.88,percent of total billed charges ,95% of total billed charges,810.4,80,,648.32,percent of total billed charges,78% of total billed charges,790.14,78,,632.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,810.4,80,,648.32,percent of total billed charges,80% of total billed charges,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,861.05,85,,688.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,962.35,
PROXIMAL PLATE RT NARROW LONG,278227081,CDM,278,RC,C1713,HCPCS,outpatient,,,2799,1959.3,,2211.21,79,,1768.97,percent of total billed charges,79% of total billed charges,2519.1,90,,2015.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1763.37,63,,1410.7,percent of total billed charges,63% of total billed charges,2161.39,77.22,,1729.11,percent of total billed charges,77.22% of total billed charges,1850.14,66.1,,1480.11,percent of total billed charges,66.1% of total billed charges,2323.17,83,,1858.54,percent of total billed charges,83% of total,2659.05,95,,2127.24,percent of total billed charges ,95% of total billed charges,2239.2,80,,1791.36,percent of total billed charges,78% of total billed charges,2183.22,78,,1746.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1763.37,63,,1410.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2519.1,90,,2015.28,percent of total billed charges,90% of total billed charges,2239.2,80,,1791.36,percent of total billed charges,80% of total billed charges,1763.37,63,,1410.7,percent of total billed charges,63% of total billed charges,2379.15,85,,1903.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2211.21,79,,1768.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2659.05,
NONLOCKING HEX SCREW 3.5X12,278227084,CDM,278,RC,C1713,HCPCS,outpatient,,,877,613.9,,692.83,79,,554.26,percent of total billed charges,79% of total billed charges,789.3,90,,631.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,552.51,63,,442.01,percent of total billed charges,63% of total billed charges,677.22,77.22,,541.78,percent of total billed charges,77.22% of total billed charges,579.7,66.1,,463.76,percent of total billed charges,66.1% of total billed charges,727.91,83,,582.33,percent of total billed charges,83% of total,833.15,95,,666.52,percent of total billed charges ,95% of total billed charges,701.6,80,,561.28,percent of total billed charges,78% of total billed charges,684.06,78,,547.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,552.51,63,,442.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,552.51,63,,442.01,percent of total billed charges,63% of total billed charges,745.45,85,,596.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,692.83,79,,554.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,833.15,
NONLOCKING HEX SCREW 3.5X10,278227085,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
LOCKING CORT SCREW 2.3X12,278227086,CDM,278,RC,C1713,HCPCS,outpatient,,,327,228.9,,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,252.51,77.22,,202.01,percent of total billed charges,77.22% of total billed charges,216.15,66.1,,172.92,percent of total billed charges,66.1% of total billed charges,271.41,83,,217.13,percent of total billed charges,83% of total,310.65,95,,248.52,percent of total billed charges ,95% of total billed charges,261.6,80,,209.28,percent of total billed charges,78% of total billed charges,255.06,78,,204.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.01,450,
LOCKING CORT SCREW 2.3X14,278227087,CDM,278,RC,C1713,HCPCS,outpatient,,,327,228.9,,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,252.51,77.22,,202.01,percent of total billed charges,77.22% of total billed charges,216.15,66.1,,172.92,percent of total billed charges,66.1% of total billed charges,271.41,83,,217.13,percent of total billed charges,83% of total,310.65,95,,248.52,percent of total billed charges ,95% of total billed charges,261.6,80,,209.28,percent of total billed charges,78% of total billed charges,255.06,78,,204.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.01,450,
LOCKING CORT SCREW 2.3X16,278227088,CDM,278,RC,C1713,HCPCS,outpatient,,,327,228.9,,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,252.51,77.22,,202.01,percent of total billed charges,77.22% of total billed charges,216.15,66.1,,172.92,percent of total billed charges,66.1% of total billed charges,271.41,83,,217.13,percent of total billed charges,83% of total,310.65,95,,248.52,percent of total billed charges ,95% of total billed charges,261.6,80,,209.28,percent of total billed charges,78% of total billed charges,255.06,78,,204.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.01,450,
LOCKING CORT SCREW 2.3X18,278227089,CDM,278,RC,C1713,HCPCS,outpatient,,,327,228.9,,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,252.51,77.22,,202.01,percent of total billed charges,77.22% of total billed charges,216.15,66.1,,172.92,percent of total billed charges,66.1% of total billed charges,271.41,83,,217.13,percent of total billed charges,83% of total,310.65,95,,248.52,percent of total billed charges ,95% of total billed charges,261.6,80,,209.28,percent of total billed charges,78% of total billed charges,255.06,78,,204.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.01,63,,164.81,percent of total billed charges,63% of total billed charges,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.01,450,
SCREW CORTEX TI 2.0X14MM,278227098,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
SCREW CORTEX TI 2.4X10MM,278227099,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEXT TI 2.4X28MM,278227100,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEX TI 2.4X32MM,278227101,CDM,278,RC,C1713,HCPCS,outpatient,,,382,267.4,,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,294.98,77.22,,235.98,percent of total billed charges,77.22% of total billed charges,252.5,66.1,,202,percent of total billed charges,66.1% of total billed charges,317.06,83,,253.65,percent of total billed charges,83% of total,362.9,95,,290.32,percent of total billed charges ,95% of total billed charges,305.6,80,,244.48,percent of total billed charges,78% of total billed charges,297.96,78,,238.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,240.66,450,
PLATE 6 HOLE 2.4 47MM,278227102,CDM,278,RC,C1713,HCPCS,outpatient,,,2623,1836.1,,2072.17,79,,1657.74,percent of total billed charges,79% of total billed charges,2360.7,90,,1888.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1652.49,63,,1321.99,percent of total billed charges,63% of total billed charges,2025.48,77.22,,1620.38,percent of total billed charges,77.22% of total billed charges,1733.8,66.1,,1387.04,percent of total billed charges,66.1% of total billed charges,2177.09,83,,1741.67,percent of total billed charges,83% of total,2491.85,95,,1993.48,percent of total billed charges ,95% of total billed charges,2098.4,80,,1678.72,percent of total billed charges,78% of total billed charges,2045.94,78,,1636.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1652.49,63,,1321.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2360.7,90,,1888.56,percent of total billed charges,90% of total billed charges,2098.4,80,,1678.72,percent of total billed charges,80% of total billed charges,1652.49,63,,1321.99,percent of total billed charges,63% of total billed charges,2229.55,85,,1783.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2072.17,79,,1657.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2491.85,
FEM COMP POST SZ 3.5 RT,278227105,CDM,278,RC,C1776,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
FIT TIBIAL TRAY SZ 3.5,278227106,CDM,278,RC,C1776,HCPCS,outpatient,,,3037,2125.9,,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2345.17,77.22,,1876.14,percent of total billed charges,77.22% of total billed charges,2007.46,66.1,,1605.97,percent of total billed charges,66.1% of total billed charges,2520.71,83,,2016.57,percent of total billed charges,83% of total,2885.15,95,,2308.12,percent of total billed charges ,95% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,78% of total billed charges,2368.86,78,,1895.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2733.3,90,,2186.64,percent of total billed charges,90% of total billed charges,2429.6,80,,1943.68,percent of total billed charges,80% of total billed charges,1913.31,63,,1530.65,percent of total billed charges,63% of total billed charges,2581.45,85,,2065.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2399.23,79,,1919.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2885.15,
TIBIAL INSERT POST SZ 3.5,278227107,CDM,278,RC,C1776,HCPCS,outpatient,,,2250,1575,,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,2025,90,,1620,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1737.45,77.22,,1389.96,percent of total billed charges,77.22% of total billed charges,1487.25,66.1,,1189.8,percent of total billed charges,66.1% of total billed charges,1867.5,83,,1494,percent of total billed charges,83% of total,2137.5,95,,1710,percent of total billed charges ,95% of total billed charges,1800,80,,1440,percent of total billed charges,78% of total billed charges,1755,78,,1404,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2025,90,,1620,percent of total billed charges,90% of total billed charges,1800,80,,1440,percent of total billed charges,80% of total billed charges,1417.5,63,,1134,percent of total billed charges,63% of total billed charges,1912.5,85,,1530,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1777.5,79,,1422,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2137.5,
VENTRALIGHT ST ECHO 2.0,278227109,CDM,278,RC,C1781,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SUTURE ANCHOR 4.75 X 19.1 MM,278227121,CDM,278,RC,C1713,HCPCS,outpatient,,,1287,900.9,,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,1158.3,90,,926.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,993.82,77.22,,795.06,percent of total billed charges,77.22% of total billed charges,850.71,66.1,,680.57,percent of total billed charges,66.1% of total billed charges,1068.21,83,,854.57,percent of total billed charges,83% of total,1222.65,95,,978.12,percent of total billed charges ,95% of total billed charges,1029.6,80,,823.68,percent of total billed charges,78% of total billed charges,1003.86,78,,803.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,1093.95,85,,875.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1222.65,
SUTURE ANCHOR 4.75 X 19.1 MM,278227122,CDM,278,RC,C1713,HCPCS,outpatient,,,1287,900.9,,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,1158.3,90,,926.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,993.82,77.22,,795.06,percent of total billed charges,77.22% of total billed charges,850.71,66.1,,680.57,percent of total billed charges,66.1% of total billed charges,1068.21,83,,854.57,percent of total billed charges,83% of total,1222.65,95,,978.12,percent of total billed charges ,95% of total billed charges,1029.6,80,,823.68,percent of total billed charges,78% of total billed charges,1003.86,78,,803.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,810.81,63,,648.65,percent of total billed charges,63% of total billed charges,1093.95,85,,875.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1016.73,79,,813.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1222.65,
SPEEDBRIDGE IMPLANT 4.75X19.1,278227123,CDM,278,RC,C1713,HCPCS,outpatient,,,5593,3915.1,,4418.47,79,,3534.78,percent of total billed charges,79% of total billed charges,5033.7,90,,4026.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3523.59,63,,2818.87,percent of total billed charges,63% of total billed charges,4318.91,77.22,,3455.13,percent of total billed charges,77.22% of total billed charges,3696.97,66.1,,2957.58,percent of total billed charges,66.1% of total billed charges,4642.19,83,,3713.75,percent of total billed charges,83% of total,5313.35,95,,4250.68,percent of total billed charges ,95% of total billed charges,4474.4,80,,3579.52,percent of total billed charges,78% of total billed charges,4362.54,78,,3490.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3523.59,63,,2818.87,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5033.7,90,,4026.96,percent of total billed charges,90% of total billed charges,4474.4,80,,3579.52,percent of total billed charges,80% of total billed charges,3523.59,63,,2818.87,percent of total billed charges,63% of total billed charges,4754.05,85,,3803.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4418.47,79,,3534.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5313.35,
TENODESIS SCREW 7X10,278227124,CDM,278,RC,C1713,HCPCS,outpatient,,,1012,708.4,,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,781.47,77.22,,625.18,percent of total billed charges,77.22% of total billed charges,668.93,66.1,,535.14,percent of total billed charges,66.1% of total billed charges,839.96,83,,671.97,percent of total billed charges,83% of total,961.4,95,,769.12,percent of total billed charges ,95% of total billed charges,809.6,80,,647.68,percent of total billed charges,78% of total billed charges,789.36,78,,631.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,809.6,80,,647.68,percent of total billed charges,80% of total billed charges,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,860.2,85,,688.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,961.4,
SUTURE ANCHOR 4.75 X 22 MM,278227134,CDM,278,RC,C1713,HCPCS,outpatient,,,1341,938.7,,1059.39,79,,847.51,percent of total billed charges,79% of total billed charges,1206.9,90,,965.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,844.83,63,,675.86,percent of total billed charges,63% of total billed charges,1035.52,77.22,,828.42,percent of total billed charges,77.22% of total billed charges,886.4,66.1,,709.12,percent of total billed charges,66.1% of total billed charges,1113.03,83,,890.42,percent of total billed charges,83% of total,1273.95,95,,1019.16,percent of total billed charges ,95% of total billed charges,1072.8,80,,858.24,percent of total billed charges,78% of total billed charges,1045.98,78,,836.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,844.83,63,,675.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1206.9,90,,965.52,percent of total billed charges,90% of total billed charges,1072.8,80,,858.24,percent of total billed charges,80% of total billed charges,844.83,63,,675.86,percent of total billed charges,63% of total billed charges,1139.85,85,,911.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1059.39,79,,847.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1273.95,
7.3 SCREW CANNULATED 16MM,278227166,CDM,278,RC,C1713,HCPCS,outpatient,,,1100,770,,869,79,,695.2,percent of total billed charges,79% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,693,63,,554.4,percent of total billed charges,63% of total billed charges,849.42,77.22,,679.54,percent of total billed charges,77.22% of total billed charges,727.1,66.1,,581.68,percent of total billed charges,66.1% of total billed charges,913,83,,730.4,percent of total billed charges,83% of total,1045,95,,836,percent of total billed charges ,95% of total billed charges,880,80,,704,percent of total billed charges,78% of total billed charges,858,78,,686.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,693,63,,554.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,693,63,,554.4,percent of total billed charges,63% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,869,79,,695.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1045,
SCREW CORTEX TITA 2.4X13,278227167,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
3 HOLE PLATE 2.4 MM,278227168,CDM,278,RC,C1713,HCPCS,outpatient,,,2907,2034.9,,2296.53,79,,1837.22,percent of total billed charges,79% of total billed charges,2616.3,90,,2093.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1831.41,63,,1465.13,percent of total billed charges,63% of total billed charges,2244.79,77.22,,1795.83,percent of total billed charges,77.22% of total billed charges,1921.53,66.1,,1537.22,percent of total billed charges,66.1% of total billed charges,2412.81,83,,1930.25,percent of total billed charges,83% of total,2761.65,95,,2209.32,percent of total billed charges ,95% of total billed charges,2325.6,80,,1860.48,percent of total billed charges,78% of total billed charges,2267.46,78,,1813.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1831.41,63,,1465.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2616.3,90,,2093.04,percent of total billed charges,90% of total billed charges,2325.6,80,,1860.48,percent of total billed charges,80% of total billed charges,1831.41,63,,1465.13,percent of total billed charges,63% of total billed charges,2470.95,85,,1976.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2296.53,79,,1837.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2761.65,
4.0 CANC SCREW (16),278227171,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
GRAFT,278227175,CDM,278,RC,C1768,HCPCS,outpatient,,,2750,1925,,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,2475,90,,1980,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2123.55,77.22,,1698.84,percent of total billed charges,77.22% of total billed charges,1817.75,66.1,,1454.2,percent of total billed charges,66.1% of total billed charges,2282.5,83,,1826,percent of total billed charges,83% of total,2612.5,95,,2090,percent of total billed charges ,95% of total billed charges,2200,80,,1760,percent of total billed charges,78% of total billed charges,2145,78,,1716,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2475,90,,1980,percent of total billed charges,90% of total billed charges,2200,80,,1760,percent of total billed charges,80% of total billed charges,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2337.5,85,,1870,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2612.5,
HUMERUS PLATE II H,278227205,CDM,278,RC,C1713,HCPCS,outpatient,,,5085,3559.5,,4017.15,79,,3213.72,percent of total billed charges,79% of total billed charges,4576.5,90,,3661.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3203.55,63,,2562.84,percent of total billed charges,63% of total billed charges,3926.64,77.22,,3141.31,percent of total billed charges,77.22% of total billed charges,3361.19,66.1,,2688.95,percent of total billed charges,66.1% of total billed charges,4220.55,83,,3376.44,percent of total billed charges,83% of total,4830.75,95,,3864.6,percent of total billed charges ,95% of total billed charges,4068,80,,3254.4,percent of total billed charges,78% of total billed charges,3966.3,78,,3173.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3203.55,63,,2562.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4576.5,90,,3661.2,percent of total billed charges,90% of total billed charges,4068,80,,3254.4,percent of total billed charges,80% of total billed charges,3203.55,63,,2562.84,percent of total billed charges,63% of total billed charges,4322.25,85,,3457.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4017.15,79,,3213.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4830.75,
3.5 COITICAL SCREW 20 MM,278227206,CDM,278,RC,C1713,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
3.5 COITICAL SCREW 24 MM,278227207,CDM,278,RC,C1713,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
3.5 COITICAL SCREW 26 MM,278227208,CDM,278,RC,C1713,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
3.5 COITICAL SCREW 28 MM,278227209,CDM,278,RC,C1713,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
3.5 COITICAL SCREW 32 MM,278227210,CDM,278,RC,C1713,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
3.5 COITICAL SCREW 22 MM,278227211,CDM,278,RC,C1713,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
3.5 LOCKING SCREW 36 MM,278227212,CDM,278,RC,C1713,HCPCS,outpatient,,,420,294,,331.8,79,,265.44,percent of total billed charges,79% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,324.32,77.22,,259.46,percent of total billed charges,77.22% of total billed charges,277.62,66.1,,222.1,percent of total billed charges,66.1% of total billed charges,348.6,83,,278.88,percent of total billed charges,83% of total,399,95,,319.2,percent of total billed charges ,95% of total billed charges,336,80,,268.8,percent of total billed charges,78% of total billed charges,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,331.8,79,,265.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,264.6,450,
3.5 LOCKING SCREW 30 MM,278227213,CDM,278,RC,C1713,HCPCS,outpatient,,,420,294,,331.8,79,,265.44,percent of total billed charges,79% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,324.32,77.22,,259.46,percent of total billed charges,77.22% of total billed charges,277.62,66.1,,222.1,percent of total billed charges,66.1% of total billed charges,348.6,83,,278.88,percent of total billed charges,83% of total,399,95,,319.2,percent of total billed charges ,95% of total billed charges,336,80,,268.8,percent of total billed charges,78% of total billed charges,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,331.8,79,,265.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,264.6,450,
3.5 LOCKING SCREW 38 MM,278227214,CDM,278,RC,C1713,HCPCS,outpatient,,,420,294,,331.8,79,,265.44,percent of total billed charges,79% of total billed charges,378,90,,302.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,324.32,77.22,,259.46,percent of total billed charges,77.22% of total billed charges,277.62,66.1,,222.1,percent of total billed charges,66.1% of total billed charges,348.6,83,,278.88,percent of total billed charges,83% of total,399,95,,319.2,percent of total billed charges ,95% of total billed charges,336,80,,268.8,percent of total billed charges,78% of total billed charges,327.6,78,,262.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,264.6,63,,211.68,percent of total billed charges,63% of total billed charges,357,85,,285.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,331.8,79,,265.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,264.6,450,
THREADED PEG 2.3 X 10 MM,278227224,CDM,278,RC,C1713,HCPCS,outpatient,,,314,219.8,,248.06,79,,198.45,percent of total billed charges,79% of total billed charges,282.6,90,,226.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,197.82,63,,158.26,percent of total billed charges,63% of total billed charges,242.47,77.22,,193.98,percent of total billed charges,77.22% of total billed charges,207.55,66.1,,166.04,percent of total billed charges,66.1% of total billed charges,260.62,83,,208.5,percent of total billed charges,83% of total,298.3,95,,238.64,percent of total billed charges ,95% of total billed charges,251.2,80,,200.96,percent of total billed charges,78% of total billed charges,244.92,78,,195.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,197.82,63,,158.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,197.82,63,,158.26,percent of total billed charges,63% of total billed charges,266.9,85,,213.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,248.06,79,,198.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,197.82,450,
THREADED PEG 2.3 X 14MM,278227225,CDM,278,RC,C1713,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,249.86,66.1,,199.89,percent of total billed charges,66.1% of total billed charges,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,238.14,450,
GEMINUS HOOK PLATE,278227226,CDM,278,RC,C1713,HCPCS,outpatient,,,1170,819,,924.3,79,,739.44,percent of total billed charges,79% of total billed charges,1053,90,,842.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,737.1,63,,589.68,percent of total billed charges,63% of total billed charges,903.47,77.22,,722.78,percent of total billed charges,77.22% of total billed charges,773.37,66.1,,618.7,percent of total billed charges,66.1% of total billed charges,971.1,83,,776.88,percent of total billed charges,83% of total,1111.5,95,,889.2,percent of total billed charges ,95% of total billed charges,936,80,,748.8,percent of total billed charges,78% of total billed charges,912.6,78,,730.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,737.1,63,,589.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1053,90,,842.4,percent of total billed charges,90% of total billed charges,936,80,,748.8,percent of total billed charges,80% of total billed charges,737.1,63,,589.68,percent of total billed charges,63% of total billed charges,994.5,85,,795.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,924.3,79,,739.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1111.5,
GEMINUS HOOK PLATE SCREW,278227227,CDM,278,RC,C1713,HCPCS,outpatient,,,253,177.1,,199.87,79,,159.9,percent of total billed charges,79% of total billed charges,227.7,90,,182.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.39,63,,127.51,percent of total billed charges,63% of total billed charges,195.37,77.22,,156.3,percent of total billed charges,77.22% of total billed charges,167.23,66.1,,133.78,percent of total billed charges,66.1% of total billed charges,209.99,83,,167.99,percent of total billed charges,83% of total,240.35,95,,192.28,percent of total billed charges ,95% of total billed charges,202.4,80,,161.92,percent of total billed charges,78% of total billed charges,197.34,78,,157.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,159.39,63,,127.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,159.39,63,,127.51,percent of total billed charges,63% of total billed charges,215.05,85,,172.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,199.87,79,,159.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,159.39,450,
2.7 CORTICAL SCREW (24MM),278227263,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
4.0 CAN CANC SCREW (18MM),278227264,CDM,278,RC,C1713,HCPCS,outpatient,,,697,487.9,,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,627.3,90,,501.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,538.22,77.22,,430.58,percent of total billed charges,77.22% of total billed charges,460.72,66.1,,368.58,percent of total billed charges,66.1% of total billed charges,578.51,83,,462.81,percent of total billed charges,83% of total,662.15,95,,529.72,percent of total billed charges ,95% of total billed charges,557.6,80,,446.08,percent of total billed charges,78% of total billed charges,543.66,78,,434.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,439.11,662.15,
IMP SYSTEM HAND WRIST INT BRAC,278227273,CDM,278,RC,C1771,HCPCS,outpatient,,,3360,2352,,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2594.59,77.22,,2075.67,percent of total billed charges,77.22% of total billed charges,2220.96,66.1,,1776.77,percent of total billed charges,66.1% of total billed charges,2788.8,83,,2231.04,percent of total billed charges,83% of total,3192,95,,2553.6,percent of total billed charges ,95% of total billed charges,2688,80,,2150.4,percent of total billed charges,78% of total billed charges,2620.8,78,,2096.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,2688,80,,2150.4,percent of total billed charges,80% of total billed charges,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2856,85,,2284.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3192,
SUTURE ANCHOR 1.7 X 5 MM,278227329,CDM,278,RC,C1713,HCPCS,outpatient,,,1100,770,,869,79,,695.2,percent of total billed charges,79% of total billed charges,990,90,,792,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,693,63,,554.4,percent of total billed charges,63% of total billed charges,849.42,77.22,,679.54,percent of total billed charges,77.22% of total billed charges,727.1,66.1,,581.68,percent of total billed charges,66.1% of total billed charges,913,83,,730.4,percent of total billed charges,83% of total,1045,95,,836,percent of total billed charges ,95% of total billed charges,880,80,,704,percent of total billed charges,78% of total billed charges,858,78,,686.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,693,63,,554.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,693,63,,554.4,percent of total billed charges,63% of total billed charges,935,85,,748,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,869,79,,695.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1045,
DX SWIVELOCK 3.5 X 13.5 MM,278227330,CDM,278,RC,C1713,HCPCS,outpatient,,,1368,957.6,,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1056.37,77.22,,845.1,percent of total billed charges,77.22% of total billed charges,904.25,66.1,,723.4,percent of total billed charges,66.1% of total billed charges,1135.44,83,,908.35,percent of total billed charges,83% of total,1299.6,95,,1039.68,percent of total billed charges ,95% of total billed charges,1094.4,80,,875.52,percent of total billed charges,78% of total billed charges,1067.04,78,,853.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1231.2,90,,984.96,percent of total billed charges,90% of total billed charges,1094.4,80,,875.52,percent of total billed charges,80% of total billed charges,861.84,63,,689.47,percent of total billed charges,63% of total billed charges,1162.8,85,,930.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1080.72,79,,864.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1299.6,
CANCELLOUS CRUSHED 1-4 MM,278227385,CDM,278,RC,C1713,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
ALLOSYNC 5 CC,278227386,CDM,278,RC,C1713,HCPCS,outpatient,,,1845,1291.5,,1457.55,79,,1166.04,percent of total billed charges,79% of total billed charges,1660.5,90,,1328.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1162.35,63,,929.88,percent of total billed charges,63% of total billed charges,1424.71,77.22,,1139.77,percent of total billed charges,77.22% of total billed charges,1219.55,66.1,,975.64,percent of total billed charges,66.1% of total billed charges,1531.35,83,,1225.08,percent of total billed charges,83% of total,1752.75,95,,1402.2,percent of total billed charges ,95% of total billed charges,1476,80,,1180.8,percent of total billed charges,78% of total billed charges,1439.1,78,,1151.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1162.35,63,,929.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1660.5,90,,1328.4,percent of total billed charges,90% of total billed charges,1476,80,,1180.8,percent of total billed charges,80% of total billed charges,1162.35,63,,929.88,percent of total billed charges,63% of total billed charges,1568.25,85,,1254.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1457.55,79,,1166.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1752.75,
SCREW CORTEX TITA 2.4X22,278227405,CDM,278,RC,C1713,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,235.98,66.1,,188.78,percent of total billed charges,66.1% of total billed charges,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,224.91,63,,179.93,percent of total billed charges,63% of total billed charges,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,224.91,450,
SCREW CORTEX TITA 2.4 X 30,278227406,CDM,278,RC,C1713,HCPCS,outpatient,,,382,267.4,,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,294.98,77.22,,235.98,percent of total billed charges,77.22% of total billed charges,252.5,66.1,,202,percent of total billed charges,66.1% of total billed charges,317.06,83,,253.65,percent of total billed charges,83% of total,362.9,95,,290.32,percent of total billed charges ,95% of total billed charges,305.6,80,,244.48,percent of total billed charges,78% of total billed charges,297.96,78,,238.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,240.66,450,
SUTURE ANCHOR 5.5 X 24.5 MM,278227434,CDM,278,RC,C1713,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,892.35,66.1,,713.88,percent of total billed charges,66.1% of total billed charges,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,850.5,63,,680.4,percent of total billed charges,63% of total billed charges,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
SCREW CORTEX 2.0MMX11MM,278227512,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
SCREW CORTEX 2.0MMX12MM,278227513,CDM,278,RC,C1713,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,107.1,450,
FIBULAR COMPOSITE PLATE,278227583,CDM,278,RC,C1713,HCPCS,outpatient,,,1192,834.4,,941.68,79,,753.34,percent of total billed charges,79% of total billed charges,1072.8,90,,858.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,750.96,63,,600.77,percent of total billed charges,63% of total billed charges,920.46,77.22,,736.37,percent of total billed charges,77.22% of total billed charges,787.91,66.1,,630.33,percent of total billed charges,66.1% of total billed charges,989.36,83,,791.49,percent of total billed charges,83% of total,1132.4,95,,905.92,percent of total billed charges ,95% of total billed charges,953.6,80,,762.88,percent of total billed charges,78% of total billed charges,929.76,78,,743.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,750.96,63,,600.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1072.8,90,,858.24,percent of total billed charges,90% of total billed charges,953.6,80,,762.88,percent of total billed charges,80% of total billed charges,750.96,63,,600.77,percent of total billed charges,63% of total billed charges,1013.2,85,,810.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,941.68,79,,753.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1132.4,
8 HOLE 1/3 TUB PLATE,278227584,CDM,278,RC,C1713,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,347.03,66.1,,277.62,percent of total billed charges,66.1% of total billed charges,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,330.75,63,,264.6,percent of total billed charges,63% of total billed charges,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,330.75,498.75,
SCREW CORTICAL 3.5 X 16,278227585,CDM,278,RC,C1713,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
SCREW CORTICAL 3.5 X 18,278227586,CDM,278,RC,C1713,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
SCREW LOCK CORTICAL 3.5X14,278227587,CDM,278,RC,C1713,HCPCS,outpatient,,,600,420,,474,79,,379.2,percent of total billed charges,79% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,463.32,77.22,,370.66,percent of total billed charges,77.22% of total billed charges,396.6,66.1,,317.28,percent of total billed charges,66.1% of total billed charges,498,83,,398.4,percent of total billed charges,83% of total,570,95,,456,percent of total billed charges ,95% of total billed charges,480,80,,384,percent of total billed charges,78% of total billed charges,468,78,,374.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,378,63,,302.4,percent of total billed charges,63% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,474,79,,379.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,570,
SCREW LOCK CORTICAL 3.5 X 46,278227588,CDM,278,RC,C1713,HCPCS,outpatient,,,600,420,,474,79,,379.2,percent of total billed charges,79% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,463.32,77.22,,370.66,percent of total billed charges,77.22% of total billed charges,396.6,66.1,,317.28,percent of total billed charges,66.1% of total billed charges,498,83,,398.4,percent of total billed charges,83% of total,570,95,,456,percent of total billed charges ,95% of total billed charges,480,80,,384,percent of total billed charges,78% of total billed charges,468,78,,374.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,378,63,,302.4,percent of total billed charges,63% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,474,79,,379.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,570,
SCREW LOCK CORTICAL 3.5 X 48,278227589,CDM,278,RC,C1713,HCPCS,outpatient,,,600,420,,474,79,,379.2,percent of total billed charges,79% of total billed charges,540,90,,432,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,463.32,77.22,,370.66,percent of total billed charges,77.22% of total billed charges,396.6,66.1,,317.28,percent of total billed charges,66.1% of total billed charges,498,83,,398.4,percent of total billed charges,83% of total,570,95,,456,percent of total billed charges ,95% of total billed charges,480,80,,384,percent of total billed charges,78% of total billed charges,468,78,,374.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,378,63,,302.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,378,63,,302.4,percent of total billed charges,63% of total billed charges,510,85,,408,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,474,79,,379.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,378,570,
SCREW CANCELLOUS 4.0 X 40,278227590,CDM,278,RC,C1713,HCPCS,outpatient,,,742,519.4,,586.18,79,,468.94,percent of total billed charges,79% of total billed charges,667.8,90,,534.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.46,63,,373.97,percent of total billed charges,63% of total billed charges,572.97,77.22,,458.38,percent of total billed charges,77.22% of total billed charges,490.46,66.1,,392.37,percent of total billed charges,66.1% of total billed charges,615.86,83,,492.69,percent of total billed charges,83% of total,704.9,95,,563.92,percent of total billed charges ,95% of total billed charges,593.6,80,,474.88,percent of total billed charges,78% of total billed charges,578.76,78,,463.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,467.46,63,,373.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,467.46,63,,373.97,percent of total billed charges,63% of total billed charges,630.7,85,,504.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,586.18,79,,468.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,704.9,
SCREW CANCELLOUS 4.0 X 20,278227591,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
10 HOLE PLATE,278227593,CDM,278,RC,C1713,HCPCS,outpatient,,,475,332.5,,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,427.5,90,,342,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,366.8,77.22,,293.44,percent of total billed charges,77.22% of total billed charges,313.98,66.1,,251.18,percent of total billed charges,66.1% of total billed charges,394.25,83,,315.4,percent of total billed charges,83% of total,451.25,95,,361,percent of total billed charges ,95% of total billed charges,380,80,,304,percent of total billed charges,78% of total billed charges,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,299.25,451.25,
SCREW CORTICAL 3.5 X 20,278227594,CDM,278,RC,C1713,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
SCREW CANCELLOUS 4.0 X 18,278227595,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CANCELLOUS 4.0 X 22,278227596,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
CANNULATED CAN SCREW 4.0X44,278227598,CDM,278,RC,C1713,HCPCS,outpatient,,,697,487.9,,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,627.3,90,,501.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,538.22,77.22,,430.58,percent of total billed charges,77.22% of total billed charges,460.72,66.1,,368.58,percent of total billed charges,66.1% of total billed charges,578.51,83,,462.81,percent of total billed charges,83% of total,662.15,95,,529.72,percent of total billed charges ,95% of total billed charges,557.6,80,,446.08,percent of total billed charges,78% of total billed charges,543.66,78,,434.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,439.11,662.15,
CANNULATED CAN SCREW 4.0X36,278227599,CDM,278,RC,C1713,HCPCS,outpatient,,,697,487.9,,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,627.3,90,,501.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,538.22,77.22,,430.58,percent of total billed charges,77.22% of total billed charges,460.72,66.1,,368.58,percent of total billed charges,66.1% of total billed charges,578.51,83,,462.81,percent of total billed charges,83% of total,662.15,95,,529.72,percent of total billed charges ,95% of total billed charges,557.6,80,,446.08,percent of total billed charges,78% of total billed charges,543.66,78,,434.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,439.11,63,,351.29,percent of total billed charges,63% of total billed charges,592.45,85,,473.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,550.63,79,,440.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,439.11,662.15,
SCREW CANCELLOUS 4.0 X 26,278227600,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
SCREW CANCELLOUS 4.0 X 34,278227601,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
SCREW CANCELLOUS 4.0 X 40,278227602,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
SCREW CANCELLOUS 4.0 X 42,278227603,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
SCREW CORTICAL 3.5 X 26,278227604,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CORTICAL 3.5 X 36,278227605,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CORTICAL 3.5 X 38,278227606,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CORTICAL 3.5 X 42,278227607,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CORTICAL 3.5 X 48,278227608,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CORTICAL 3.5 X 55,278227609,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
X-LG CALCAN PERI PLATE,278227610,CDM,278,RC,C1713,HCPCS,outpatient,,,1912,1338.4,,1510.48,79,,1208.38,percent of total billed charges,79% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1204.56,63,,963.65,percent of total billed charges,63% of total billed charges,1476.45,77.22,,1181.16,percent of total billed charges,77.22% of total billed charges,1263.83,66.1,,1011.06,percent of total billed charges,66.1% of total billed charges,1586.96,83,,1269.57,percent of total billed charges,83% of total,1816.4,95,,1453.12,percent of total billed charges ,95% of total billed charges,1529.6,80,,1223.68,percent of total billed charges,78% of total billed charges,1491.36,78,,1193.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1204.56,63,,963.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1204.56,63,,963.65,percent of total billed charges,63% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1510.48,79,,1208.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1816.4,
SCREW CORTICAL 3.5 X 12,278227685,CDM,278,RC,C1713,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
SCREW CORTICAL 3.5 X 14,278227686,CDM,278,RC,C1713,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
SCREEN CANCELLOUS 4.0 X 14,278227798,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CANCELLOUS 4.0 X 16,278227799,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SCREW CORTICAL 3.5X15,278227847,CDM,278,RC,C1713,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
ECHO 2 10 X 15 MESH,278227858,CDM,278,RC,C1781,HCPCS,outpatient,,,2182,1527.4,,1723.78,79,,1379.02,percent of total billed charges,79% of total billed charges,1963.8,90,,1571.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1374.66,63,,1099.73,percent of total billed charges,63% of total billed charges,1684.94,77.22,,1347.95,percent of total billed charges,77.22% of total billed charges,1442.3,66.1,,1153.84,percent of total billed charges,66.1% of total billed charges,1811.06,83,,1448.85,percent of total billed charges,83% of total,2072.9,95,,1658.32,percent of total billed charges ,95% of total billed charges,1745.6,80,,1396.48,percent of total billed charges,78% of total billed charges,1701.96,78,,1361.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1374.66,63,,1099.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1963.8,90,,1571.04,percent of total billed charges,90% of total billed charges,1745.6,80,,1396.48,percent of total billed charges,80% of total billed charges,1374.66,63,,1099.73,percent of total billed charges,63% of total billed charges,1854.7,85,,1483.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1723.78,79,,1379.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2072.9,
SCREW CORTICAL 3.5X22,278227888,CDM,278,RC,C1713,HCPCS,outpatient,,,330,231,,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,297,90,,237.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,254.83,77.22,,203.86,percent of total billed charges,77.22% of total billed charges,218.13,66.1,,174.5,percent of total billed charges,66.1% of total billed charges,273.9,83,,219.12,percent of total billed charges,83% of total,313.5,95,,250.8,percent of total billed charges ,95% of total billed charges,264,80,,211.2,percent of total billed charges,78% of total billed charges,257.4,78,,205.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.9,63,,166.32,percent of total billed charges,63% of total billed charges,280.5,85,,224.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,260.7,79,,208.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.9,450,
SCREW CANCELLOUS 4.0 X 24,278227889,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
5.5 55MM JONES SCREW,278227929,CDM,278,RC,C1713,HCPCS,outpatient,,,2813,1969.1,,2222.27,79,,1777.82,percent of total billed charges,79% of total billed charges,2531.7,90,,2025.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1772.19,63,,1417.75,percent of total billed charges,63% of total billed charges,2172.2,77.22,,1737.76,percent of total billed charges,77.22% of total billed charges,1859.39,66.1,,1487.51,percent of total billed charges,66.1% of total billed charges,2334.79,83,,1867.83,percent of total billed charges,83% of total,2672.35,95,,2137.88,percent of total billed charges ,95% of total billed charges,2250.4,80,,1800.32,percent of total billed charges,78% of total billed charges,2194.14,78,,1755.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1772.19,63,,1417.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2531.7,90,,2025.36,percent of total billed charges,90% of total billed charges,2250.4,80,,1800.32,percent of total billed charges,80% of total billed charges,1772.19,63,,1417.75,percent of total billed charges,63% of total billed charges,2391.05,85,,1912.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2222.27,79,,1777.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2672.35,
5.5 TAP,278227930,CDM,278,RC,C1713,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,227.38,66.1,,181.9,percent of total billed charges,66.1% of total billed charges,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,216.72,450,
4.5 TAP,278227931,CDM,278,RC,C1713,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,227.38,66.1,,181.9,percent of total billed charges,66.1% of total billed charges,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,216.72,450,
SCREW CANCELLOUS 2.7 X 20,278227957,CDM,278,RC,C1713,HCPCS,outpatient,,,302,211.4,,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,271.8,90,,217.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,233.2,77.22,,186.56,percent of total billed charges,77.22% of total billed charges,199.62,66.1,,159.7,percent of total billed charges,66.1% of total billed charges,250.66,83,,200.53,percent of total billed charges,83% of total,286.9,95,,229.52,percent of total billed charges ,95% of total billed charges,241.6,80,,193.28,percent of total billed charges,78% of total billed charges,235.56,78,,188.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,190.26,63,,152.21,percent of total billed charges,63% of total billed charges,256.7,85,,205.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,238.58,79,,190.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,190.26,450,
SUTURE ANCHOR 4.75 X 14MM,278227960,CDM,278,RC,C1713,HCPCS,outpatient,,,1012,708.4,,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,781.47,77.22,,625.18,percent of total billed charges,77.22% of total billed charges,668.93,66.1,,535.14,percent of total billed charges,66.1% of total billed charges,839.96,83,,671.97,percent of total billed charges,83% of total,961.4,95,,769.12,percent of total billed charges ,95% of total billed charges,809.6,80,,647.68,percent of total billed charges,78% of total billed charges,789.36,78,,631.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,910.8,90,,728.64,percent of total billed charges,90% of total billed charges,809.6,80,,647.68,percent of total billed charges,80% of total billed charges,637.56,63,,510.05,percent of total billed charges,63% of total billed charges,860.2,85,,688.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,799.48,79,,639.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,961.4,
IMPLANT SEC FIX W PEEK,278227961,CDM,278,RC,C1713,HCPCS,outpatient,,,2331,1631.7,,1841.49,79,,1473.19,percent of total billed charges,79% of total billed charges,2097.9,90,,1678.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1468.53,63,,1174.82,percent of total billed charges,63% of total billed charges,1800,77.22,,1440,percent of total billed charges,77.22% of total billed charges,1540.79,66.1,,1232.63,percent of total billed charges,66.1% of total billed charges,1934.73,83,,1547.78,percent of total billed charges,83% of total,2214.45,95,,1771.56,percent of total billed charges ,95% of total billed charges,1864.8,80,,1491.84,percent of total billed charges,78% of total billed charges,1818.18,78,,1454.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1468.53,63,,1174.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2097.9,90,,1678.32,percent of total billed charges,90% of total billed charges,1864.8,80,,1491.84,percent of total billed charges,80% of total billed charges,1468.53,63,,1174.82,percent of total billed charges,63% of total billed charges,1981.35,85,,1585.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1841.49,79,,1473.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2214.45,
8.0 CANNULATED SCREW 80MM,278227986,CDM,278,RC,C1713,HCPCS,outpatient,,,1170,819,,924.3,79,,739.44,percent of total billed charges,79% of total billed charges,1053,90,,842.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,737.1,63,,589.68,percent of total billed charges,63% of total billed charges,903.47,77.22,,722.78,percent of total billed charges,77.22% of total billed charges,773.37,66.1,,618.7,percent of total billed charges,66.1% of total billed charges,971.1,83,,776.88,percent of total billed charges,83% of total,1111.5,95,,889.2,percent of total billed charges ,95% of total billed charges,936,80,,748.8,percent of total billed charges,78% of total billed charges,912.6,78,,730.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,737.1,63,,589.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1053,90,,842.4,percent of total billed charges,90% of total billed charges,936,80,,748.8,percent of total billed charges,80% of total billed charges,737.1,63,,589.68,percent of total billed charges,63% of total billed charges,994.5,85,,795.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,924.3,79,,739.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1111.5,
4.5 CORTICAL SCREW 36MM,278227987,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
4.5 CORTICAL SCREW 38MM,278227988,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
4.5 CORTICAL SCREW 42MM,278227989,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
4.5 CORTICAL SCREW 44MM,278227990,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
4.5 CORTICAL SCREW 46MM,278227991,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
FEMORAL PLATE RIGHT,278227992,CDM,278,RC,C1713,HCPCS,outpatient,,,6255,4378.5,,4941.45,79,,3953.16,percent of total billed charges,79% of total billed charges,5629.5,90,,4503.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3940.65,63,,3152.52,percent of total billed charges,63% of total billed charges,4830.11,77.22,,3864.09,percent of total billed charges,77.22% of total billed charges,4134.56,66.1,,3307.65,percent of total billed charges,66.1% of total billed charges,5191.65,83,,4153.32,percent of total billed charges,83% of total,5942.25,95,,4753.8,percent of total billed charges ,95% of total billed charges,5004,80,,4003.2,percent of total billed charges,78% of total billed charges,4878.9,78,,3903.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3940.65,63,,3152.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5629.5,90,,4503.6,percent of total billed charges,90% of total billed charges,5004,80,,4003.2,percent of total billed charges,80% of total billed charges,3940.65,63,,3152.52,percent of total billed charges,63% of total billed charges,5316.75,85,,4253.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4941.45,79,,3953.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5942.25,
5.0 CORTICAL SCREW 38MM,278227994,CDM,278,RC,C1713,HCPCS,outpatient,,,765,535.5,,604.35,79,,483.48,percent of total billed charges,79% of total billed charges,688.5,90,,550.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,481.95,63,,385.56,percent of total billed charges,63% of total billed charges,590.73,77.22,,472.58,percent of total billed charges,77.22% of total billed charges,505.67,66.1,,404.54,percent of total billed charges,66.1% of total billed charges,634.95,83,,507.96,percent of total billed charges,83% of total,726.75,95,,581.4,percent of total billed charges ,95% of total billed charges,612,80,,489.6,percent of total billed charges,78% of total billed charges,596.7,78,,477.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,481.95,63,,385.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,688.5,90,,550.8,percent of total billed charges,90% of total billed charges,612,80,,489.6,percent of total billed charges,80% of total billed charges,481.95,63,,385.56,percent of total billed charges,63% of total billed charges,650.25,85,,520.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,604.35,79,,483.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,726.75,
5.0 CORTICAL SCREW 70MM,278227995,CDM,278,RC,C1713,HCPCS,outpatient,,,765,535.5,,604.35,79,,483.48,percent of total billed charges,79% of total billed charges,688.5,90,,550.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,481.95,63,,385.56,percent of total billed charges,63% of total billed charges,590.73,77.22,,472.58,percent of total billed charges,77.22% of total billed charges,505.67,66.1,,404.54,percent of total billed charges,66.1% of total billed charges,634.95,83,,507.96,percent of total billed charges,83% of total,726.75,95,,581.4,percent of total billed charges ,95% of total billed charges,612,80,,489.6,percent of total billed charges,78% of total billed charges,596.7,78,,477.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,481.95,63,,385.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,688.5,90,,550.8,percent of total billed charges,90% of total billed charges,612,80,,489.6,percent of total billed charges,80% of total billed charges,481.95,63,,385.56,percent of total billed charges,63% of total billed charges,650.25,85,,520.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,604.35,79,,483.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,726.75,
4.5 CORTICAL SCREW 40MM,278227996,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
4.5 LOCKING SCREW 40MM,278227997,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
4.5 LOCKING SCREW 45MM,278227998,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
5.5 LOCKING SCREW 35MM,278227999,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
5.5 LOCKING SCREW 65MM,278228000,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
5.5 LOCKING SCREW 70MM,278228001,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
7.3 MM CANNULATED 85 MM,278228129,CDM,278,RC,C1713,HCPCS,outpatient,,,1084,758.8,,856.36,79,,685.09,percent of total billed charges,79% of total billed charges,975.6,90,,780.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,682.92,63,,546.34,percent of total billed charges,63% of total billed charges,837.06,77.22,,669.65,percent of total billed charges,77.22% of total billed charges,716.52,66.1,,573.22,percent of total billed charges,66.1% of total billed charges,899.72,83,,719.78,percent of total billed charges,83% of total,1029.8,95,,823.84,percent of total billed charges ,95% of total billed charges,867.2,80,,693.76,percent of total billed charges,78% of total billed charges,845.52,78,,676.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,682.92,63,,546.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,682.92,63,,546.34,percent of total billed charges,63% of total billed charges,921.4,85,,737.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,856.36,79,,685.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1029.8,
IMPLANT SCORPION 4.75X19.1 MM,278228172,CDM,278,RC,C1781,HCPCS,outpatient,,,7164,5014.8,,5659.56,79,,4527.65,percent of total billed charges,79% of total billed charges,6447.6,90,,5158.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4513.32,63,,3610.66,percent of total billed charges,63% of total billed charges,5532.04,77.22,,4425.63,percent of total billed charges,77.22% of total billed charges,4735.4,66.1,,3788.32,percent of total billed charges,66.1% of total billed charges,5946.12,83,,4756.9,percent of total billed charges,83% of total,6805.8,95,,5444.64,percent of total billed charges ,95% of total billed charges,5731.2,80,,4584.96,percent of total billed charges,78% of total billed charges,5587.92,78,,4470.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4513.32,63,,3610.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6447.6,90,,5158.08,percent of total billed charges,90% of total billed charges,5731.2,80,,4584.96,percent of total billed charges,80% of total billed charges,4513.32,63,,3610.66,percent of total billed charges,63% of total billed charges,6089.4,85,,4871.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5659.56,79,,4527.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,6805.8,
ISTENT G2W,278228391,CDM,278,RC,L8612,HCPCS,outpatient,,,3656,2559.2,,2888.24,79,,2310.59,percent of total billed charges,79% of total billed charges,3290.4,90,,2632.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,2823.16,77.22,,2258.53,percent of total billed charges,77.22% of total billed charges,2416.62,66.1,,1933.3,percent of total billed charges,66.1% of total billed charges,3034.48,83,,2427.58,percent of total billed charges,83% of total,3473.2,95,,2778.56,percent of total billed charges ,95% of total billed charges,2924.8,80,,2339.84,percent of total billed charges,78% of total billed charges,2851.68,78,,2281.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3290.4,90,,2632.32,percent of total billed charges,90% of total billed charges,2924.8,80,,2339.84,percent of total billed charges,80% of total billed charges,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,3107.6,85,,2486.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2888.24,79,,2310.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3473.2,
ANCHOR 4.75X19.1MM W/ #2 SUTUR,278228411,CDM,278,RC,C1713,HCPCS,outpatient,,,1726,1208.2,,1363.54,79,,1090.83,percent of total billed charges,79% of total billed charges,1553.4,90,,1242.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1087.38,63,,869.9,percent of total billed charges,63% of total billed charges,1332.82,77.22,,1066.26,percent of total billed charges,77.22% of total billed charges,1140.89,66.1,,912.71,percent of total billed charges,66.1% of total billed charges,1432.58,83,,1146.06,percent of total billed charges,83% of total,1639.7,95,,1311.76,percent of total billed charges ,95% of total billed charges,1380.8,80,,1104.64,percent of total billed charges,78% of total billed charges,1346.28,78,,1077.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1087.38,63,,869.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1553.4,90,,1242.72,percent of total billed charges,90% of total billed charges,1380.8,80,,1104.64,percent of total billed charges,80% of total billed charges,1087.38,63,,869.9,percent of total billed charges,63% of total billed charges,1467.1,85,,1173.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1363.54,79,,1090.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1639.7,
BIOCOMP SWIVELOCK 4.75X19.1,278228631,CDM,278,RC,C1713,HCPCS,outpatient,,,2401,1680.7,,1896.79,79,,1517.43,percent of total billed charges,79% of total billed charges,2160.9,90,,1728.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1512.63,63,,1210.1,percent of total billed charges,63% of total billed charges,1854.05,77.22,,1483.24,percent of total billed charges,77.22% of total billed charges,1587.06,66.1,,1269.65,percent of total billed charges,66.1% of total billed charges,1992.83,83,,1594.26,percent of total billed charges,83% of total,2280.95,95,,1824.76,percent of total billed charges ,95% of total billed charges,1920.8,80,,1536.64,percent of total billed charges,78% of total billed charges,1872.78,78,,1498.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1512.63,63,,1210.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1512.63,63,,1210.1,percent of total billed charges,63% of total billed charges,2040.85,85,,1632.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1896.79,79,,1517.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2280.95,
ANCHOR W CLOSED PEEL 4.75X19.1,278228633,CDM,278,RC,C1713,HCPCS,outpatient,,,1764,1234.8,,1393.56,79,,1114.85,percent of total billed charges,79% of total billed charges,1587.6,90,,1270.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,1362.16,77.22,,1089.73,percent of total billed charges,77.22% of total billed charges,1166,66.1,,932.8,percent of total billed charges,66.1% of total billed charges,1464.12,83,,1171.3,percent of total billed charges,83% of total,1675.8,95,,1340.64,percent of total billed charges ,95% of total billed charges,1411.2,80,,1128.96,percent of total billed charges,78% of total billed charges,1375.92,78,,1100.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1587.6,90,,1270.08,percent of total billed charges,90% of total billed charges,1411.2,80,,1128.96,percent of total billed charges,80% of total billed charges,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,1499.4,85,,1199.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1393.56,79,,1114.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1675.8,
4.75 BC LOOP N TRACK,278228776,CDM,278,RC,C1713,HCPCS,outpatient,,,3002,2101.4,,2371.58,79,,1897.26,percent of total billed charges,79% of total billed charges,2701.8,90,,2161.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1891.26,63,,1513.01,percent of total billed charges,63% of total billed charges,2318.14,77.22,,1854.51,percent of total billed charges,77.22% of total billed charges,1984.32,66.1,,1587.46,percent of total billed charges,66.1% of total billed charges,2491.66,83,,1993.33,percent of total billed charges,83% of total,2851.9,95,,2281.52,percent of total billed charges ,95% of total billed charges,2401.6,80,,1921.28,percent of total billed charges,78% of total billed charges,2341.56,78,,1873.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1891.26,63,,1513.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2701.8,90,,2161.44,percent of total billed charges,90% of total billed charges,2401.6,80,,1921.28,percent of total billed charges,80% of total billed charges,1891.26,63,,1513.01,percent of total billed charges,63% of total billed charges,2551.7,85,,2041.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2371.58,79,,1897.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2851.9,
PANNUS RETENTION SYS CZ PRS04,278228800,CDM,278,RC,,,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.56,450,
CANCELLOUS SCREW 4.0X16,278228952,CDM,278,RC,C1713,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,214.83,66.1,,171.86,percent of total billed charges,66.1% of total billed charges,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.75,63,,163.8,percent of total billed charges,63% of total billed charges,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.75,450,
INTERNALBRACE,278228953,CDM,278,RC,C1713,HCPCS,outpatient,,,4806,3364.2,,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,3711.19,77.22,,2968.95,percent of total billed charges,77.22% of total billed charges,3176.77,66.1,,2541.42,percent of total billed charges,66.1% of total billed charges,3988.98,83,,3191.18,percent of total billed charges,83% of total,4565.7,95,,3652.56,percent of total billed charges ,95% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,78% of total billed charges,3748.68,78,,2998.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,80% of total billed charges,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,4085.1,85,,3268.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4565.7,
MESH PHASIX 6X8,278228968,CDM,278,RC,C1781,HCPCS,outpatient,,,12993.81,9095.67,,10265.11,79,,8212.09,percent of total billed charges,79% of total billed charges,11694.43,90,,9355.54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8186.1,63,,6548.88,percent of total billed charges,63% of total billed charges,10033.82,77.22,,8027.06,percent of total billed charges,77.22% of total billed charges,8588.91,66.1,,6871.13,percent of total billed charges,66.1% of total billed charges,10784.86,83,,8627.89,percent of total billed charges,83% of total,12344.12,95,,9875.3,percent of total billed charges ,95% of total billed charges,10395.05,80,,8316.04,percent of total billed charges,78% of total billed charges,10135.17,78,,8108.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8186.1,63,,6548.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,11694.43,90,,9355.54,percent of total billed charges,90% of total billed charges,10395.05,80,,8316.04,percent of total billed charges,80% of total billed charges,8186.1,63,,6548.88,percent of total billed charges,63% of total billed charges,11044.74,85,,8835.792,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10265.11,79,,8212.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,12344.12,
INTERBRACE IMP KNEE LIG AUG,278228984,CDM,278,RC,C1781,HCPCS,outpatient,,,3843,2690.1,,3035.97,79,,2428.78,percent of total billed charges,79% of total billed charges,3458.7,90,,2766.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2421.09,63,,1936.87,percent of total billed charges,63% of total billed charges,2967.56,77.22,,2374.05,percent of total billed charges,77.22% of total billed charges,2540.22,66.1,,2032.18,percent of total billed charges,66.1% of total billed charges,3189.69,83,,2551.75,percent of total billed charges,83% of total,3650.85,95,,2920.68,percent of total billed charges ,95% of total billed charges,3074.4,80,,2459.52,percent of total billed charges,78% of total billed charges,2997.54,78,,2398.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2421.09,63,,1936.87,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3458.7,90,,2766.96,percent of total billed charges,90% of total billed charges,3074.4,80,,2459.52,percent of total billed charges,80% of total billed charges,2421.09,63,,1936.87,percent of total billed charges,63% of total billed charges,3266.55,85,,2613.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3035.97,79,,2428.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3650.85,
PRESUTURED TENDON 4.5X230MM,278229031,CDM,278,RC,C1768,HCPCS,outpatient,,,2750,1925,,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,2475,90,,1980,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2123.55,77.22,,1698.84,percent of total billed charges,77.22% of total billed charges,1817.75,66.1,,1454.2,percent of total billed charges,66.1% of total billed charges,2282.5,83,,1826,percent of total billed charges,83% of total,2612.5,95,,2090,percent of total billed charges ,95% of total billed charges,2200,80,,1760,percent of total billed charges,78% of total billed charges,2145,78,,1716,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2475,90,,1980,percent of total billed charges,90% of total billed charges,2200,80,,1760,percent of total billed charges,80% of total billed charges,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2337.5,85,,1870,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2612.5,
IMPLANT 5.5 MM,278229033,CDM,278,RC,C1781,HCPCS,outpatient,,,4806,3364.2,,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,3711.19,77.22,,2968.95,percent of total billed charges,77.22% of total billed charges,3176.77,66.1,,2541.42,percent of total billed charges,66.1% of total billed charges,3988.98,83,,3191.18,percent of total billed charges,83% of total,4565.7,95,,3652.56,percent of total billed charges ,95% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,78% of total billed charges,3748.68,78,,2998.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,80% of total billed charges,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,4085.1,85,,3268.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4565.7,
IMPLANT 6.25 MM,278229034,CDM,278,RC,C1781,HCPCS,outpatient,,,4806,3364.2,,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,3711.19,77.22,,2968.95,percent of total billed charges,77.22% of total billed charges,3176.77,66.1,,2541.42,percent of total billed charges,66.1% of total billed charges,3988.98,83,,3191.18,percent of total billed charges,83% of total,4565.7,95,,3652.56,percent of total billed charges ,95% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,78% of total billed charges,3748.68,78,,2998.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4325.4,90,,3460.32,percent of total billed charges,90% of total billed charges,3844.8,80,,3075.84,percent of total billed charges,80% of total billed charges,3027.78,63,,2422.22,percent of total billed charges,63% of total billed charges,4085.1,85,,3268.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3796.74,79,,3037.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4565.7,
FIBULOCK NAIL 3.0X130,27822910,CDM,278,RC,C1713,HCPCS,outpatient,,,9628,6739.6,,7606.12,79,,6084.9,percent of total billed charges,79% of total billed charges,8665.2,90,,6932.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6065.64,63,,4852.51,percent of total billed charges,63% of total billed charges,7434.74,77.22,,5947.79,percent of total billed charges,77.22% of total billed charges,6364.11,66.1,,5091.29,percent of total billed charges,66.1% of total billed charges,7991.24,83,,6392.99,percent of total billed charges,83% of total,9146.6,95,,7317.28,percent of total billed charges ,95% of total billed charges,7702.4,80,,6161.92,percent of total billed charges,78% of total billed charges,7509.84,78,,6007.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6065.64,63,,4852.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,8665.2,90,,6932.16,percent of total billed charges,90% of total billed charges,7702.4,80,,6161.92,percent of total billed charges,80% of total billed charges,6065.64,63,,4852.51,percent of total billed charges,63% of total billed charges,8183.8,85,,6547.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7606.12,79,,6084.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,9146.6,
PT CANNULATED SCREW 4.0X38,278229154,CDM,278,RC,C1713,HCPCS,outpatient,,,832,582.4,,657.28,79,,525.82,percent of total billed charges,79% of total billed charges,748.8,90,,599.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,524.16,63,,419.33,percent of total billed charges,63% of total billed charges,642.47,77.22,,513.98,percent of total billed charges,77.22% of total billed charges,549.95,66.1,,439.96,percent of total billed charges,66.1% of total billed charges,690.56,83,,552.45,percent of total billed charges,83% of total,790.4,95,,632.32,percent of total billed charges ,95% of total billed charges,665.6,80,,532.48,percent of total billed charges,78% of total billed charges,648.96,78,,519.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,524.16,63,,419.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,524.16,63,,419.33,percent of total billed charges,63% of total billed charges,707.2,85,,565.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,657.28,79,,525.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,790.4,
NONLOCKING SCREW 2.7X32MM,278229155,CDM,278,RC,C1713,HCPCS,outpatient,,,862,603.4,,680.98,79,,544.78,percent of total billed charges,79% of total billed charges,775.8,90,,620.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.06,63,,434.45,percent of total billed charges,63% of total billed charges,665.64,77.22,,532.51,percent of total billed charges,77.22% of total billed charges,569.78,66.1,,455.82,percent of total billed charges,66.1% of total billed charges,715.46,83,,572.37,percent of total billed charges,83% of total,818.9,95,,655.12,percent of total billed charges ,95% of total billed charges,689.6,80,,551.68,percent of total billed charges,78% of total billed charges,672.36,78,,537.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,543.06,63,,434.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,775.8,90,,620.64,percent of total billed charges,90% of total billed charges,689.6,80,,551.68,percent of total billed charges,80% of total billed charges,543.06,63,,434.45,percent of total billed charges,63% of total billed charges,732.7,85,,586.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,680.98,79,,544.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,818.9,
NONLOCKING SCREW 2.7X28,278229156,CDM,278,RC,C1713,HCPCS,outpatient,,,431,301.7,,340.49,79,,272.39,percent of total billed charges,79% of total billed charges,387.9,90,,310.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,332.82,77.22,,266.26,percent of total billed charges,77.22% of total billed charges,284.89,66.1,,227.91,percent of total billed charges,66.1% of total billed charges,357.73,83,,286.18,percent of total billed charges,83% of total,409.45,95,,327.56,percent of total billed charges ,95% of total billed charges,344.8,80,,275.84,percent of total billed charges,78% of total billed charges,336.18,78,,268.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,340.49,79,,272.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,271.53,450,
NONLOCKING SCREW 2.7X30MM,278229157,CDM,278,RC,C1713,HCPCS,outpatient,,,431,301.7,,340.49,79,,272.39,percent of total billed charges,79% of total billed charges,387.9,90,,310.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,332.82,77.22,,266.26,percent of total billed charges,77.22% of total billed charges,284.89,66.1,,227.91,percent of total billed charges,66.1% of total billed charges,357.73,83,,286.18,percent of total billed charges,83% of total,409.45,95,,327.56,percent of total billed charges ,95% of total billed charges,344.8,80,,275.84,percent of total billed charges,78% of total billed charges,336.18,78,,268.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,271.53,63,,217.22,percent of total billed charges,63% of total billed charges,366.35,85,,293.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,340.49,79,,272.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,271.53,450,
LOCKING PLATE 5 HOLE,278229160,CDM,278,RC,C1713,HCPCS,outpatient,,,2331,1631.7,,1841.49,79,,1473.19,percent of total billed charges,79% of total billed charges,2097.9,90,,1678.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1468.53,63,,1174.82,percent of total billed charges,63% of total billed charges,1800,77.22,,1440,percent of total billed charges,77.22% of total billed charges,1540.79,66.1,,1232.63,percent of total billed charges,66.1% of total billed charges,1934.73,83,,1547.78,percent of total billed charges,83% of total,2214.45,95,,1771.56,percent of total billed charges ,95% of total billed charges,1864.8,80,,1491.84,percent of total billed charges,78% of total billed charges,1818.18,78,,1454.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1468.53,63,,1174.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2097.9,90,,1678.32,percent of total billed charges,90% of total billed charges,1864.8,80,,1491.84,percent of total billed charges,80% of total billed charges,1468.53,63,,1174.82,percent of total billed charges,63% of total billed charges,1981.35,85,,1585.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1841.49,79,,1473.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2214.45,
LOCKING SCREW 2.7X16MM,278229161,CDM,278,RC,C1713,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
LOCKING SCREW 2.7X18 MM,278229162,CDM,278,RC,C1713,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
LOCKING SCREW 2.7X28MM,278229163,CDM,278,RC,C1713,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
CORTIAL SCREW 14MM,278229164,CDM,278,RC,C1713,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
LOCKING SCREW 14MM 3.5,278229165,CDM,278,RC,C1713,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
LOCKING SCREW 16MM 3.5,278229166,CDM,278,RC,C1713,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,259.56,450,
ECHO PS LAP MESH 11CM CIRCLE,278229186,CDM,278,RC,C1781,HCPCS,outpatient,,,1418,992.6,,1120.22,79,,896.18,percent of total billed charges,79% of total billed charges,1276.2,90,,1020.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,893.34,63,,714.67,percent of total billed charges,63% of total billed charges,1094.98,77.22,,875.98,percent of total billed charges,77.22% of total billed charges,937.3,66.1,,749.84,percent of total billed charges,66.1% of total billed charges,1176.94,83,,941.55,percent of total billed charges,83% of total,1347.1,95,,1077.68,percent of total billed charges ,95% of total billed charges,1134.4,80,,907.52,percent of total billed charges,78% of total billed charges,1106.04,78,,884.832,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,893.34,63,,714.67,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1276.2,90,,1020.96,percent of total billed charges,90% of total billed charges,1134.4,80,,907.52,percent of total billed charges,80% of total billed charges,893.34,63,,714.67,percent of total billed charges,63% of total billed charges,1205.3,85,,964.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1120.22,79,,896.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1347.1,
SCREW COMPRESSION 4.0,278229261,CDM,278,RC,C1713,HCPCS,outpatient,,,1125,787.5,,888.75,79,,711,percent of total billed charges,79% of total billed charges,1012.5,90,,810,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,868.73,77.22,,694.98,percent of total billed charges,77.22% of total billed charges,743.63,66.1,,594.9,percent of total billed charges,66.1% of total billed charges,933.75,83,,747,percent of total billed charges,83% of total,1068.75,95,,855,percent of total billed charges ,95% of total billed charges,900,80,,720,percent of total billed charges,78% of total billed charges,877.5,78,,702,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,708.75,63,,567,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1012.5,90,,810,percent of total billed charges,90% of total billed charges,900,80,,720,percent of total billed charges,80% of total billed charges,708.75,63,,567,percent of total billed charges,63% of total billed charges,956.25,85,,765,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,888.75,79,,711,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1068.75,
THREADED PEG 2.3MM X 17MM,278229275,CDM,278,RC,C1713,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,249.86,66.1,,199.89,percent of total billed charges,66.1% of total billed charges,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,238.14,450,
4.75 BC LOOP N TRACK,278229277,CDM,278,RC,C1713,HCPCS,outpatient,,,2572,1800.4,,2031.88,79,,1625.5,percent of total billed charges,79% of total billed charges,2314.8,90,,1851.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1620.36,63,,1296.29,percent of total billed charges,63% of total billed charges,1986.1,77.22,,1588.88,percent of total billed charges,77.22% of total billed charges,1700.09,66.1,,1360.07,percent of total billed charges,66.1% of total billed charges,2134.76,83,,1707.81,percent of total billed charges,83% of total,2443.4,95,,1954.72,percent of total billed charges ,95% of total billed charges,2057.6,80,,1646.08,percent of total billed charges,78% of total billed charges,2006.16,78,,1604.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1620.36,63,,1296.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2314.8,90,,1851.84,percent of total billed charges,90% of total billed charges,2057.6,80,,1646.08,percent of total billed charges,80% of total billed charges,1620.36,63,,1296.29,percent of total billed charges,63% of total billed charges,2186.2,85,,1748.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2031.88,79,,1625.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2443.4,
2.6 FIBERTAK RC,278229278,CDM,278,RC,C1713,HCPCS,outpatient,,,1512,1058.4,,1194.48,79,,955.58,percent of total billed charges,79% of total billed charges,1360.8,90,,1088.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,1167.57,77.22,,934.06,percent of total billed charges,77.22% of total billed charges,999.43,66.1,,799.54,percent of total billed charges,66.1% of total billed charges,1254.96,83,,1003.97,percent of total billed charges,83% of total,1436.4,95,,1149.12,percent of total billed charges ,95% of total billed charges,1209.6,80,,967.68,percent of total billed charges,78% of total billed charges,1179.36,78,,943.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,1285.2,85,,1028.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1194.48,79,,955.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1436.4,
2.6 FIBERTAK RC W/B,278229279,CDM,278,RC,C1713,HCPCS,outpatient,,,1512,1058.4,,1194.48,79,,955.58,percent of total billed charges,79% of total billed charges,1360.8,90,,1088.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,1167.57,77.22,,934.06,percent of total billed charges,77.22% of total billed charges,999.43,66.1,,799.54,percent of total billed charges,66.1% of total billed charges,1254.96,83,,1003.97,percent of total billed charges,83% of total,1436.4,95,,1149.12,percent of total billed charges ,95% of total billed charges,1209.6,80,,967.68,percent of total billed charges,78% of total billed charges,1179.36,78,,943.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,1285.2,85,,1028.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1194.48,79,,955.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1436.4,
2.6 FIBERTAK RC BLUE,278229280,CDM,278,RC,C1713,HCPCS,outpatient,,,1512,1058.4,,1194.48,79,,955.58,percent of total billed charges,79% of total billed charges,1360.8,90,,1088.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,1167.57,77.22,,934.06,percent of total billed charges,77.22% of total billed charges,999.43,66.1,,799.54,percent of total billed charges,66.1% of total billed charges,1254.96,83,,1003.97,percent of total billed charges,83% of total,1436.4,95,,1149.12,percent of total billed charges ,95% of total billed charges,1209.6,80,,967.68,percent of total billed charges,78% of total billed charges,1179.36,78,,943.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,952.56,63,,762.05,percent of total billed charges,63% of total billed charges,1285.2,85,,1028.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1194.48,79,,955.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1436.4,
SWIVELOCK 4.75 X 19.1MM,278229281,CDM,278,RC,C1713,HCPCS,outpatient,,,1764,1234.8,,1393.56,79,,1114.85,percent of total billed charges,79% of total billed charges,1587.6,90,,1270.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,1362.16,77.22,,1089.73,percent of total billed charges,77.22% of total billed charges,1166,66.1,,932.8,percent of total billed charges,66.1% of total billed charges,1464.12,83,,1171.3,percent of total billed charges,83% of total,1675.8,95,,1340.64,percent of total billed charges ,95% of total billed charges,1411.2,80,,1128.96,percent of total billed charges,78% of total billed charges,1375.92,78,,1100.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1587.6,90,,1270.08,percent of total billed charges,90% of total billed charges,1411.2,80,,1128.96,percent of total billed charges,80% of total billed charges,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,1499.4,85,,1199.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1393.56,79,,1114.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1675.8,
3.5 BEVELED FT SCREW,278229287,CDM,278,RC,C1713,HCPCS,outpatient,,,2556,1789.2,,2019.24,79,,1615.39,percent of total billed charges,79% of total billed charges,2300.4,90,,1840.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,1973.74,77.22,,1578.99,percent of total billed charges,77.22% of total billed charges,1689.52,66.1,,1351.62,percent of total billed charges,66.1% of total billed charges,2121.48,83,,1697.18,percent of total billed charges,83% of total,2428.2,95,,1942.56,percent of total billed charges ,95% of total billed charges,2044.8,80,,1635.84,percent of total billed charges,78% of total billed charges,1993.68,78,,1594.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2300.4,90,,1840.32,percent of total billed charges,90% of total billed charges,2044.8,80,,1635.84,percent of total billed charges,80% of total billed charges,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,2172.6,85,,1738.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2019.24,79,,1615.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2428.2,
4.5MM PT SCREW 50MM,278229308,CDM,278,RC,C1713,HCPCS,outpatient,,,2556,1789.2,,2019.24,79,,1615.39,percent of total billed charges,79% of total billed charges,2300.4,90,,1840.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,1973.74,77.22,,1578.99,percent of total billed charges,77.22% of total billed charges,1689.52,66.1,,1351.62,percent of total billed charges,66.1% of total billed charges,2121.48,83,,1697.18,percent of total billed charges,83% of total,2428.2,95,,1942.56,percent of total billed charges ,95% of total billed charges,2044.8,80,,1635.84,percent of total billed charges,78% of total billed charges,1993.68,78,,1594.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2300.4,90,,1840.32,percent of total billed charges,90% of total billed charges,2044.8,80,,1635.84,percent of total billed charges,80% of total billed charges,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,2172.6,85,,1738.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2019.24,79,,1615.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2428.2,
FIBULOCK NAIL 3.0X130,278229310,CDM,278,RC,C1713,HCPCS,outpatient,,,9628,6739.6,,7606.12,79,,6084.9,percent of total billed charges,79% of total billed charges,8665.2,90,,6932.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6065.64,63,,4852.51,percent of total billed charges,63% of total billed charges,7434.74,77.22,,5947.79,percent of total billed charges,77.22% of total billed charges,6364.11,66.1,,5091.29,percent of total billed charges,66.1% of total billed charges,7991.24,83,,6392.99,percent of total billed charges,83% of total,9146.6,95,,7317.28,percent of total billed charges ,95% of total billed charges,7702.4,80,,6161.92,percent of total billed charges,78% of total billed charges,7509.84,78,,6007.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6065.64,63,,4852.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,8665.2,90,,6932.16,percent of total billed charges,90% of total billed charges,7702.4,80,,6161.92,percent of total billed charges,80% of total billed charges,6065.64,63,,4852.51,percent of total billed charges,63% of total billed charges,8183.8,85,,6547.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7606.12,79,,6084.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,9146.6,
3 HOLE PLATE,278229351,CDM,278,RC,C1713,HCPCS,outpatient,,,2981,2086.7,,2354.99,79,,1883.99,percent of total billed charges,79% of total billed charges,2682.9,90,,2146.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1878.03,63,,1502.42,percent of total billed charges,63% of total billed charges,2301.93,77.22,,1841.54,percent of total billed charges,77.22% of total billed charges,1970.44,66.1,,1576.35,percent of total billed charges,66.1% of total billed charges,2474.23,83,,1979.38,percent of total billed charges,83% of total,2831.95,95,,2265.56,percent of total billed charges ,95% of total billed charges,2384.8,80,,1907.84,percent of total billed charges,78% of total billed charges,2325.18,78,,1860.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1878.03,63,,1502.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2682.9,90,,2146.32,percent of total billed charges,90% of total billed charges,2384.8,80,,1907.84,percent of total billed charges,80% of total billed charges,1878.03,63,,1502.42,percent of total billed charges,63% of total billed charges,2533.85,85,,2027.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2354.99,79,,1883.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2831.95,
2.4 LOCKING SCREW 20MM,278229352,CDM,278,RC,C1713,HCPCS,outpatient,,,585,409.5,,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,451.74,77.22,,361.39,percent of total billed charges,77.22% of total billed charges,386.69,66.1,,309.35,percent of total billed charges,66.1% of total billed charges,485.55,83,,388.44,percent of total billed charges,83% of total,555.75,95,,444.6,percent of total billed charges ,95% of total billed charges,468,80,,374.4,percent of total billed charges,78% of total billed charges,456.3,78,,365.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,468,80,,374.4,percent of total billed charges,80% of total billed charges,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,497.25,85,,397.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,555.75,
2.4 LOCKING SCREW 18MM,278229353,CDM,278,RC,C1713,HCPCS,outpatient,,,585,409.5,,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,451.74,77.22,,361.39,percent of total billed charges,77.22% of total billed charges,386.69,66.1,,309.35,percent of total billed charges,66.1% of total billed charges,485.55,83,,388.44,percent of total billed charges,83% of total,555.75,95,,444.6,percent of total billed charges ,95% of total billed charges,468,80,,374.4,percent of total billed charges,78% of total billed charges,456.3,78,,365.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,468,80,,374.4,percent of total billed charges,80% of total billed charges,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,497.25,85,,397.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,555.75,
2.4 CORTICAL SCREW 24 MM,278229354,CDM,278,RC,C1713,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,355.21,77.22,,284.17,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,289.8,450,
3.5 CORTICAL SCREW 14 MM,278229355,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
3.5 CORTICAL SCREW 16MM,278229356,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
TRULIANT FEMORAL COMP SZ 3 LFT,278229389,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIBIAL TRAY PRS 3F/2T,278229390,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
TRULIANT CRC TIBIAL SZ 3 11MM,278229391,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
3 PEG PATELLA CEMENTED 35MM,278229392,CDM,278,RC,C1776,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,425.25,641.25,
CEMEX GENTA HIGH VISCOSITY,278229393,CDM,278,RC,C1734,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
LOW PROFILE IMPLANTED PORT,278229478,CDM,278,RC,C1788,HCPCS,outpatient,,,1037,725.9,,819.23,79,,655.38,percent of total billed charges,79% of total billed charges,933.3,90,,746.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,653.31,63,,522.65,percent of total billed charges,63% of total billed charges,800.77,77.22,,640.62,percent of total billed charges,77.22% of total billed charges,685.46,66.1,,548.37,percent of total billed charges,66.1% of total billed charges,860.71,83,,688.57,percent of total billed charges,83% of total,985.15,95,,788.12,percent of total billed charges ,95% of total billed charges,829.6,80,,663.68,percent of total billed charges,78% of total billed charges,808.86,78,,647.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,653.31,63,,522.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,933.3,90,,746.64,percent of total billed charges,90% of total billed charges,829.6,80,,663.68,percent of total billed charges,80% of total billed charges,653.31,63,,522.65,percent of total billed charges,63% of total billed charges,881.45,85,,705.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,819.23,79,,655.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,985.15,
TRULIANT FEM COMP CRC SZ 1 LFT,278229499,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIBIAL TRAY PRS 1F/1T,278229500,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
TRULIANT CRC TBL INS SZ 1 13MM,278229501,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
THREE HOLE PLATE GMN-LTN-3HL,278229502,CDM,278,RC,C1713,HCPCS,outpatient,,,2876,2013.2,,2272.04,79,,1817.63,percent of total billed charges,79% of total billed charges,2588.4,90,,2070.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1811.88,63,,1449.5,percent of total billed charges,63% of total billed charges,2220.85,77.22,,1776.68,percent of total billed charges,77.22% of total billed charges,1901.04,66.1,,1520.83,percent of total billed charges,66.1% of total billed charges,2387.08,83,,1909.66,percent of total billed charges,83% of total,2732.2,95,,2185.76,percent of total billed charges ,95% of total billed charges,2300.8,80,,1840.64,percent of total billed charges,78% of total billed charges,2243.28,78,,1794.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1811.88,63,,1449.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2588.4,90,,2070.72,percent of total billed charges,90% of total billed charges,2300.8,80,,1840.64,percent of total billed charges,80% of total billed charges,1811.88,63,,1449.5,percent of total billed charges,63% of total billed charges,2444.6,85,,1955.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2272.04,79,,1817.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2732.2,
TRULIANT CRC TIB CR SZ 3 15MM,278229503,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
HYDRUS MICROSTENT,278229520,CDM,278,RC,C1783,HCPCS,outpatient,,,3825,2677.5,,3021.75,79,,2417.4,percent of total billed charges,79% of total billed charges,3442.5,90,,2754,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2409.75,63,,1927.8,percent of total billed charges,63% of total billed charges,2953.67,77.22,,2362.94,percent of total billed charges,77.22% of total billed charges,2528.33,66.1,,2022.66,percent of total billed charges,66.1% of total billed charges,3174.75,83,,2539.8,percent of total billed charges,83% of total,3633.75,95,,2907,percent of total billed charges ,95% of total billed charges,3060,80,,2448,percent of total billed charges,78% of total billed charges,2983.5,78,,2386.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2409.75,63,,1927.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3442.5,90,,2754,percent of total billed charges,90% of total billed charges,3060,80,,2448,percent of total billed charges,80% of total billed charges,2409.75,63,,1927.8,percent of total billed charges,63% of total billed charges,3251.25,85,,2601,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3021.75,79,,2417.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3633.75,
TRULIANT FEM CMP CRUC 2.5 RT,278229532,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIBIAL TRAY,278229533,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
"TRULIANT CRC TIB INS 2.5, 10MM",278229534,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
SPANNING PLATE,278229545,CDM,278,RC,C1713,HCPCS,outpatient,,,6732,4712.4,,5318.28,79,,4254.62,percent of total billed charges,79% of total billed charges,6058.8,90,,4847.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4241.16,63,,3392.93,percent of total billed charges,63% of total billed charges,5198.45,77.22,,4158.76,percent of total billed charges,77.22% of total billed charges,4449.85,66.1,,3559.88,percent of total billed charges,66.1% of total billed charges,5587.56,83,,4470.05,percent of total billed charges,83% of total,6395.4,95,,5116.32,percent of total billed charges ,95% of total billed charges,5385.6,80,,4308.48,percent of total billed charges,78% of total billed charges,5250.96,78,,4200.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4241.16,63,,3392.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6058.8,90,,4847.04,percent of total billed charges,90% of total billed charges,5385.6,80,,4308.48,percent of total billed charges,80% of total billed charges,4241.16,63,,3392.93,percent of total billed charges,63% of total billed charges,5722.2,85,,4577.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5318.28,79,,4254.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,6395.4,
2.4 SCREW CORTICAL,278229546,CDM,278,RC,C1713,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,355.21,77.22,,284.17,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,289.8,450,
3.5 CORTICAL SCREW,278229547,CDM,278,RC,C1713,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,181.78,66.1,,145.42,percent of total billed charges,66.1% of total billed charges,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,173.25,63,,138.6,percent of total billed charges,63% of total billed charges,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.25,450,
3.5 LOCKING SCREW,278229548,CDM,278,RC,C1713,HCPCS,outpatient,,,625,437.5,,493.75,79,,395,percent of total billed charges,79% of total billed charges,562.5,90,,450,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,482.63,77.22,,386.1,percent of total billed charges,77.22% of total billed charges,413.13,66.1,,330.5,percent of total billed charges,66.1% of total billed charges,518.75,83,,415,percent of total billed charges,83% of total,593.75,95,,475,percent of total billed charges ,95% of total billed charges,500,80,,400,percent of total billed charges,78% of total billed charges,487.5,78,,390,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,393.75,63,,315,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,562.5,90,,450,percent of total billed charges,90% of total billed charges,500,80,,400,percent of total billed charges,80% of total billed charges,393.75,63,,315,percent of total billed charges,63% of total billed charges,531.25,85,,425,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,493.75,79,,395,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,393.75,593.75,
2.4 LOCKING SCREW,278229549,CDM,278,RC,C1713,HCPCS,outpatient,,,585,409.5,,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,451.74,77.22,,361.39,percent of total billed charges,77.22% of total billed charges,386.69,66.1,,309.35,percent of total billed charges,66.1% of total billed charges,485.55,83,,388.44,percent of total billed charges,83% of total,555.75,95,,444.6,percent of total billed charges ,95% of total billed charges,468,80,,374.4,percent of total billed charges,78% of total billed charges,456.3,78,,365.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,468,80,,374.4,percent of total billed charges,80% of total billed charges,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,497.25,85,,397.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,555.75,
2.4 LOCKING SCREW,278229550,CDM,278,RC,C1713,HCPCS,outpatient,,,585,409.5,,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,451.74,77.22,,361.39,percent of total billed charges,77.22% of total billed charges,386.69,66.1,,309.35,percent of total billed charges,66.1% of total billed charges,485.55,83,,388.44,percent of total billed charges,83% of total,555.75,95,,444.6,percent of total billed charges ,95% of total billed charges,468,80,,374.4,percent of total billed charges,78% of total billed charges,456.3,78,,365.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,468,80,,374.4,percent of total billed charges,80% of total billed charges,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,497.25,85,,397.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,555.75,
2.4 LOCKING SCREW,278229551,CDM,278,RC,C1713,HCPCS,outpatient,,,585,409.5,,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,451.74,77.22,,361.39,percent of total billed charges,77.22% of total billed charges,386.69,66.1,,309.35,percent of total billed charges,66.1% of total billed charges,485.55,83,,388.44,percent of total billed charges,83% of total,555.75,95,,444.6,percent of total billed charges ,95% of total billed charges,468,80,,374.4,percent of total billed charges,78% of total billed charges,456.3,78,,365.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,526.5,90,,421.2,percent of total billed charges,90% of total billed charges,468,80,,374.4,percent of total billed charges,80% of total billed charges,368.55,63,,294.84,percent of total billed charges,63% of total billed charges,497.25,85,,397.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,462.15,79,,369.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,368.55,555.75,
FIBERTAG TIGHTROPE W/ATT NEEDL,278229552,CDM,278,RC,C1713,HCPCS,outpatient,,,3807,2664.9,,3007.53,79,,2406.02,percent of total billed charges,79% of total billed charges,3426.3,90,,2741.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2398.41,63,,1918.73,percent of total billed charges,63% of total billed charges,2939.77,77.22,,2351.82,percent of total billed charges,77.22% of total billed charges,2516.43,66.1,,2013.14,percent of total billed charges,66.1% of total billed charges,3159.81,83,,2527.85,percent of total billed charges,83% of total,3616.65,95,,2893.32,percent of total billed charges ,95% of total billed charges,3045.6,80,,2436.48,percent of total billed charges,78% of total billed charges,2969.46,78,,2375.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2398.41,63,,1918.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2398.41,63,,1918.73,percent of total billed charges,63% of total billed charges,3235.95,85,,2588.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3007.53,79,,2406.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3616.65,
ACL FIBERTAG TIGHTROPE ABS,278229556,CDM,278,RC,C1713,HCPCS,outpatient,,,1258,880.6,,993.82,79,,795.06,percent of total billed charges,79% of total billed charges,1132.2,90,,905.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,792.54,63,,634.03,percent of total billed charges,63% of total billed charges,971.43,77.22,,777.14,percent of total billed charges,77.22% of total billed charges,831.54,66.1,,665.23,percent of total billed charges,66.1% of total billed charges,1044.14,83,,835.31,percent of total billed charges,83% of total,1195.1,95,,956.08,percent of total billed charges ,95% of total billed charges,1006.4,80,,805.12,percent of total billed charges,78% of total billed charges,981.24,78,,784.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,792.54,63,,634.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1132.2,90,,905.76,percent of total billed charges,90% of total billed charges,1006.4,80,,805.12,percent of total billed charges,80% of total billed charges,792.54,63,,634.03,percent of total billed charges,63% of total billed charges,1069.3,85,,855.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,993.82,79,,795.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1195.1,
TIGHTROPE ABS BUTTON 11MM,278229557,CDM,278,RC,C1713,HCPCS,outpatient,,,1033,723.1,,816.07,79,,652.86,percent of total billed charges,79% of total billed charges,929.7,90,,743.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,650.79,63,,520.63,percent of total billed charges,63% of total billed charges,797.68,77.22,,638.14,percent of total billed charges,77.22% of total billed charges,682.81,66.1,,546.25,percent of total billed charges,66.1% of total billed charges,857.39,83,,685.91,percent of total billed charges,83% of total,981.35,95,,785.08,percent of total billed charges ,95% of total billed charges,826.4,80,,661.12,percent of total billed charges,78% of total billed charges,805.74,78,,644.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,650.79,63,,520.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,929.7,90,,743.76,percent of total billed charges,90% of total billed charges,826.4,80,,661.12,percent of total billed charges,80% of total billed charges,650.79,63,,520.63,percent of total billed charges,63% of total billed charges,878.05,85,,702.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,816.07,79,,652.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,981.35,
MENISCAL ROOT RPR PK SWIVELOCK,278229567,CDM,278,RC,C1713,HCPCS,outpatient,,,5231,3661.7,,4132.49,79,,3305.99,percent of total billed charges,79% of total billed charges,4707.9,90,,3766.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3295.53,63,,2636.42,percent of total billed charges,63% of total billed charges,4039.38,77.22,,3231.5,percent of total billed charges,77.22% of total billed charges,3457.69,66.1,,2766.15,percent of total billed charges,66.1% of total billed charges,4341.73,83,,3473.38,percent of total billed charges,83% of total,4969.45,95,,3975.56,percent of total billed charges ,95% of total billed charges,4184.8,80,,3347.84,percent of total billed charges,78% of total billed charges,4080.18,78,,3264.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3295.53,63,,2636.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4707.9,90,,3766.32,percent of total billed charges,90% of total billed charges,4184.8,80,,3347.84,percent of total billed charges,80% of total billed charges,3295.53,63,,2636.42,percent of total billed charges,63% of total billed charges,4446.35,85,,3557.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4132.49,79,,3305.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4969.45,
SEC FIX W/BIOCOMP SWIVELOCK,278229570,CDM,278,RC,C1713,HCPCS,outpatient,,,2720,1904,,2148.8,79,,1719.04,percent of total billed charges,79% of total billed charges,2448,90,,1958.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1713.6,63,,1370.88,percent of total billed charges,63% of total billed charges,2100.38,77.22,,1680.3,percent of total billed charges,77.22% of total billed charges,1797.92,66.1,,1438.34,percent of total billed charges,66.1% of total billed charges,2257.6,83,,1806.08,percent of total billed charges,83% of total,2584,95,,2067.2,percent of total billed charges ,95% of total billed charges,2176,80,,1740.8,percent of total billed charges,78% of total billed charges,2121.6,78,,1697.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1713.6,63,,1370.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2448,90,,1958.4,percent of total billed charges,90% of total billed charges,2176,80,,1740.8,percent of total billed charges,80% of total billed charges,1713.6,63,,1370.88,percent of total billed charges,63% of total billed charges,2312,85,,1849.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2148.8,79,,1719.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2584,
4.75 TENODIS BC KLLOOP & TRACK,278229595,CDM,278,RC,C1713,HCPCS,outpatient,,,3226,2258.2,,2548.54,79,,2038.83,percent of total billed charges,79% of total billed charges,2903.4,90,,2322.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2032.38,63,,1625.9,percent of total billed charges,63% of total billed charges,2491.12,77.22,,1992.9,percent of total billed charges,77.22% of total billed charges,2132.39,66.1,,1705.91,percent of total billed charges,66.1% of total billed charges,2677.58,83,,2142.06,percent of total billed charges,83% of total,3064.7,95,,2451.76,percent of total billed charges ,95% of total billed charges,2580.8,80,,2064.64,percent of total billed charges,78% of total billed charges,2516.28,78,,2013.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2032.38,63,,1625.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2903.4,90,,2322.72,percent of total billed charges,90% of total billed charges,2580.8,80,,2064.64,percent of total billed charges,80% of total billed charges,2032.38,63,,1625.9,percent of total billed charges,63% of total billed charges,2742.1,85,,2193.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2548.54,79,,2038.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3064.7,
TRIGEN INTERTAN INTERLOCK LAG,278229596,CDM,278,RC,C1713,HCPCS,outpatient,,,2447,1712.9,,1933.13,79,,1546.5,percent of total billed charges,79% of total billed charges,2202.3,90,,1761.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1541.61,63,,1233.29,percent of total billed charges,63% of total billed charges,1889.57,77.22,,1511.66,percent of total billed charges,77.22% of total billed charges,1617.47,66.1,,1293.98,percent of total billed charges,66.1% of total billed charges,2031.01,83,,1624.81,percent of total billed charges,83% of total,2324.65,95,,1859.72,percent of total billed charges ,95% of total billed charges,1957.6,80,,1566.08,percent of total billed charges,78% of total billed charges,1908.66,78,,1526.928,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1541.61,63,,1233.29,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2202.3,90,,1761.84,percent of total billed charges,90% of total billed charges,1957.6,80,,1566.08,percent of total billed charges,80% of total billed charges,1541.61,63,,1233.29,percent of total billed charges,63% of total billed charges,2079.95,85,,1663.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1933.13,79,,1546.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2324.65,
TRIGEN INTERTAN 1.5 11.5MMX125,278229597,CDM,278,RC,C1713,HCPCS,outpatient,,,14366,10056.2,,11349.14,79,,9079.31,percent of total billed charges,79% of total billed charges,12929.4,90,,10343.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9050.58,63,,7240.46,percent of total billed charges,63% of total billed charges,11093.43,77.22,,8874.74,percent of total billed charges,77.22% of total billed charges,9495.93,66.1,,7596.74,percent of total billed charges,66.1% of total billed charges,11923.78,83,,9539.02,percent of total billed charges,83% of total,13647.7,95,,10918.16,percent of total billed charges ,95% of total billed charges,11492.8,80,,9194.24,percent of total billed charges,78% of total billed charges,11205.48,78,,8964.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9050.58,63,,7240.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,12929.4,90,,10343.52,percent of total billed charges,90% of total billed charges,11492.8,80,,9194.24,percent of total billed charges,80% of total billed charges,9050.58,63,,7240.46,percent of total billed charges,63% of total billed charges,12211.1,85,,9768.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11349.14,79,,9079.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,13647.7,
3.5MM SUP MS CLAV PLATE 12HOLE,278229602,CDM,278,RC,C1713,HCPCS,outpatient,,,4736,3315.2,,3741.44,79,,2993.15,percent of total billed charges,79% of total billed charges,4262.4,90,,3409.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2983.68,63,,2386.94,percent of total billed charges,63% of total billed charges,3657.14,77.22,,2925.71,percent of total billed charges,77.22% of total billed charges,3130.5,66.1,,2504.4,percent of total billed charges,66.1% of total billed charges,3930.88,83,,3144.7,percent of total billed charges,83% of total,4499.2,95,,3599.36,percent of total billed charges ,95% of total billed charges,3788.8,80,,3031.04,percent of total billed charges,78% of total billed charges,3694.08,78,,2955.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2983.68,63,,2386.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4262.4,90,,3409.92,percent of total billed charges,90% of total billed charges,3788.8,80,,3031.04,percent of total billed charges,80% of total billed charges,2983.68,63,,2386.94,percent of total billed charges,63% of total billed charges,4025.6,85,,3220.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3741.44,79,,2993.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4499.2,
3.5MMX15MM CORTEX SCREW,278229603,CDM,278,RC,C1713,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.29,450,
3.5MMX16MM CORTEX SCREW,278229604,CDM,278,RC,C1713,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.29,450,
3.5MMX18MM CORTEX SCREW,278229605,CDM,278,RC,C1713,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.29,450,
3.5MMX19MM CORTEX SCREW,278229606,CDM,278,RC,C1713,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.29,450,
3.5MMX20MM CORTEX SCREW,278229607,CDM,278,RC,C1713,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.29,450,
3.5MMX17MM CORTEX SCREW,278229608,CDM,278,RC,C1713,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.29,450,
TRULIANT FEM CMP CRUC 2 RT,278229609,CDM,278,RC,C1776,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,1784.7,66.1,,1427.76,percent of total billed charges,66.1% of total billed charges,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,1701,63,,1360.8,percent of total billed charges,63% of total billed charges,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2565,
TRULIANT TIBIAL TRAY,278229610,CDM,278,RC,C1776,HCPCS,outpatient,,,3038,2126.6,,2400.02,79,,1920.02,percent of total billed charges,79% of total billed charges,2734.2,90,,2187.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1913.94,63,,1531.15,percent of total billed charges,63% of total billed charges,2345.94,77.22,,1876.75,percent of total billed charges,77.22% of total billed charges,2008.12,66.1,,1606.5,percent of total billed charges,66.1% of total billed charges,2521.54,83,,2017.23,percent of total billed charges,83% of total,2886.1,95,,2308.88,percent of total billed charges ,95% of total billed charges,2430.4,80,,1944.32,percent of total billed charges,78% of total billed charges,2369.64,78,,1895.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1913.94,63,,1531.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2734.2,90,,2187.36,percent of total billed charges,90% of total billed charges,2430.4,80,,1944.32,percent of total billed charges,80% of total billed charges,1913.94,63,,1531.15,percent of total billed charges,63% of total billed charges,2582.3,85,,2065.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2400.02,79,,1920.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2886.1,
OPTETRAK STEM STRAIGHT FEM/TIB,278229611,CDM,278,RC,,,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,425.25,641.25,
TRULIANT PSC TIBIAL INSERT,278229612,CDM,278,RC,C1713,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
GLYCERIN CORNEA IMPLANT,278229619,CDM,278,RC,V2785,HCPCS,outpatient,,,731,511.7,,577.49,79,,461.99,percent of total billed charges,79% of total billed charges,657.9,90,,526.32,percent of total billed charges,90% of total billed charges,450.38,100,,,Fee Schedule,100% of CMS OPPS rate,484.87,160,,,Fee Schedule,160% of CMS OPPS rate,467.62,130,,,Fee Schedule,130% of CMS OPPS rate,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,564.48,77.22,,451.58,percent of total billed charges,77.22% of total billed charges,483.19,66.1,,386.55,percent of total billed charges,66.1% of total billed charges,606.73,83,,485.38,percent of total billed charges,83% of total,694.45,95,,555.56,percent of total billed charges ,95% of total billed charges,584.8,80,,467.84,percent of total billed charges,78% of total billed charges,570.18,78,,456.144,percent of total billed charges,78% of total billed charges,450.38,100,,,Fee Schedule,100% of CMS OPPS rate,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,450.38,100,,,Fee Schedule,100% of CMS OPPS rate,657.9,90,,526.32,percent of total billed charges,90% of total billed charges,584.8,80,,467.84,percent of total billed charges,80% of total billed charges,460.53,63,,368.42,percent of total billed charges,63% of total billed charges,621.35,85,,497.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,446.36,93,,,fee schedule,93% of CMS OPPS rate,577.49,79,,461.99,percent of total billed charges,79% of total billed charges,450.38,100,,,Fee Schedule,100% of CMS OPPS rate,450.38,100,,,Fee Schedule,100% of CMS OPPS rate,446.36,694.45,
TRULIANT FEMORAL COMP SZ 4 LFT,278229659,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIBIAL TRAY POROUS,278229660,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
TRULIANT CRC TIB INSRT CR CONS,278229661,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
TRULIANT PSC TIB POSTR STBLZD,278229662,CDM,278,RC,C1713,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
TRULIANT FEMORAL SZ 2 LEFT,278229719,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIBIAL TRAY PRS 2F/2T,278229720,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
TRULIANT CRC TIB SZ 2/9MM,278229721,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
3.9 BC LOOP N TRACK TENODESIS,278229723,CDM,278,RC,C1713,HCPCS,outpatient,,,3002,2101.4,,2371.58,79,,1897.26,percent of total billed charges,79% of total billed charges,2701.8,90,,2161.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1891.26,63,,1513.01,percent of total billed charges,63% of total billed charges,2318.14,77.22,,1854.51,percent of total billed charges,77.22% of total billed charges,1984.32,66.1,,1587.46,percent of total billed charges,66.1% of total billed charges,2491.66,83,,1993.33,percent of total billed charges,83% of total,2851.9,95,,2281.52,percent of total billed charges ,95% of total billed charges,2401.6,80,,1921.28,percent of total billed charges,78% of total billed charges,2341.56,78,,1873.248,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1891.26,63,,1513.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2701.8,90,,2161.44,percent of total billed charges,90% of total billed charges,2401.6,80,,1921.28,percent of total billed charges,80% of total billed charges,1891.26,63,,1513.01,percent of total billed charges,63% of total billed charges,2551.7,85,,2041.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2371.58,79,,1897.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2851.9,
SUTURE ANCHOR 4.75 X 19.1 MM,278229724,CDM,278,RC,C1713,HCPCS,outpatient,,,1764,1234.8,,1393.56,79,,1114.85,percent of total billed charges,79% of total billed charges,1587.6,90,,1270.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,1362.16,77.22,,1089.73,percent of total billed charges,77.22% of total billed charges,1166,66.1,,932.8,percent of total billed charges,66.1% of total billed charges,1464.12,83,,1171.3,percent of total billed charges,83% of total,1675.8,95,,1340.64,percent of total billed charges ,95% of total billed charges,1411.2,80,,1128.96,percent of total billed charges,78% of total billed charges,1375.92,78,,1100.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1587.6,90,,1270.08,percent of total billed charges,90% of total billed charges,1411.2,80,,1128.96,percent of total billed charges,80% of total billed charges,1111.32,63,,889.06,percent of total billed charges,63% of total billed charges,1499.4,85,,1199.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1393.56,79,,1114.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1675.8,
TRULIANT FEMORAL COMP SZ 5 LFT,278229771,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
TRULIANT TIBIAL TRAY,278229772,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
"TRULIANT CRC TIB INS SZ 5, 9MM",278229773,CDM,278,RC,C1776,HCPCS,outpatient,,,1800,1260,,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,1620,90,,1296,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1389.96,77.22,,1111.97,percent of total billed charges,77.22% of total billed charges,1189.8,66.1,,951.84,percent of total billed charges,66.1% of total billed charges,1494,83,,1195.2,percent of total billed charges,83% of total,1710,95,,1368,percent of total billed charges ,95% of total billed charges,1440,80,,1152,percent of total billed charges,78% of total billed charges,1404,78,,1123.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1134,63,,907.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1134,63,,907.2,percent of total billed charges,63% of total billed charges,1530,85,,1224,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1422,79,,1137.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1710,
KNOTLESS 2.6 FIBER TAK BLUE,278229791,CDM,278,RC,C1713,HCPCS,outpatient,,,1989,1392.3,,1571.31,79,,1257.05,percent of total billed charges,79% of total billed charges,1790.1,90,,1432.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,1535.91,77.22,,1228.73,percent of total billed charges,77.22% of total billed charges,1314.73,66.1,,1051.78,percent of total billed charges,66.1% of total billed charges,1650.87,83,,1320.7,percent of total billed charges,83% of total,1889.55,95,,1511.64,percent of total billed charges ,95% of total billed charges,1591.2,80,,1272.96,percent of total billed charges,78% of total billed charges,1551.42,78,,1241.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1790.1,90,,1432.08,percent of total billed charges,90% of total billed charges,1591.2,80,,1272.96,percent of total billed charges,80% of total billed charges,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,1690.65,85,,1352.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1571.31,79,,1257.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1889.55,
KNOTLESS 2.6 FIBER TAK WT/BLK,278229792,CDM,278,RC,C1713,HCPCS,outpatient,,,1989,1392.3,,1571.31,79,,1257.05,percent of total billed charges,79% of total billed charges,1790.1,90,,1432.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,1535.91,77.22,,1228.73,percent of total billed charges,77.22% of total billed charges,1314.73,66.1,,1051.78,percent of total billed charges,66.1% of total billed charges,1650.87,83,,1320.7,percent of total billed charges,83% of total,1889.55,95,,1511.64,percent of total billed charges ,95% of total billed charges,1591.2,80,,1272.96,percent of total billed charges,78% of total billed charges,1551.42,78,,1241.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1790.1,90,,1432.08,percent of total billed charges,90% of total billed charges,1591.2,80,,1272.96,percent of total billed charges,80% of total billed charges,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,1690.65,85,,1352.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1571.31,79,,1257.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1889.55,
FLEXI GRAFT,278229797,CDM,278,RC,C1762,HCPCS,outpatient,,,2750,1925,,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,2475,90,,1980,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2123.55,77.22,,1698.84,percent of total billed charges,77.22% of total billed charges,1817.75,66.1,,1454.2,percent of total billed charges,66.1% of total billed charges,2282.5,83,,1826,percent of total billed charges,83% of total,2612.5,95,,2090,percent of total billed charges ,95% of total billed charges,2200,80,,1760,percent of total billed charges,78% of total billed charges,2145,78,,1716,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2475,90,,1980,percent of total billed charges,90% of total billed charges,2200,80,,1760,percent of total billed charges,80% of total billed charges,1732.5,63,,1386,percent of total billed charges,63% of total billed charges,2337.5,85,,1870,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2172.5,79,,1738,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2612.5,
SWIVELOCK 3.9X17.9 MM/6/20,278229802,CDM,278,RC,C1713,HCPCS,outpatient,,,7481,5236.7,,5909.99,79,,4727.99,percent of total billed charges,79% of total billed charges,6732.9,90,,5386.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4713.03,63,,3770.42,percent of total billed charges,63% of total billed charges,5776.83,77.22,,4621.46,percent of total billed charges,77.22% of total billed charges,4944.94,66.1,,3955.95,percent of total billed charges,66.1% of total billed charges,6209.23,83,,4967.38,percent of total billed charges,83% of total,7106.95,95,,5685.56,percent of total billed charges ,95% of total billed charges,5984.8,80,,4787.84,percent of total billed charges,78% of total billed charges,5835.18,78,,4668.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4713.03,63,,3770.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6732.9,90,,5386.32,percent of total billed charges,90% of total billed charges,5984.8,80,,4787.84,percent of total billed charges,80% of total billed charges,4713.03,63,,3770.42,percent of total billed charges,63% of total billed charges,6358.85,85,,5087.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5909.99,79,,4727.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7106.95,
BIOCOMP INTERFER SCREW 7X20MM,278229803,CDM,278,RC,C1713,HCPCS,outpatient,,,1107,774.9,,874.53,79,,699.62,percent of total billed charges,79% of total billed charges,996.3,90,,797.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,697.41,63,,557.93,percent of total billed charges,63% of total billed charges,854.83,77.22,,683.86,percent of total billed charges,77.22% of total billed charges,731.73,66.1,,585.38,percent of total billed charges,66.1% of total billed charges,918.81,83,,735.05,percent of total billed charges,83% of total,1051.65,95,,841.32,percent of total billed charges ,95% of total billed charges,885.6,80,,708.48,percent of total billed charges,78% of total billed charges,863.46,78,,690.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,697.41,63,,557.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,996.3,90,,797.04,percent of total billed charges,90% of total billed charges,885.6,80,,708.48,percent of total billed charges,80% of total billed charges,697.41,63,,557.93,percent of total billed charges,63% of total billed charges,940.95,85,,752.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,874.53,79,,699.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1051.65,
BIOCOMPOSITE SWIVELOCK SUTURE,278229804,CDM,278,RC,C1713,HCPCS,outpatient,,,1595,1116.5,,1260.05,79,,1008.04,percent of total billed charges,79% of total billed charges,1435.5,90,,1148.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1004.85,63,,803.88,percent of total billed charges,63% of total billed charges,1231.66,77.22,,985.33,percent of total billed charges,77.22% of total billed charges,1054.3,66.1,,843.44,percent of total billed charges,66.1% of total billed charges,1323.85,83,,1059.08,percent of total billed charges,83% of total,1515.25,95,,1212.2,percent of total billed charges ,95% of total billed charges,1276,80,,1020.8,percent of total billed charges,78% of total billed charges,1244.1,78,,995.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1004.85,63,,803.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1435.5,90,,1148.4,percent of total billed charges,90% of total billed charges,1276,80,,1020.8,percent of total billed charges,80% of total billed charges,1004.85,63,,803.88,percent of total billed charges,63% of total billed charges,1355.75,85,,1084.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1260.05,79,,1008.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1515.25,
ULNA 5 HOLE PLATE,278229811,CDM,278,RC,C1713,HCPCS,outpatient,,,3800,2660,,3002,79,,2401.6,percent of total billed charges,79% of total billed charges,3420,90,,2736,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2394,63,,1915.2,percent of total billed charges,63% of total billed charges,2934.36,77.22,,2347.49,percent of total billed charges,77.22% of total billed charges,2511.8,66.1,,2009.44,percent of total billed charges,66.1% of total billed charges,3154,83,,2523.2,percent of total billed charges,83% of total,3610,95,,2888,percent of total billed charges ,95% of total billed charges,3040,80,,2432,percent of total billed charges,78% of total billed charges,2964,78,,2371.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2394,63,,1915.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3420,90,,2736,percent of total billed charges,90% of total billed charges,3040,80,,2432,percent of total billed charges,80% of total billed charges,2394,63,,1915.2,percent of total billed charges,63% of total billed charges,3230,85,,2584,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3002,79,,2401.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3610,
3.5 POLYAXIAL 15M,278229812,CDM,278,RC,C1713,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
3.5 POLYAXIAL 13M,278229813,CDM,278,RC,C1713,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
ALTEON CLUSTERHOLE GRP4 50MMOD,278229846,CDM,278,RC,C1776,HCPCS,outpatient,,,1620,1134,,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1250.96,77.22,,1000.77,percent of total billed charges,77.22% of total billed charges,1070.82,66.1,,856.66,percent of total billed charges,66.1% of total billed charges,1344.6,83,,1075.68,percent of total billed charges,83% of total,1539,95,,1231.2,percent of total billed charges ,95% of total billed charges,1296,80,,1036.8,percent of total billed charges,78% of total billed charges,1263.6,78,,1010.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,1296,80,,1036.8,percent of total billed charges,80% of total billed charges,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1377,85,,1101.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1539,
ALTEON XLE LINER GRP 4 36MM ID,278229847,CDM,278,RC,C1776,HCPCS,outpatient,,,1181,826.7,,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,911.97,77.22,,729.58,percent of total billed charges,77.22% of total billed charges,780.64,66.1,,624.51,percent of total billed charges,66.1% of total billed charges,980.23,83,,784.18,percent of total billed charges,83% of total,1121.95,95,,897.56,percent of total billed charges ,95% of total billed charges,944.8,80,,755.84,percent of total billed charges,78% of total billed charges,921.18,78,,736.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,944.8,80,,755.84,percent of total billed charges,80% of total billed charges,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,1003.85,85,,803.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1121.95,
ALTEON HA FEMRL STEM SZ8 110MM,278229848,CDM,278,RC,C1776,HCPCS,outpatient,,,1620,1134,,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1250.96,77.22,,1000.77,percent of total billed charges,77.22% of total billed charges,1070.82,66.1,,856.66,percent of total billed charges,66.1% of total billed charges,1344.6,83,,1075.68,percent of total billed charges,83% of total,1539,95,,1231.2,percent of total billed charges ,95% of total billed charges,1296,80,,1036.8,percent of total billed charges,78% of total billed charges,1263.6,78,,1010.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,1296,80,,1036.8,percent of total billed charges,80% of total billed charges,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1377,85,,1101.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1539,
KNOTLESS SWIVELOCK BLU 2 SUTUR,278229849,CDM,278,RC,C1713,HCPCS,outpatient,,,1856,1299.2,,1466.24,79,,1172.99,percent of total billed charges,79% of total billed charges,1670.4,90,,1336.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1169.28,63,,935.42,percent of total billed charges,63% of total billed charges,1433.2,77.22,,1146.56,percent of total billed charges,77.22% of total billed charges,1226.82,66.1,,981.46,percent of total billed charges,66.1% of total billed charges,1540.48,83,,1232.38,percent of total billed charges,83% of total,1763.2,95,,1410.56,percent of total billed charges ,95% of total billed charges,1484.8,80,,1187.84,percent of total billed charges,78% of total billed charges,1447.68,78,,1158.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1169.28,63,,935.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1670.4,90,,1336.32,percent of total billed charges,90% of total billed charges,1484.8,80,,1187.84,percent of total billed charges,80% of total billed charges,1169.28,63,,935.42,percent of total billed charges,63% of total billed charges,1577.6,85,,1262.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1466.24,79,,1172.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1763.2,
DOUBLELOADED KNEE FIBERTAK 2.6,278229855,CDM,278,RC,C1713,HCPCS,outpatient,,,1595,1116.5,,1260.05,79,,1008.04,percent of total billed charges,79% of total billed charges,1435.5,90,,1148.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1004.85,63,,803.88,percent of total billed charges,63% of total billed charges,1231.66,77.22,,985.33,percent of total billed charges,77.22% of total billed charges,1054.3,66.1,,843.44,percent of total billed charges,66.1% of total billed charges,1323.85,83,,1059.08,percent of total billed charges,83% of total,1515.25,95,,1212.2,percent of total billed charges ,95% of total billed charges,1276,80,,1020.8,percent of total billed charges,78% of total billed charges,1244.1,78,,995.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1004.85,63,,803.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1435.5,90,,1148.4,percent of total billed charges,90% of total billed charges,1276,80,,1020.8,percent of total billed charges,80% of total billed charges,1004.85,63,,803.88,percent of total billed charges,63% of total billed charges,1355.75,85,,1084.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1260.05,79,,1008.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1515.25,
IMPLANT ANCHILLES MIDSUB SB,278229856,CDM,278,RC,C1713,HCPCS,outpatient,,,3656,2559.2,,2888.24,79,,2310.59,percent of total billed charges,79% of total billed charges,3290.4,90,,2632.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,2823.16,77.22,,2258.53,percent of total billed charges,77.22% of total billed charges,2416.62,66.1,,1933.3,percent of total billed charges,66.1% of total billed charges,3034.48,83,,2427.58,percent of total billed charges,83% of total,3473.2,95,,2778.56,percent of total billed charges ,95% of total billed charges,2924.8,80,,2339.84,percent of total billed charges,78% of total billed charges,2851.68,78,,2281.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3290.4,90,,2632.32,percent of total billed charges,90% of total billed charges,2924.8,80,,2339.84,percent of total billed charges,80% of total billed charges,2303.28,63,,1842.62,percent of total billed charges,63% of total billed charges,3107.6,85,,2486.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2888.24,79,,2310.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3473.2,
SUTURE LOC MENISCAL ROOT RKIT,278229905,CDM,278,RC,C1713,HCPCS,outpatient,,,7501,5250.7,,5925.79,79,,4740.63,percent of total billed charges,79% of total billed charges,6750.9,90,,5400.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4725.63,63,,3780.5,percent of total billed charges,63% of total billed charges,5792.27,77.22,,4633.82,percent of total billed charges,77.22% of total billed charges,4958.16,66.1,,3966.53,percent of total billed charges,66.1% of total billed charges,6225.83,83,,4980.66,percent of total billed charges,83% of total,7125.95,95,,5700.76,percent of total billed charges ,95% of total billed charges,6000.8,80,,4800.64,percent of total billed charges,78% of total billed charges,5850.78,78,,4680.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4725.63,63,,3780.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6750.9,90,,5400.72,percent of total billed charges,90% of total billed charges,6000.8,80,,4800.64,percent of total billed charges,80% of total billed charges,4725.63,63,,3780.5,percent of total billed charges,63% of total billed charges,6375.85,85,,5100.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5925.79,79,,4740.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7125.95,
BIOCOMP KNOTLESS SL4.75X19.1MM,278229906,CDM,278,RC,C1713,HCPCS,outpatient,,,1989,1392.3,,1571.31,79,,1257.05,percent of total billed charges,79% of total billed charges,1790.1,90,,1432.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,1535.91,77.22,,1228.73,percent of total billed charges,77.22% of total billed charges,1314.73,66.1,,1051.78,percent of total billed charges,66.1% of total billed charges,1650.87,83,,1320.7,percent of total billed charges,83% of total,1889.55,95,,1511.64,percent of total billed charges ,95% of total billed charges,1591.2,80,,1272.96,percent of total billed charges,78% of total billed charges,1551.42,78,,1241.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1790.1,90,,1432.08,percent of total billed charges,90% of total billed charges,1591.2,80,,1272.96,percent of total billed charges,80% of total billed charges,1253.07,63,,1002.46,percent of total billed charges,63% of total billed charges,1690.65,85,,1352.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1571.31,79,,1257.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1889.55,
FIBERTAK SPEEDBRIDGE IMPLANT,278229907,CDM,278,RC,C1713,HCPCS,outpatient,,,9731,6811.7,,7687.49,79,,6149.99,percent of total billed charges,79% of total billed charges,8757.9,90,,7006.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6130.53,63,,4904.42,percent of total billed charges,63% of total billed charges,7514.28,77.22,,6011.42,percent of total billed charges,77.22% of total billed charges,6432.19,66.1,,5145.75,percent of total billed charges,66.1% of total billed charges,8076.73,83,,6461.38,percent of total billed charges,83% of total,9244.45,95,,7395.56,percent of total billed charges ,95% of total billed charges,7784.8,80,,6227.84,percent of total billed charges,78% of total billed charges,7590.18,78,,6072.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6130.53,63,,4904.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,8757.9,90,,7006.32,percent of total billed charges,90% of total billed charges,7784.8,80,,6227.84,percent of total billed charges,80% of total billed charges,6130.53,63,,4904.42,percent of total billed charges,63% of total billed charges,8271.35,85,,6617.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7687.49,79,,6149.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,9244.45,
ALTEON CLUSTERHOLE CUP7 56MM,278229908,CDM,278,RC,C1776,HCPCS,outpatient,,,1620,1134,,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1250.96,77.22,,1000.77,percent of total billed charges,77.22% of total billed charges,1070.82,66.1,,856.66,percent of total billed charges,66.1% of total billed charges,1344.6,83,,1075.68,percent of total billed charges,83% of total,1539,95,,1231.2,percent of total billed charges ,95% of total billed charges,1296,80,,1036.8,percent of total billed charges,78% of total billed charges,1263.6,78,,1010.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,1296,80,,1036.8,percent of total billed charges,80% of total billed charges,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1377,85,,1101.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1539,
ALTEON XLE LINER GRP 7 36MM,278229909,CDM,278,RC,C1776,HCPCS,outpatient,,,1181,826.7,,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,911.97,77.22,,729.58,percent of total billed charges,77.22% of total billed charges,780.64,66.1,,624.51,percent of total billed charges,66.1% of total billed charges,980.23,83,,784.18,percent of total billed charges,83% of total,1121.95,95,,897.56,percent of total billed charges ,95% of total billed charges,944.8,80,,755.84,percent of total billed charges,78% of total billed charges,921.18,78,,736.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,944.8,80,,755.84,percent of total billed charges,80% of total billed charges,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,1003.85,85,,803.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1121.95,
ALTEON HA FEM STEM PRESSFIT CE,278229910,CDM,278,RC,C1776,HCPCS,outpatient,,,4500,3150,,3555,79,,2844,percent of total billed charges,79% of total billed charges,4050,90,,3240,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,3474.9,77.22,,2779.92,percent of total billed charges,77.22% of total billed charges,2974.5,66.1,,2379.6,percent of total billed charges,66.1% of total billed charges,3735,83,,2988,percent of total billed charges,83% of total,4275,95,,3420,percent of total billed charges ,95% of total billed charges,3600,80,,2880,percent of total billed charges,78% of total billed charges,3510,78,,2808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4050,90,,3240,percent of total billed charges,90% of total billed charges,3600,80,,2880,percent of total billed charges,80% of total billed charges,2835,63,,2268,percent of total billed charges,63% of total billed charges,3825,85,,3060,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3555,79,,2844,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4275,
BIOCOMP KNOTLESS ANCHO5.5X19.1,278229915,CDM,278,RC,C1713,HCPCS,outpatient,,,1726,1208.2,,1363.54,79,,1090.83,percent of total billed charges,79% of total billed charges,1553.4,90,,1242.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1087.38,63,,869.9,percent of total billed charges,63% of total billed charges,1332.82,77.22,,1066.26,percent of total billed charges,77.22% of total billed charges,1140.89,66.1,,912.71,percent of total billed charges,66.1% of total billed charges,1432.58,83,,1146.06,percent of total billed charges,83% of total,1639.7,95,,1311.76,percent of total billed charges ,95% of total billed charges,1380.8,80,,1104.64,percent of total billed charges,78% of total billed charges,1346.28,78,,1077.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1087.38,63,,869.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1553.4,90,,1242.72,percent of total billed charges,90% of total billed charges,1380.8,80,,1104.64,percent of total billed charges,80% of total billed charges,1087.38,63,,869.9,percent of total billed charges,63% of total billed charges,1467.1,85,,1173.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1363.54,79,,1090.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1639.7,
TIGHTROPE BIOCOMPSL 3.9X17.9MM,278229938,CDM,278,RC,C1713,HCPCS,outpatient,,,7481,5236.7,,5909.99,79,,4727.99,percent of total billed charges,79% of total billed charges,6732.9,90,,5386.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4713.03,63,,3770.42,percent of total billed charges,63% of total billed charges,5776.83,77.22,,4621.46,percent of total billed charges,77.22% of total billed charges,4944.94,66.1,,3955.95,percent of total billed charges,66.1% of total billed charges,6209.23,83,,4967.38,percent of total billed charges,83% of total,7106.95,95,,5685.56,percent of total billed charges ,95% of total billed charges,5984.8,80,,4787.84,percent of total billed charges,78% of total billed charges,5835.18,78,,4668.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4713.03,63,,3770.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6732.9,90,,5386.32,percent of total billed charges,90% of total billed charges,5984.8,80,,4787.84,percent of total billed charges,80% of total billed charges,4713.03,63,,3770.42,percent of total billed charges,63% of total billed charges,6358.85,85,,5087.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5909.99,79,,4727.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7106.95,
ALTEON HA FEM STEM PRESSFIT CL,278229939,CDM,278,RC,C1776,HCPCS,outpatient,,,4500,3150,,3555,79,,2844,percent of total billed charges,79% of total billed charges,4050,90,,3240,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,3474.9,77.22,,2779.92,percent of total billed charges,77.22% of total billed charges,2974.5,66.1,,2379.6,percent of total billed charges,66.1% of total billed charges,3735,83,,2988,percent of total billed charges,83% of total,4275,95,,3420,percent of total billed charges ,95% of total billed charges,3600,80,,2880,percent of total billed charges,78% of total billed charges,3510,78,,2808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4050,90,,3240,percent of total billed charges,90% of total billed charges,3600,80,,2880,percent of total billed charges,80% of total billed charges,2835,63,,2268,percent of total billed charges,63% of total billed charges,3825,85,,3060,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3555,79,,2844,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4275,
TRULIANT FEM CMP CRUC 3.5 RT,278229966,CDM,278,RC,C1776,HCPCS,outpatient,,,3600,2520,,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,3240,90,,2592,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,2779.92,77.22,,2223.94,percent of total billed charges,77.22% of total billed charges,2379.6,66.1,,1903.68,percent of total billed charges,66.1% of total billed charges,2988,83,,2390.4,percent of total billed charges,83% of total,3420,95,,2736,percent of total billed charges ,95% of total billed charges,2880,80,,2304,percent of total billed charges,78% of total billed charges,2808,78,,2246.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3240,90,,2592,percent of total billed charges,90% of total billed charges,2880,80,,2304,percent of total billed charges,80% of total billed charges,2268,63,,1814.4,percent of total billed charges,63% of total billed charges,3060,85,,2448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2844,79,,2275.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3420,
"ACTIVIT-E CRC TIB INS 3.5, 9MM",278229967,CDM,278,RC,C1713,HCPCS,outpatient,,,2025,1417.5,,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1563.71,77.22,,1250.97,percent of total billed charges,77.22% of total billed charges,1338.53,66.1,,1070.82,percent of total billed charges,66.1% of total billed charges,1680.75,83,,1344.6,percent of total billed charges,83% of total,1923.75,95,,1539,percent of total billed charges ,95% of total billed charges,1620,80,,1296,percent of total billed charges,78% of total billed charges,1579.5,78,,1263.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,1620,80,,1296,percent of total billed charges,80% of total billed charges,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1721.25,85,,1377,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1923.75,
TRULIANT TIB TRY PRS 3.5F/3.5T,278229968,CDM,278,RC,C1776,HCPCS,outpatient,,,3150,2205,,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,2835,90,,2268,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2432.43,77.22,,1945.94,percent of total billed charges,77.22% of total billed charges,2082.15,66.1,,1665.72,percent of total billed charges,66.1% of total billed charges,2614.5,83,,2091.6,percent of total billed charges,83% of total,2992.5,95,,2394,percent of total billed charges ,95% of total billed charges,2520,80,,2016,percent of total billed charges,78% of total billed charges,2457,78,,1965.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2835,90,,2268,percent of total billed charges,90% of total billed charges,2520,80,,2016,percent of total billed charges,80% of total billed charges,1984.5,63,,1587.6,percent of total billed charges,63% of total billed charges,2677.5,85,,2142,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2488.5,79,,1990.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2992.5,
DISTAL PLATE 4 HOLE,278230014,CDM,278,RC,C1713,HCPCS,outpatient,,,2306,1614.2,,1821.74,79,,1457.39,percent of total billed charges,79% of total billed charges,2075.4,90,,1660.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1452.78,63,,1162.22,percent of total billed charges,63% of total billed charges,1780.69,77.22,,1424.55,percent of total billed charges,77.22% of total billed charges,1524.27,66.1,,1219.42,percent of total billed charges,66.1% of total billed charges,1913.98,83,,1531.18,percent of total billed charges,83% of total,2190.7,95,,1752.56,percent of total billed charges ,95% of total billed charges,1844.8,80,,1475.84,percent of total billed charges,78% of total billed charges,1798.68,78,,1438.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1452.78,63,,1162.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2075.4,90,,1660.32,percent of total billed charges,90% of total billed charges,1844.8,80,,1475.84,percent of total billed charges,80% of total billed charges,1452.78,63,,1162.22,percent of total billed charges,63% of total billed charges,1960.1,85,,1568.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1821.74,79,,1457.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2190.7,
KNOTLESS SPEEBRIDGE,278230015,CDM,278,RC,C1713,HCPCS,outpatient,,,8064,5644.8,,6370.56,79,,5096.45,percent of total billed charges,79% of total billed charges,7257.6,90,,5806.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5080.32,63,,4064.26,percent of total billed charges,63% of total billed charges,6227.02,77.22,,4981.62,percent of total billed charges,77.22% of total billed charges,5330.3,66.1,,4264.24,percent of total billed charges,66.1% of total billed charges,6693.12,83,,5354.5,percent of total billed charges,83% of total,7660.8,95,,6128.64,percent of total billed charges ,95% of total billed charges,6451.2,80,,5160.96,percent of total billed charges,78% of total billed charges,6289.92,78,,5031.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5080.32,63,,4064.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7257.6,90,,5806.08,percent of total billed charges,90% of total billed charges,6451.2,80,,5160.96,percent of total billed charges,80% of total billed charges,5080.32,63,,4064.26,percent of total billed charges,63% of total billed charges,6854.4,85,,5483.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6370.56,79,,5096.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7660.8,
ALTEON CLUSTERHOLE CUP5 52MM,278230031,CDM,278,RC,C1776,HCPCS,outpatient,,,1620,1134,,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1250.96,77.22,,1000.77,percent of total billed charges,77.22% of total billed charges,1070.82,66.1,,856.66,percent of total billed charges,66.1% of total billed charges,1344.6,83,,1075.68,percent of total billed charges,83% of total,1539,95,,1231.2,percent of total billed charges ,95% of total billed charges,1296,80,,1036.8,percent of total billed charges,78% of total billed charges,1263.6,78,,1010.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,1296,80,,1036.8,percent of total billed charges,80% of total billed charges,1020.6,63,,816.48,percent of total billed charges,63% of total billed charges,1377,85,,1101.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1539,
ALTEON XLE LINER GRP 5 36MM,278230032,CDM,278,RC,C1776,HCPCS,outpatient,,,1181,826.7,,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,911.97,77.22,,729.58,percent of total billed charges,77.22% of total billed charges,780.64,66.1,,624.51,percent of total billed charges,66.1% of total billed charges,980.23,83,,784.18,percent of total billed charges,83% of total,1121.95,95,,897.56,percent of total billed charges ,95% of total billed charges,944.8,80,,755.84,percent of total billed charges,78% of total billed charges,921.18,78,,736.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1062.9,90,,850.32,percent of total billed charges,90% of total billed charges,944.8,80,,755.84,percent of total billed charges,80% of total billed charges,744.03,63,,595.22,percent of total billed charges,63% of total billed charges,1003.85,85,,803.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,932.99,79,,746.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1121.95,
ALTEON HA FEMRL STEM SZ9 113MM,278230033,CDM,278,RC,C1776,HCPCS,outpatient,,,4500,3150,,3555,79,,2844,percent of total billed charges,79% of total billed charges,4050,90,,3240,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,3474.9,77.22,,2779.92,percent of total billed charges,77.22% of total billed charges,2974.5,66.1,,2379.6,percent of total billed charges,66.1% of total billed charges,3735,83,,2988,percent of total billed charges,83% of total,4275,95,,3420,percent of total billed charges ,95% of total billed charges,3600,80,,2880,percent of total billed charges,78% of total billed charges,3510,78,,2808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2835,63,,2268,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4050,90,,3240,percent of total billed charges,90% of total billed charges,3600,80,,2880,percent of total billed charges,80% of total billed charges,2835,63,,2268,percent of total billed charges,63% of total billed charges,3825,85,,3060,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3555,79,,2844,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4275,
ACTIVIT-E TIB CR SZ 3.9,278230101,CDM,278,RC,C1713,HCPCS,outpatient,,,2025,1417.5,,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1563.71,77.22,,1250.97,percent of total billed charges,77.22% of total billed charges,1338.53,66.1,,1070.82,percent of total billed charges,66.1% of total billed charges,1680.75,83,,1344.6,percent of total billed charges,83% of total,1923.75,95,,1539,percent of total billed charges ,95% of total billed charges,1620,80,,1296,percent of total billed charges,78% of total billed charges,1579.5,78,,1263.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1822.5,90,,1458,percent of total billed charges,90% of total billed charges,1620,80,,1296,percent of total billed charges,80% of total billed charges,1275.75,63,,1020.6,percent of total billed charges,63% of total billed charges,1721.25,85,,1377,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1599.75,79,,1279.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1923.75,
SDC INFUSION CATH.TUNNEL CTRL,4900C1751,CDM,278,RC,C1751,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SDC URINE INCONT REPAIR W/SLNG,4900C1771,CDM,278,RC,C1771,HCPCS,outpatient,,,3360,2352,,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2594.59,77.22,,2075.67,percent of total billed charges,77.22% of total billed charges,2220.96,66.1,,1776.77,percent of total billed charges,66.1% of total billed charges,2788.8,83,,2231.04,percent of total billed charges,83% of total,3192,95,,2553.6,percent of total billed charges ,95% of total billed charges,2688,80,,2150.4,percent of total billed charges,78% of total billed charges,2620.8,78,,2096.64,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,2688,80,,2150.4,percent of total billed charges,80% of total billed charges,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2856,85,,2284.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3192,
"INDWELLING PORT, IMPLANTABLE",4900C1788,CDM,278,RC,C1788,HCPCS,outpatient,,,1357,949.9,,1072.03,79,,857.62,percent of total billed charges,79% of total billed charges,1221.3,90,,977.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,854.91,63,,683.93,percent of total billed charges,63% of total billed charges,1047.88,77.22,,838.3,percent of total billed charges,77.22% of total billed charges,896.98,66.1,,717.58,percent of total billed charges,66.1% of total billed charges,1126.31,83,,901.05,percent of total billed charges,83% of total,1289.15,95,,1031.32,percent of total billed charges ,95% of total billed charges,1085.6,80,,868.48,percent of total billed charges,78% of total billed charges,1058.46,78,,846.768,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,854.91,63,,683.93,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,854.91,63,,683.93,percent of total billed charges,63% of total billed charges,1153.45,85,,922.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1072.03,79,,857.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1289.15,
TOTAL EOSINOPHILE COUNT,300000013,CDM,300,RC,89190,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,5.79,100,,,fee schedule,100% of CMS fee schedule,9.26,160,,,fee schedule,160% of CMS fee schedule,7.53,130,,,fee schedule,130% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,6.28,105,,,fee schedule,105% of GA fee schedule,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,5.79,100,,,fee schedule,100% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,5.79,100,,,fee schedule,100% of CMS 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,5.98,100,,,fee schedule,100% of GA fee schedule,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.38,93,,,fee schedule,93% of CMS fee schedule,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,5.79,100,,,fee schedule,100% of CMS fee schedule,5.79,100,,,fee schedule,100% of CMS fee schedule,5.38,450,
CELL COUNT &  DIFF BODY FLUIDS,300000036,CDM,300,RC,89051,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,8.96,160,,,fee schedule,160% of CMS fee schedule,7.28,130,,,fee schedule,130% of CMS fee schedule,2.21,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,2.32,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,2.21,100,,,fee schedule,100% of GA fee schedule,5.6,100,,,fee schedule,100% of CMS 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,2.21,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.21,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,2.21,450,
SPINAL FLUID PROFILE,300000042,CDM,300,RC,,,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,143.64,450,
GRAM STAIN,300000045,CDM,300,RC,87205,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,2.95,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,3.1,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,2.95,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,2.95,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,2.95,450,
O&P (INC OCCULT BLOOD),300000047,CDM,300,RC,87177,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,14.24,160,,,fee schedule,160% of CMS fee schedule,11.57,130,,,fee schedule,130% of CMS fee schedule,11.19,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,11.75,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,11.19,100,,,fee schedule,100% of GA fee schedule,8.9,100,,,fee schedule,100% of CMS 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,11.19,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.28,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,8.9,100,,,fee schedule,100% of CMS fee schedule,8.28,450,
SEMEN ANALYSIS (FERTILITY),300000049,CDM,300,RC,89320,HCPCS,outpatient,,,258,180.6,,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,12.31,100,,,fee schedule,100% of CMS fee schedule,19.7,160,,,fee schedule,160% of CMS fee schedule,16,130,,,fee schedule,130% of CMS fee schedule,7.25,100,,,fee schedule,100% of GA fee schedule,199.23,77.22,,159.38,percent of total billed charges,77.22% of total billed charges,7.61,105,,,fee schedule,105% of GA fee schedule,214.14,83,,171.31,percent of total billed charges,83% of total,245.1,95,,196.08,percent of total billed charges ,95% of total billed charges,206.4,80,,165.12,percent of total billed charges,78% of total billed charges,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,12.31,100,,,fee schedule,100% of CMS fee schedule,7.25,100,,,fee schedule,100% of GA fee schedule,12.31,100,,,fee schedule,100% of CMS 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,7.25,100,,,fee schedule,100% of GA fee schedule,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.45,93,,,fee schedule,93% of CMS fee schedule,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,12.31,100,,,fee schedule,100% of CMS fee schedule,12.31,100,,,fee schedule,100% of CMS fee schedule,7.25,450,
SEMEN ANALYSIS (POST VAS),300000050,CDM,300,RC,89321,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,7.25,100,,,fee schedule,100% of GA fee schedule,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,7.61,105,,,fee schedule,105% of GA fee schedule,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,7.25,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,7.25,100,,,fee schedule,100% of GA fee schedule,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,7.25,450,
MIC,300000069,CDM,300,RC,87186,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,13.84,160,,,fee schedule,160% of CMS fee schedule,11.25,130,,,fee schedule,130% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,11.41,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,8.65,100,,,fee schedule,100% of CMS 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,10.87,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.04,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,8.04,450,
HYPOTHYROID I  CP,300000148,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
WBC (FECES),300000162,CDM,300,RC,87205,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,2.95,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,3.1,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,2.95,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,2.95,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,2.95,450,
RBC FLUIDS,300000164,CDM,300,RC,89050,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,7.55,160,,,fee schedule,160% of CMS fee schedule,6.14,130,,,fee schedule,130% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,6.25,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,4.72,100,,,fee schedule,100% of CMS 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,5.95,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.39,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,4.72,100,,,fee schedule,100% of CMS fee schedule,4.39,450,
WBC FLUIDS,300000165,CDM,300,RC,89050,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,7.55,160,,,fee schedule,160% of CMS fee schedule,6.14,130,,,fee schedule,130% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,6.25,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,4.72,100,,,fee schedule,100% of CMS 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,5.95,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.39,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,4.72,100,,,fee schedule,100% of CMS fee schedule,4.39,450,
CLOSTRIDIUM TOXIN ASSAY,300000168,CDM,300,RC,87230,HCPCS,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,19.74,100,,,fee schedule,100% of CMS fee schedule,31.58,160,,,fee schedule,160% of CMS fee schedule,25.66,130,,,fee schedule,130% of CMS fee schedule,24.83,100,,,fee schedule,100% of GA fee schedule,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,26.07,105,,,fee schedule,105% of GA fee schedule,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,19.74,100,,,fee schedule,100% of CMS fee schedule,24.83,100,,,fee schedule,100% of GA fee schedule,19.74,100,,,fee schedule,100% of CMS 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,24.83,100,,,fee schedule,100% of GA fee schedule,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.36,93,,,fee schedule,93% of CMS fee schedule,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,19.74,100,,,fee schedule,100% of CMS fee schedule,19.74,100,,,fee schedule,100% of CMS fee schedule,18.36,450,
VENIPUNCTURE,300000182,CDM,300,RC,36415,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,14.13,160,,,fee schedule,160% of CMS fee schedule,11.48,130,,,fee schedule,130% of CMS fee schedule,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,8.83,100,,,fee schedule,100% of CMS 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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.21,93,,,fee schedule,93% of CMS fee schedule,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.21,450,
FUNGUS CULTURE/PAS,300000191,CDM,300,RC,87207,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,9.58,160,,,fee schedule,160% of CMS fee schedule,7.79,130,,,fee schedule,130% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,5.99,100,,,fee schedule,100% of CMS 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,7.53,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.57,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,5.99,100,,,fee schedule,100% of CMS fee schedule,5.57,450,
VIRAL CULTURE,300000209,CDM,300,RC,87250,HCPCS,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,19.56,100,,,fee schedule,100% of CMS fee schedule,31.3,160,,,fee schedule,160% of CMS fee schedule,25.43,130,,,fee schedule,130% of CMS fee schedule,24.59,100,,,fee schedule,100% of GA fee schedule,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,25.82,105,,,fee schedule,105% of GA fee schedule,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,19.56,100,,,fee schedule,100% of CMS fee schedule,24.59,100,,,fee schedule,100% of GA fee schedule,19.56,100,,,fee schedule,100% of CMS 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,24.59,100,,,fee schedule,100% of GA fee schedule,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.19,93,,,fee schedule,93% of CMS fee schedule,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,19.56,100,,,fee schedule,100% of CMS fee schedule,19.56,100,,,fee schedule,100% of CMS fee schedule,18.19,450,
GC CULTURE SCREEN ONLY,300000216,CDM,300,RC,87081,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,10.61,160,,,fee schedule,160% of CMS fee schedule,8.62,130,,,fee schedule,130% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.75,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,6.63,100,,,fee schedule,100% of CMS 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,8.33,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.17,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.17,450,
MALARIA SMEAR,300000266,CDM,300,RC,87207,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,9.58,160,,,fee schedule,160% of CMS fee schedule,7.79,130,,,fee schedule,130% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,5.99,100,,,fee schedule,100% of CMS 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,7.53,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.57,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,5.99,100,,,fee schedule,100% of CMS fee schedule,5.57,450,
CHLAMYDIA CULTURE,300000313,CDM,300,RC,87110,HCPCS,outpatient,,,284,198.8,,224.36,79,,179.49,percent of total billed charges,79% of total billed charges,255.6,90,,204.48,percent of total billed charges,90% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,31.36,160,,,fee schedule,160% of CMS fee schedule,25.48,130,,,fee schedule,130% of CMS fee schedule,24.63,100,,,fee schedule,100% of GA fee schedule,219.3,77.22,,175.44,percent of total billed charges,77.22% of total billed charges,25.86,105,,,fee schedule,105% of GA fee schedule,235.72,83,,188.58,percent of total billed charges,83% of total,269.8,95,,215.84,percent of total billed charges ,95% of total billed charges,227.2,80,,181.76,percent of total billed charges,78% of total billed charges,221.52,78,,177.216,percent of total billed charges,78% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,24.63,100,,,fee schedule,100% of GA fee schedule,19.6,100,,,fee schedule,100% of CMS fee schedule,255.6,90,,204.48,percent of total billed charges,90% of total billed charges,227.2,80,,181.76,percent of total billed charges,80% of total billed charges,24.63,100,,,fee schedule,100% of GA fee schedule,241.4,85,,193.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.23,93,,,fee schedule,93% of CMS fee schedule,224.36,79,,179.49,percent of total billed charges,79% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,19.6,100,,,fee schedule,100% of CMS fee schedule,18.23,450,
CHLAMYDIA SMEAR,300000315,CDM,300,RC,87110,HCPCS,outpatient,,,284,198.8,,224.36,79,,179.49,percent of total billed charges,79% of total billed charges,255.6,90,,204.48,percent of total billed charges,90% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,31.36,160,,,fee schedule,160% of CMS fee schedule,25.48,130,,,fee schedule,130% of CMS fee schedule,24.63,100,,,fee schedule,100% of GA fee schedule,219.3,77.22,,175.44,percent of total billed charges,77.22% of total billed charges,25.86,105,,,fee schedule,105% of GA fee schedule,235.72,83,,188.58,percent of total billed charges,83% of total,269.8,95,,215.84,percent of total billed charges ,95% of total billed charges,227.2,80,,181.76,percent of total billed charges,78% of total billed charges,221.52,78,,177.216,percent of total billed charges,78% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,24.63,100,,,fee schedule,100% of GA fee schedule,19.6,100,,,fee schedule,100% of CMS fee schedule,255.6,90,,204.48,percent of total billed charges,90% of total billed charges,227.2,80,,181.76,percent of total billed charges,80% of total billed charges,24.63,100,,,fee schedule,100% of GA fee schedule,241.4,85,,193.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.23,93,,,fee schedule,93% of CMS fee schedule,224.36,79,,179.49,percent of total billed charges,79% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,19.6,100,,,fee schedule,100% of CMS fee schedule,18.23,450,
CRYSTAL EXAM,300000319,CDM,300,RC,89060,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,11.73,160,,,fee schedule,160% of CMS fee schedule,9.53,130,,,fee schedule,130% of CMS fee schedule,8.99,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,9.44,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,8.99,100,,,fee schedule,100% of GA fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,8.99,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.82,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,7.33,100,,,fee schedule,100% of CMS fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,6.82,450,
AFB CULTURE,300000335,CDM,300,RC,87116,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,17.28,160,,,fee schedule,160% of CMS fee schedule,14.04,130,,,fee schedule,130% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,10.8,100,,,fee schedule,100% of CMS 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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.04,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,10.8,100,,,fee schedule,100% of CMS fee schedule,10.04,450,
HERPES CULTURE,300000344,CDM,300,RC,87252,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,41.71,160,,,fee schedule,160% of CMS fee schedule,33.89,130,,,fee schedule,130% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,29.19,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,26.07,100,,,fee schedule,100% of CMS 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,27.8,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.25,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,24.25,450,
FLUID DIFF,300000366,CDM,300,RC,89051,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,8.96,160,,,fee schedule,160% of CMS fee schedule,7.28,130,,,fee schedule,130% of CMS fee schedule,2.21,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,2.32,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,2.21,100,,,fee schedule,100% of GA fee schedule,5.6,100,,,fee schedule,100% of CMS 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,2.21,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.21,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,5.6,100,,,fee schedule,100% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,2.21,450,
CULTURE NOSE & THROAT,300000382,CDM,300,RC,87070,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,13.79,160,,,fee schedule,160% of CMS fee schedule,11.21,130,,,fee schedule,130% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,11.37,105,,,fee schedule,105% of GA fee schedule,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,8.62,100,,,fee schedule,100% of CMS 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,10.83,100,,,fee schedule,100% of GA fee schedule,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.02,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.02,450,
CULTURE URINE,300000383,CDM,300,RC,87086,HCPCS,outpatient,,,127,88.9,,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,114.3,90,,91.44,percent of total billed charges,90% of total billed charges,8.07,100,,,fee schedule,100% of CMS fee schedule,12.91,160,,,fee schedule,160% of CMS fee schedule,10.49,130,,,fee schedule,130% of CMS fee schedule,10.15,100,,,fee schedule,100% of GA fee schedule,98.07,77.22,,78.46,percent of total billed charges,77.22% of total billed charges,10.66,105,,,fee schedule,105% of GA fee schedule,105.41,83,,84.33,percent of total billed charges,83% of total,120.65,95,,96.52,percent of total billed charges ,95% of total billed charges,101.6,80,,81.28,percent of total billed charges,78% of total billed charges,99.06,78,,79.248,percent of total billed charges,78% of total billed charges,8.07,100,,,fee schedule,100% of CMS fee schedule,10.15,100,,,fee schedule,100% of GA fee schedule,8.07,100,,,fee schedule,100% of CMS 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,10.15,100,,,fee schedule,100% of GA fee schedule,107.95,85,,86.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.51,93,,,fee schedule,93% of CMS fee schedule,100.33,79,,80.26,percent of total billed charges,79% of total billed charges,8.07,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of CMS fee schedule,7.51,450,
RSV SMEAR ONLY,300000385,CDM,300,RC,87206,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,8.62,160,,,fee schedule,160% of CMS fee schedule,7.01,130,,,fee schedule,130% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,7.09,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,5.39,100,,,fee schedule,100% of CMS 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,6.75,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.01,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,5.01,450,
BIOTYPE,300000399,CDM,300,RC,87081,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,10.61,160,,,fee schedule,160% of CMS fee schedule,8.62,130,,,fee schedule,130% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.75,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,6.63,100,,,fee schedule,100% of CMS 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,8.33,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.17,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.17,450,
FUNGAL CULTURE,300000402,CDM,300,RC,87102,HCPCS,outpatient,,,210,147,,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,13.46,160,,,fee schedule,160% of CMS fee schedule,10.93,130,,,fee schedule,130% of CMS fee schedule,10.57,100,,,fee schedule,100% of GA fee schedule,162.16,77.22,,129.73,percent of total billed charges,77.22% of total billed charges,11.1,105,,,fee schedule,105% of GA fee schedule,174.3,83,,139.44,percent of total billed charges,83% of total,199.5,95,,159.6,percent of total billed charges ,95% of total billed charges,168,80,,134.4,percent of total billed charges,78% of total billed charges,163.8,78,,131.04,percent of total billed charges,78% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,10.57,100,,,fee schedule,100% of GA fee schedule,8.41,100,,,fee schedule,100% of CMS 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,10.57,100,,,fee schedule,100% of GA fee schedule,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.82,93,,,fee schedule,93% of CMS fee schedule,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,8.41,100,,,fee schedule,100% of CMS fee schedule,7.82,450,
SENSITIVITY,300000425,CDM,300,RC,87186,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,13.84,160,,,fee schedule,160% of CMS fee schedule,11.25,130,,,fee schedule,130% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,11.41,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,8.65,100,,,fee schedule,100% of CMS 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,10.87,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.04,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,8.04,450,
AEROBIC CULTURE ID,300000426,CDM,300,RC,87077,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,12.93,160,,,fee schedule,160% of CMS fee schedule,10.5,130,,,fee schedule,130% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,10.67,105,,,fee schedule,105% of GA fee schedule,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,8.08,100,,,fee schedule,100% of CMS 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,10.16,100,,,fee schedule,100% of GA fee schedule,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.51,93,,,fee schedule,93% of CMS fee schedule,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,7.51,450,
CULTURE,300000427,CDM,300,RC,87070,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,13.79,160,,,fee schedule,160% of CMS fee schedule,11.21,130,,,fee schedule,130% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,11.37,105,,,fee schedule,105% of GA fee schedule,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,8.62,100,,,fee schedule,100% of CMS 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,10.83,100,,,fee schedule,100% of GA fee schedule,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.02,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.02,450,
OVA AND PARASITE (O&P),300000429,CDM,300,RC,87177,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,14.24,160,,,fee schedule,160% of CMS fee schedule,11.57,130,,,fee schedule,130% of CMS fee schedule,11.19,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,11.75,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,11.19,100,,,fee schedule,100% of GA fee schedule,8.9,100,,,fee schedule,100% of CMS 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,11.19,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.28,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,8.9,100,,,fee schedule,100% of CMS fee schedule,8.28,450,
STOOL CULTURE,300000445,CDM,300,RC,87045,HCPCS,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,15.1,160,,,fee schedule,160% of CMS fee schedule,12.27,130,,,fee schedule,130% of CMS fee schedule,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,9.44,100,,,fee schedule,100% of CMS 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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.78,93,,,fee schedule,93% of CMS fee schedule,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,8.78,450,
BLOOD CULTURE,300000446,CDM,300,RC,87040,HCPCS,outpatient,,,213,149.1,,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,16.51,160,,,fee schedule,160% of CMS fee schedule,13.42,130,,,fee schedule,130% of CMS fee schedule,12.98,100,,,fee schedule,100% of GA fee schedule,164.48,77.22,,131.58,percent of total billed charges,77.22% of total billed charges,13.63,105,,,fee schedule,105% of GA fee schedule,176.79,83,,141.43,percent of total billed charges,83% of total,202.35,95,,161.88,percent of total billed charges ,95% of total billed charges,170.4,80,,136.32,percent of total billed charges,78% of total billed charges,166.14,78,,132.912,percent of total billed charges,78% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,12.98,100,,,fee schedule,100% of GA fee schedule,10.32,100,,,fee schedule,100% of CMS 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,12.98,100,,,fee schedule,100% of GA fee schedule,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.6,93,,,fee schedule,93% of CMS fee schedule,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,9.6,450,
MIC SENSITIVITY/AEROBIC CP,300000472,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RSV SMEAR/CULT,300000477,CDM,300,RC,87206,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,8.62,160,,,fee schedule,160% of CMS fee schedule,7.01,130,,,fee schedule,130% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,7.09,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,5.39,100,,,fee schedule,100% of CMS 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,6.75,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.01,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,5.01,450,
3HR GLUCOSE TOLERANCE CHG CP,300000483,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
4HR GLUCOSE TOLERANCE CHG CP,300000484,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
5HR GLUCOSE TOLERANCE CHG CP,300000485,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
TISSUE CULTURE INOCULATION,300000487,CDM,300,RC,87252,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,41.71,160,,,fee schedule,160% of CMS fee schedule,33.89,130,,,fee schedule,130% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,29.19,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,26.07,100,,,fee schedule,100% of CMS 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,27.8,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.25,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,24.25,450,
TISSUE CULTURE,300000488,CDM,300,RC,87253,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,20.2,100,,,fee schedule,100% of CMS fee schedule,32.32,160,,,fee schedule,160% of CMS fee schedule,26.26,130,,,fee schedule,130% of CMS fee schedule,20.48,100,,,fee schedule,100% of GA fee schedule,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,21.5,105,,,fee schedule,105% of GA fee schedule,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,20.2,100,,,fee schedule,100% of CMS fee schedule,20.48,100,,,fee schedule,100% of GA fee schedule,20.2,100,,,fee schedule,100% of CMS 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,20.48,100,,,fee schedule,100% of GA fee schedule,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.79,93,,,fee schedule,93% of CMS fee schedule,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,20.2,100,,,fee schedule,100% of CMS fee schedule,20.2,100,,,fee schedule,100% of CMS fee schedule,18.79,450,
FIFB C&SM TO ARL,300000497,CDM,300,RC,87116,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,17.28,160,,,fee schedule,160% of CMS fee schedule,14.04,130,,,fee schedule,130% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,10.8,100,,,fee schedule,100% of CMS 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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.04,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,10.8,100,,,fee schedule,100% of CMS fee schedule,10.04,450,
AFB/FUNGUS/ARL,300000498,CDM,300,RC,87116,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,17.28,160,,,fee schedule,160% of CMS fee schedule,14.04,130,,,fee schedule,130% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,10.8,100,,,fee schedule,100% of CMS 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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.04,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,10.8,100,,,fee schedule,100% of CMS fee schedule,10.04,450,
DOWNS SYNDROME TRIPLE SCRN CP,300000514,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NS B PERTUSSIS,300000521,CDM,300,RC,,,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
EPSDT SCREENING 0-8 (<14),300000531,CDM,300,RC,,,outpatient,,,312,218.4,,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,240.93,77.22,,192.74,percent of total billed charges,77.22% of total billed charges,206.23,66.1,,164.98,percent of total billed charges,66.1% of total billed charges,258.96,83,,207.17,percent of total billed charges,83% of total,296.4,95,,237.12,percent of total billed charges ,95% of total billed charges,249.6,80,,199.68,percent of total billed charges,78% of total billed charges,243.36,78,,194.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,196.56,450,
EPSDT SCREENING 8-21 (=> 14),300000532,CDM,300,RC,,,outpatient,,,424,296.8,,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,381.6,90,,305.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,327.41,77.22,,261.93,percent of total billed charges,77.22% of total billed charges,280.26,66.1,,224.21,percent of total billed charges,66.1% of total billed charges,351.92,83,,281.54,percent of total billed charges,83% of total,402.8,95,,322.24,percent of total billed charges ,95% of total billed charges,339.2,80,,271.36,percent of total billed charges,78% of total billed charges,330.72,78,,264.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.12,450,
TB SKIN TEST HEALTH CHECK,300000533,CDM,300,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,450,
CELL COUNT FLUID,300000537,CDM,300,RC,89050,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,7.55,160,,,fee schedule,160% of CMS fee schedule,6.14,130,,,fee schedule,130% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,6.25,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,4.72,100,,,fee schedule,100% of CMS 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,5.95,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.39,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,4.72,100,,,fee schedule,100% of CMS fee schedule,4.39,450,
RBC/WBC FLUIDS,300000542,CDM,300,RC,89050,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,7.55,160,,,fee schedule,160% of CMS fee schedule,6.14,130,,,fee schedule,130% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,6.25,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,4.72,100,,,fee schedule,100% of CMS 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,5.95,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.39,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,4.72,100,,,fee schedule,100% of CMS fee schedule,4.39,450,
KOH,300000554,CDM,300,RC,87220,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,5.63,105,,,fee schedule,105% of GA fee schedule,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,5.36,100,,,fee schedule,100% of GA fee schedule,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.97,450,
DISK METHOD,300000557,CDM,300,RC,87184,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,7.48,100,,,fee schedule,100% of CMS fee schedule,11.97,160,,,fee schedule,160% of CMS fee schedule,9.72,130,,,fee schedule,130% of CMS fee schedule,8.67,100,,,fee schedule,100% of GA fee schedule,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,9.1,105,,,fee schedule,105% of GA fee schedule,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,7.48,100,,,fee schedule,100% of CMS fee schedule,8.67,100,,,fee schedule,100% of GA fee schedule,7.48,100,,,fee schedule,100% of CMS 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,8.67,100,,,fee schedule,100% of GA fee schedule,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.96,93,,,fee schedule,93% of CMS fee schedule,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,7.48,100,,,fee schedule,100% of CMS fee schedule,7.48,100,,,fee schedule,100% of CMS fee schedule,6.96,450,
DRUG SCREEN COLLECTION,300000558,CDM,300,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
LEAD SCREEN,300000580,CDM,300,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
CHLAMYDIA/GC/TRICH AMP PROB CP,300000999,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HLA DRB1/3/4/5,300001375,CDM,300,RC,81375,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,220.74,100,,,fee schedule,100% of CMS fee schedule,353.18,160,,,fee schedule,160% of CMS fee schedule,286.96,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,220.74,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,220.74,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,98.4,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,205.29,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,220.74,100,,,fee schedule,100% of CMS fee schedule,220.74,100,,,fee schedule,100% of CMS fee schedule,98.4,450,
MYCOBACTERIUM AVIUM COMPLEX,300007186,CDM,300,RC,87186,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,13.84,160,,,fee schedule,160% of CMS fee schedule,11.25,130,,,fee schedule,130% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,11.41,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,8.65,100,,,fee schedule,100% of CMS 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,10.87,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.04,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,8.04,450,
PARASITE EXAMINE WHOLE BLOOD,300007207,CDM,300,RC,87207,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,9.58,160,,,fee schedule,160% of CMS fee schedule,7.79,130,,,fee schedule,130% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,5.99,100,,,fee schedule,100% of CMS 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,7.53,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.57,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,5.99,100,,,fee schedule,100% of CMS fee schedule,5.57,450,
LIPID WITH LDL:HDL RATIO,300008015,CDM,300,RC,80061,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,21.42,160,,,fee schedule,160% of CMS fee schedule,17.41,130,,,fee schedule,130% of CMS fee schedule,16.85,100,,,fee schedule,100% of GA fee schedule,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,17.69,105,,,fee schedule,105% of GA fee schedule,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of GA fee schedule,13.39,100,,,fee schedule,100% of CMS 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,16.85,100,,,fee schedule,100% of GA fee schedule,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.45,93,,,fee schedule,93% of CMS fee schedule,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,12.45,450,
CRYSTOSPORDIUM,300008026,CDM,300,RC,87177,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,14.24,160,,,fee schedule,160% of CMS fee schedule,11.57,130,,,fee schedule,130% of CMS fee schedule,11.19,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,11.75,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,11.19,100,,,fee schedule,100% of GA fee schedule,8.9,100,,,fee schedule,100% of CMS 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,11.19,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.28,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,8.9,100,,,fee schedule,100% of CMS fee schedule,8.9,100,,,fee schedule,100% of CMS fee schedule,8.28,450,
BACTERIA ID,300008039,CDM,300,RC,87088,HCPCS,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,8.09,100,,,fee schedule,100% of CMS fee schedule,12.94,160,,,fee schedule,160% of CMS fee schedule,10.52,130,,,fee schedule,130% of CMS fee schedule,10.18,100,,,fee schedule,100% of GA fee schedule,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,10.69,105,,,fee schedule,105% of GA fee schedule,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,8.09,100,,,fee schedule,100% of CMS fee schedule,10.18,100,,,fee schedule,100% of GA fee schedule,8.09,100,,,fee schedule,100% of CMS 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,10.18,100,,,fee schedule,100% of GA fee schedule,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.52,93,,,fee schedule,93% of CMS fee schedule,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,8.09,100,,,fee schedule,100% of CMS fee schedule,8.09,100,,,fee schedule,100% of CMS fee schedule,7.52,450,
INDIA INK,300008049,CDM,300,RC,87210,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,9.31,160,,,fee schedule,160% of CMS fee schedule,7.57,130,,,fee schedule,130% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,5.63,105,,,fee schedule,105% of GA fee schedule,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,5.82,100,,,fee schedule,100% of CMS 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,5.36,100,,,fee schedule,100% of GA fee schedule,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.41,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,5.82,100,,,fee schedule,100% of CMS fee schedule,5.82,100,,,fee schedule,100% of CMS fee schedule,5.36,450,
LEGIONELLA SMEAR,300008050,CDM,300,RC,87207,HCPCS,outpatient,,,93,65.1,,73.47,79,,58.78,percent of total billed charges,79% of total billed charges,83.7,90,,66.96,percent of total billed charges,90% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,9.58,160,,,fee schedule,160% of CMS fee schedule,7.79,130,,,fee schedule,130% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,71.81,77.22,,57.45,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,77.19,83,,61.75,percent of total billed charges,83% of total,88.35,95,,70.68,percent of total billed charges ,95% of total billed charges,74.4,80,,59.52,percent of total billed charges,78% of total billed charges,72.54,78,,58.032,percent of total billed charges,78% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,5.99,100,,,fee schedule,100% of CMS 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,7.53,100,,,fee schedule,100% of GA fee schedule,79.05,85,,63.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.57,93,,,fee schedule,93% of CMS fee schedule,73.47,79,,58.78,percent of total billed charges,79% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,5.99,100,,,fee schedule,100% of CMS fee schedule,5.57,450,
GROUP B CULTURE,300008053,CDM,300,RC,87077,HCPCS,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,12.93,160,,,fee schedule,160% of CMS fee schedule,10.5,130,,,fee schedule,130% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,10.67,105,,,fee schedule,105% of GA fee schedule,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,8.08,100,,,fee schedule,100% of CMS 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,10.16,100,,,fee schedule,100% of GA fee schedule,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.51,93,,,fee schedule,93% of CMS fee schedule,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,7.51,450,
MYCOPLASMA CULTURE,300008064,CDM,300,RC,87109,HCPCS,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,15.39,100,,,fee schedule,100% of CMS fee schedule,24.62,160,,,fee schedule,160% of CMS fee schedule,20.01,130,,,fee schedule,130% of CMS fee schedule,19.35,100,,,fee schedule,100% of GA fee schedule,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,20.32,105,,,fee schedule,105% of GA fee schedule,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,15.39,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of GA fee schedule,15.39,100,,,fee schedule,100% of CMS 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,19.35,100,,,fee schedule,100% of GA fee schedule,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.31,93,,,fee schedule,93% of CMS fee schedule,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,15.39,100,,,fee schedule,100% of CMS fee schedule,15.39,100,,,fee schedule,100% of CMS fee schedule,14.31,450,
SMITH KLINE DRUG SCREEN,300008072,CDM,300,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
GROUPB CULTURE PATH SCREEN ONL,300008079,CDM,300,RC,87081,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,10.61,160,,,fee schedule,160% of CMS fee schedule,8.62,130,,,fee schedule,130% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.75,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,6.63,100,,,fee schedule,100% of CMS 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,8.33,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.17,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.17,450,
GROUP B CP,300008081,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DRUG COLLECTION (ONLY),300008326,CDM,300,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
LUNG MATURITY CHG CP,300008335,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
AFB SMEAR,300008361,CDM,300,RC,87206,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,8.62,160,,,fee schedule,160% of CMS fee schedule,7.01,130,,,fee schedule,130% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,7.09,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,5.39,100,,,fee schedule,100% of CMS 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,6.75,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.01,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,5.01,450,
PATERNITY,300008362,CDM,300,RC,,,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
3HR GLUCOSE  NO 1/2 HR  CP,300008371,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
3HR GLUCOSE OB CP,3000083710,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHROMOSONE ANAYLSIS CHG CP,300008373,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
GT 2 HR/NO FASTING CP,300008385,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ECHINOCOCCUS ANTIBODY CP,300008391,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HEPATIC IRON WEIGHT,300008432,CDM,300,RC,,,outpatient,,,413,289.1,,326.27,79,,261.02,percent of total billed charges,79% of total billed charges,371.7,90,,297.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.19,63,,208.15,percent of total billed charges,63% of total billed charges,318.92,77.22,,255.14,percent of total billed charges,77.22% of total billed charges,272.99,66.1,,218.39,percent of total billed charges,66.1% of total billed charges,342.79,83,,274.23,percent of total billed charges,83% of total,392.35,95,,313.88,percent of total billed charges ,95% of total billed charges,330.4,80,,264.32,percent of total billed charges,78% of total billed charges,322.14,78,,257.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,260.19,63,,208.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,371.7,90,,297.36,percent of total billed charges,90% of total billed charges,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,260.19,63,,208.15,percent of total billed charges,63% of total billed charges,351.05,85,,280.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,326.27,79,,261.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,260.19,450,
TRICHROME STAIN,300008451,CDM,300,RC,87209,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,28.77,160,,,fee schedule,160% of CMS fee schedule,23.37,130,,,fee schedule,130% of CMS fee schedule,22.6,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,23.73,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,22.6,100,,,fee schedule,100% of GA fee schedule,17.98,100,,,fee schedule,100% of CMS 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,22.6,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.72,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,17.98,100,,,fee schedule,100% of CMS fee schedule,16.72,450,
BACTERIAL MENINGI ANTIGEN CP,300008457,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FUNGAL BLOOD CULTURE,300008476,CDM,300,RC,87103,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,20.46,100,,,fee schedule,100% of CMS fee schedule,32.74,160,,,fee schedule,160% of CMS fee schedule,26.6,130,,,fee schedule,130% of CMS fee schedule,11.34,100,,,fee schedule,100% of GA fee schedule,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,11.91,105,,,fee schedule,105% of GA fee schedule,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,20.46,100,,,fee schedule,100% of CMS fee schedule,11.34,100,,,fee schedule,100% of GA fee schedule,20.46,100,,,fee schedule,100% of CMS 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,11.34,100,,,fee schedule,100% of GA fee schedule,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.03,93,,,fee schedule,93% of CMS fee schedule,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,20.46,100,,,fee schedule,100% of CMS fee schedule,20.46,100,,,fee schedule,100% of CMS fee schedule,11.34,450,
AFB BLOOD SMEAR,300008478,CDM,300,RC,87206,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,8.62,160,,,fee schedule,160% of CMS fee schedule,7.01,130,,,fee schedule,130% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,7.09,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,5.39,100,,,fee schedule,100% of CMS 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,6.75,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.01,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,5.01,450,
AFB BLOOD CULTURE CP,300008479,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
COLLECTION FEE,300008495,CDM,300,RC,36415,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,14.13,160,,,fee schedule,160% of CMS fee schedule,11.48,130,,,fee schedule,130% of CMS fee schedule,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,8.83,100,,,fee schedule,100% of CMS 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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.21,93,,,fee schedule,93% of CMS fee schedule,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.21,450,
CHLAMYDIA ANTIBODY PANEL CP,300008503,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CONCENTRA FOR INFECTIOUS AGENT,300008522,CDM,300,RC,87015,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,10.69,160,,,fee schedule,160% of CMS fee schedule,8.68,130,,,fee schedule,130% of CMS fee schedule,8.4,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,8.82,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,8.4,100,,,fee schedule,100% of GA fee schedule,6.68,100,,,fee schedule,100% of CMS 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,8.4,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.21,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,6.68,100,,,fee schedule,100% of CMS fee schedule,6.21,450,
PANEL ACID FAST CULT & SMEA CP,300008523,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PIN WORM EXAM,300008530,CDM,300,RC,87172,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,5.63,105,,,fee schedule,105% of GA fee schedule,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,5.36,100,,,fee schedule,100% of GA fee schedule,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.97,450,
WEST NILE VIRUS IgG & IgM CP,300008534,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MULTIPLE SCLEROSIS CP,300008539,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MPO/PR-3 (ANCA)  PANEL CP,300008543,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LIPOMED,300008566,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PNEUMOCYSTIS CARINII DFA,300008571,CDM,300,RC,87281,HCPCS,outpatient,,,327,228.9,,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,294.3,90,,235.44,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,252.51,77.22,,202.01,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,271.41,83,,217.13,percent of total billed charges,83% of total,310.65,95,,248.52,percent of total billed charges ,95% of total billed charges,261.6,80,,209.28,percent of total billed charges,78% of total billed charges,255.06,78,,204.048,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,277.95,85,,222.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,258.33,79,,206.66,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
HR DRUG SCREEN,300008586,CDM,300,RC,,,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
HR PHYSICIAL,300008587,CDM,300,RC,,,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,26.44,66.1,,21.15,percent of total billed charges,66.1% of total billed charges,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,25.2,63,,20.16,percent of total billed charges,63% of total billed charges,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.2,450,
HR  QUANTIFERON TB,300008588,CDM,300,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
ISOSPORA STOOL,300008590,CDM,300,RC,87206,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,8.62,160,,,fee schedule,160% of CMS fee schedule,7.01,130,,,fee schedule,130% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,7.09,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,6.75,100,,,fee schedule,100% of GA fee schedule,5.39,100,,,fee schedule,100% of CMS 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,6.75,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.01,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,5.39,100,,,fee schedule,100% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,5.01,450,
CYCLOSPORA STOOL,300008591,CDM,300,RC,87015,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,10.69,160,,,fee schedule,160% of CMS fee schedule,8.68,130,,,fee schedule,130% of CMS fee schedule,8.4,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,8.82,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,8.4,100,,,fee schedule,100% of GA fee schedule,6.68,100,,,fee schedule,100% of CMS 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,8.4,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.21,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,6.68,100,,,fee schedule,100% of CMS fee schedule,6.68,100,,,fee schedule,100% of CMS fee schedule,6.21,450,
ISOSPORA CYCLOSPORA CP,300008592,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RSV CULTURE,300008617,CDM,300,RC,87280,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,21.47,160,,,fee schedule,160% of CMS fee schedule,17.45,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.42,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.08,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.48,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,13.42,100,,,fee schedule,100% of CMS fee schedule,12.48,450,
ENVIRONMENTAL CULTURE,300008643,CDM,300,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
MULTIPLEX AMPLIFICATION,300008649,CDM,300,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
SEPARATION BY GEL ELECTROPHORE,300008651,CDM,300,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
STOOL CULTURE YERSINIA,300008676,CDM,300,RC,87081,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,10.61,160,,,fee schedule,160% of CMS fee schedule,8.62,130,,,fee schedule,130% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.75,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,6.63,100,,,fee schedule,100% of CMS 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,8.33,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.17,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.17,450,
TRIAGE PARASITE PANEL CP,300008682,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HI ENERGY WEIGHT CONTROL PROFI,300008683,CDM,300,RC,,,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,25.78,66.1,,20.62,percent of total billed charges,66.1% of total billed charges,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.57,450,
COAGULATION THROMBOSIS,300008686,CDM,300,RC,,,outpatient,,,2463,1724.1,,1945.77,79,,1556.62,percent of total billed charges,79% of total billed charges,2216.7,90,,1773.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1551.69,63,,1241.35,percent of total billed charges,63% of total billed charges,1901.93,77.22,,1521.54,percent of total billed charges,77.22% of total billed charges,1628.04,66.1,,1302.43,percent of total billed charges,66.1% of total billed charges,2044.29,83,,1635.43,percent of total billed charges,83% of total,2339.85,95,,1871.88,percent of total billed charges ,95% of total billed charges,1970.4,80,,1576.32,percent of total billed charges,78% of total billed charges,1921.14,78,,1536.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1551.69,63,,1241.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2216.7,90,,1773.36,percent of total billed charges,90% of total billed charges,1970.4,80,,1576.32,percent of total billed charges,80% of total billed charges,1551.69,63,,1241.35,percent of total billed charges,63% of total billed charges,2093.55,85,,1674.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1945.77,79,,1556.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2339.85,
PROTEIN/CREATININE RATIO CP,300008701,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
EOSINOPHIL COUNT URINE,300008704,CDM,300,RC,89050,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,7.55,160,,,fee schedule,160% of CMS fee schedule,6.14,130,,,fee schedule,130% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,6.25,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,5.95,100,,,fee schedule,100% of GA fee schedule,4.72,100,,,fee schedule,100% of CMS 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,5.95,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.39,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,4.72,100,,,fee schedule,100% of CMS fee schedule,4.72,100,,,fee schedule,100% of CMS fee schedule,4.39,450,
CHLAMYDIA RESPIRATORY,300008709,CDM,300,RC,87110,HCPCS,outpatient,,,284,198.8,,224.36,79,,179.49,percent of total billed charges,79% of total billed charges,255.6,90,,204.48,percent of total billed charges,90% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,31.36,160,,,fee schedule,160% of CMS fee schedule,25.48,130,,,fee schedule,130% of CMS fee schedule,24.63,100,,,fee schedule,100% of GA fee schedule,219.3,77.22,,175.44,percent of total billed charges,77.22% of total billed charges,25.86,105,,,fee schedule,105% of GA fee schedule,235.72,83,,188.58,percent of total billed charges,83% of total,269.8,95,,215.84,percent of total billed charges ,95% of total billed charges,227.2,80,,181.76,percent of total billed charges,78% of total billed charges,221.52,78,,177.216,percent of total billed charges,78% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,24.63,100,,,fee schedule,100% of GA fee schedule,19.6,100,,,fee schedule,100% of CMS fee schedule,255.6,90,,204.48,percent of total billed charges,90% of total billed charges,227.2,80,,181.76,percent of total billed charges,80% of total billed charges,24.63,100,,,fee schedule,100% of GA fee schedule,241.4,85,,193.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.23,93,,,fee schedule,93% of CMS fee schedule,224.36,79,,179.49,percent of total billed charges,79% of total billed charges,19.6,100,,,fee schedule,100% of CMS fee schedule,19.6,100,,,fee schedule,100% of CMS fee schedule,18.23,450,
HYPERSENSITIVITY PNEUMONITI CP,300008712,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CMV NASAL,300008730,CDM,300,RC,87252,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,41.71,160,,,fee schedule,160% of CMS fee schedule,33.89,130,,,fee schedule,130% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,29.19,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,26.07,100,,,fee schedule,100% of CMS 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,27.8,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.25,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,24.25,450,
CMV DFA,300008731,CDM,300,RC,87271,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,21.47,160,,,fee schedule,160% of CMS fee schedule,17.45,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.42,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.48,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,13.42,100,,,fee schedule,100% of CMS fee schedule,12.48,450,
"HSV,DFA",300008732,CDM,300,RC,87274,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
CMV CULTURE,300008733,CDM,300,RC,87252,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,41.71,160,,,fee schedule,160% of CMS fee schedule,33.89,130,,,fee schedule,130% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,29.19,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,27.8,100,,,fee schedule,100% of GA fee schedule,26.07,100,,,fee schedule,100% of CMS 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,27.8,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.25,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,24.25,450,
LEBER'S HEREDITARY OPTIC,300008737,CDM,300,RC,,,outpatient,,,1537,1075.9,,1214.23,79,,971.38,percent of total billed charges,79% of total billed charges,1383.3,90,,1106.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968.31,63,,774.65,percent of total billed charges,63% of total billed charges,1186.87,77.22,,949.5,percent of total billed charges,77.22% of total billed charges,1015.96,66.1,,812.77,percent of total billed charges,66.1% of total billed charges,1275.71,83,,1020.57,percent of total billed charges,83% of total,1460.15,95,,1168.12,percent of total billed charges ,95% of total billed charges,1229.6,80,,983.68,percent of total billed charges,78% of total billed charges,1198.86,78,,959.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,968.31,63,,774.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1383.3,90,,1106.64,percent of total billed charges,90% of total billed charges,1229.6,80,,983.68,percent of total billed charges,80% of total billed charges,968.31,63,,774.65,percent of total billed charges,63% of total billed charges,1306.45,85,,1045.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1214.23,79,,971.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1460.15,
CHROMOSOME ROUTINE CP,300008748,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
"CHLAMYDIA/GC,AMPLIF PROBE CP",300008772,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HSV TYPE I,300008780,CDM,300,RC,87274,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
HSV TYPE II,300008781,CDM,300,RC,87273,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
CHROMOSONE ANAYLSIS CHG CP,300008783,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DRUG SCREEN HEART & HANDS,300008784,CDM,300,RC,,,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.5,450,
PROTEIN ELECTROPHORES URINE CP,300008788,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
IMMUNOFIXATION SERUM CP,300008790,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PRADER WILLI SYNDROME CP,300008854,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MICROSPORIDIA,300008855,CDM,300,RC,87207,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,9.58,160,,,fee schedule,160% of CMS fee schedule,7.79,130,,,fee schedule,130% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,7.53,100,,,fee schedule,100% of GA fee schedule,5.99,100,,,fee schedule,100% of CMS 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,7.53,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.57,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,5.99,100,,,fee schedule,100% of CMS fee schedule,5.99,100,,,fee schedule,100% of CMS fee schedule,5.57,450,
CLOSTRIDIUM DIFFICILE CULTURE,300008856,CDM,300,RC,87075,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,9.47,100,,,fee schedule,100% of CMS fee schedule,15.15,160,,,fee schedule,160% of CMS fee schedule,12.31,130,,,fee schedule,130% of CMS fee schedule,11.9,100,,,fee schedule,100% of GA fee schedule,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,12.5,105,,,fee schedule,105% of GA fee schedule,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,9.47,100,,,fee schedule,100% of CMS fee schedule,11.9,100,,,fee schedule,100% of GA fee schedule,9.47,100,,,fee schedule,100% of CMS 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,11.9,100,,,fee schedule,100% of GA fee schedule,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.81,93,,,fee schedule,93% of CMS fee schedule,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,9.47,100,,,fee schedule,100% of CMS fee schedule,9.47,100,,,fee schedule,100% of CMS fee schedule,8.81,450,
HELICOBACTER CULTURE,300008864,CDM,300,RC,87081,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,10.61,160,,,fee schedule,160% of CMS fee schedule,8.62,130,,,fee schedule,130% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.75,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,6.63,100,,,fee schedule,100% of CMS 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,8.33,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.17,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.17,450,
MEDTOX DRUG SCREEN,300008868,CDM,300,RC,,,outpatient,,,89,62.3,,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,80.1,90,,64.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,68.73,77.22,,54.98,percent of total billed charges,77.22% of total billed charges,58.83,66.1,,47.06,percent of total billed charges,66.1% of total billed charges,73.87,83,,59.1,percent of total billed charges,83% of total,84.55,95,,67.64,percent of total billed charges ,95% of total billed charges,71.2,80,,56.96,percent of total billed charges,78% of total billed charges,69.42,78,,55.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.07,63,,44.86,percent of total billed charges,63% of total billed charges,75.65,85,,60.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,70.31,79,,56.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.07,450,
ALCOHOL STATE TROOPER,300008886,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CULTURE SCREEN DIPHTHERIA,300008891,CDM,300,RC,87081,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,10.61,160,,,fee schedule,160% of CMS fee schedule,8.62,130,,,fee schedule,130% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.75,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,6.63,100,,,fee schedule,100% of CMS 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,8.33,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.17,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.17,450,
ID DIPHTHERIA,300008892,CDM,300,RC,87077,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,12.93,160,,,fee schedule,160% of CMS fee schedule,10.5,130,,,fee schedule,130% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,10.67,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,8.08,100,,,fee schedule,100% of CMS 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,10.16,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.51,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,7.51,450,
C DIPHTHERIA CULTURE CP,300008893,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HYPERSENSITIVITY PNEUM I CP,300008912,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HYPERSENSITIVITY  PNEUM II CP,300008913,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
QUAD PANEL CP,300008920,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LABORATORY OR PAP (NON-BILL),300008935,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ABO BLOOD TYPING SEROLOGIC,300008940,CDM,300,RC,86901,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,53.65,160,,,Fee Schedule,160% of CMS OPPS rate,43.59,130,,,Fee Schedule,130% of CMS OPPS rate,14.51,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,15.24,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,14.51,100,,,fee schedule,100% of GA fee schedule,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,14.51,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.18,93,,,fee schedule,93% of CMS OPPS rate,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,14.51,450,
RH BLOOD TYPING SEROLOGIC ABO,300008941,CDM,300,RC,86900,HCPCS,outpatient,,,246,172.2,,194.34,79,,155.47,percent of total billed charges,79% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,3.75,100,,,fee schedule,100% of GA fee schedule,189.96,77.22,,151.97,percent of total billed charges,77.22% of total billed charges,3.94,105,,,fee schedule,105% of GA fee schedule,204.18,83,,163.34,percent of total billed charges,83% of total,233.7,95,,186.96,percent of total billed charges ,95% of total billed charges,196.8,80,,157.44,percent of total billed charges,78% of total billed charges,191.88,78,,153.504,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,3.75,100,,,fee schedule,100% of GA fee schedule,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,3.75,100,,,fee schedule,100% of GA fee schedule,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,194.34,79,,155.47,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,3.75,450,
JIC TYPE AND SCREEN,300008943,CDM,300,RC,,,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
B2 GLYCOPROTE I ABS IGG/IGM CP,300008948,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
URTICARIA CHRONIC INDEX CP,300008962,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
AFB (STATE),300008966,CDM,300,RC,87116,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,17.28,160,,,fee schedule,160% of CMS fee schedule,14.04,130,,,fee schedule,130% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,10.8,100,,,fee schedule,100% of CMS 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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.04,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,10.8,100,,,fee schedule,100% of CMS fee schedule,10.8,100,,,fee schedule,100% of CMS fee schedule,10.04,450,
MMRV CP,300008971,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ISOHEMA CP,300008974,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ALLERGIC BRONCHOPULMON ASPE CP,300008979,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
N GONORRHEA URINE CULTURE,300008988,CDM,300,RC,87070,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,13.79,160,,,fee schedule,160% of CMS fee schedule,11.21,130,,,fee schedule,130% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,11.37,105,,,fee schedule,105% of GA fee schedule,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,8.62,100,,,fee schedule,100% of CMS 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,10.83,100,,,fee schedule,100% of GA fee schedule,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.02,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.02,450,
PYLORITEK,300009000,CDM,300,RC,87077,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,12.93,160,,,fee schedule,160% of CMS fee schedule,10.5,130,,,fee schedule,130% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,10.67,105,,,fee schedule,105% of GA fee schedule,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,8.08,100,,,fee schedule,100% of CMS 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,10.16,100,,,fee schedule,100% of GA fee schedule,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.51,93,,,fee schedule,93% of CMS fee schedule,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,7.51,450,
FDS 22 (DOCTOR OFFICE),300009037,CDM,300,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
IGA SUBCLASS CP,300009073,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
GIARDIA ANTIGEN,300009074,CDM,300,RC,87269,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,13.61,100,,,fee schedule,100% of CMS fee schedule,21.78,160,,,fee schedule,160% of CMS fee schedule,17.69,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,13.61,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.61,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.66,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,13.61,100,,,fee schedule,100% of CMS fee schedule,13.61,100,,,fee schedule,100% of CMS fee schedule,12.66,450,
CRYPTOSPORIDIUM AG DETECTION,300009075,CDM,300,RC,87272,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
PACPRA CP,300009079,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PROLIFERATION PANEL CP,300009093,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LEGAL ALCOHOL (PD BY PATIENT),300009095,CDM,300,RC,,,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
LAXATIVE PROFILE CP,300009119,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
Acetylcholine Receptor (AChR),300009134,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MACROPROLACTIN CP,300009137,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
E SCREEN DRUG PH,300009139,CDM,300,RC,,,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,9.45,450,
PERTUSSIS CULTURE,300009141,CDM,300,RC,87070,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,13.79,160,,,fee schedule,160% of CMS fee schedule,11.21,130,,,fee schedule,130% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,11.37,105,,,fee schedule,105% of GA fee schedule,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,8.62,100,,,fee schedule,100% of CMS 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,10.83,100,,,fee schedule,100% of GA fee schedule,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.02,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.02,450,
VAP CHOLESTEROL PANEL CP,300009144,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CLOSTRIDIUM DIFFICLE CYTOTOXIN,300009145,CDM,300,RC,87230,HCPCS,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,19.74,100,,,fee schedule,100% of CMS fee schedule,31.58,160,,,fee schedule,160% of CMS fee schedule,25.66,130,,,fee schedule,130% of CMS fee schedule,24.83,100,,,fee schedule,100% of GA fee schedule,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,26.07,105,,,fee schedule,105% of GA fee schedule,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,19.74,100,,,fee schedule,100% of CMS fee schedule,24.83,100,,,fee schedule,100% of GA fee schedule,19.74,100,,,fee schedule,100% of CMS 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,24.83,100,,,fee schedule,100% of GA fee schedule,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.36,93,,,fee schedule,93% of CMS fee schedule,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,19.74,100,,,fee schedule,100% of CMS fee schedule,19.74,100,,,fee schedule,100% of CMS fee schedule,18.36,450,
COCCIDIOIDES ANTIB IGG IGM CP,300009148,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CAPILLARY COLLECTION,300009201,CDM,300,RC,36416,HCPCS,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
NON-BILLABLE CHARGE LAB,300009265,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
GESTATIONAL GTT 3 HR  CP,300009287,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INFLUENZA CP,300009666,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BORDETELLA PERTUSSIS CP,300040904,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PERTUSSIS,300040905,CDM,300,RC,87070,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,13.79,160,,,fee schedule,160% of CMS fee schedule,11.21,130,,,fee schedule,130% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,11.37,105,,,fee schedule,105% of GA fee schedule,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,10.83,100,,,fee schedule,100% of GA fee schedule,8.62,100,,,fee schedule,100% of CMS 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,10.83,100,,,fee schedule,100% of GA fee schedule,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.02,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.02,450,
BCR ABL TRANSLOCATION CP,300040941,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ACANTHAMOEBA CULTURE,300040950,CDM,300,RC,87081,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,10.61,160,,,fee schedule,160% of CMS fee schedule,8.62,130,,,fee schedule,130% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.75,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,8.33,100,,,fee schedule,100% of GA fee schedule,6.63,100,,,fee schedule,100% of CMS 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,8.33,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.17,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.17,450,
PARANEOPLASTIC PROFILE CP,300040955,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
STONER  STONE RISK CP,300081027,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FISH B CELL LYMPHOCYTIC CP,300081028,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HCV FIBROSURE,300081596,CDM,300,RC,81596,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,72.19,100,,,fee schedule,100% of CMS fee schedule,115.5,160,,,fee schedule,160% of CMS fee schedule,93.85,130,,,fee schedule,130% of CMS fee schedule,57.75,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,60.64,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,72.19,100,,,fee schedule,100% of CMS fee schedule,57.75,100,,,fee schedule,100% of GA fee schedule,72.19,100,,,fee schedule,100% of CMS fee schedule,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,57.75,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,67.14,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,72.19,100,,,fee schedule,100% of CMS fee schedule,72.19,100,,,fee schedule,100% of CMS fee schedule,57.75,450,
LIPOPROTEIN ASSC PHOSPHOLIPASE,300083698,CDM,300,RC,83698,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,46.31,100,,,fee schedule,100% of CMS fee schedule,74.1,160,,,fee schedule,160% of CMS fee schedule,60.2,130,,,fee schedule,130% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,44.82,105,,,fee schedule,105% of GA fee schedule,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,46.31,100,,,fee schedule,100% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,46.31,100,,,fee schedule,100% of CMS 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,42.69,100,,,fee schedule,100% of GA fee schedule,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,43.07,93,,,fee schedule,93% of CMS fee schedule,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,46.31,100,,,fee schedule,100% of CMS fee schedule,46.31,100,,,fee schedule,100% of CMS fee schedule,42.69,450,
DES-YCARBOXY PROTHROMBIN,300083951,CDM,300,RC,83951,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,103.06,160,,,fee schedule,160% of CMS fee schedule,83.73,130,,,fee schedule,130% of CMS fee schedule,75.23,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,78.99,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,75.23,100,,,fee schedule,100% of GA fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,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,75.23,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,59.9,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,59.9,450,
COVIGG,300086769,CDM,300,RC,86769,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,67.41,160,,,fee schedule,160% of CMS fee schedule,54.77,130,,,fee schedule,130% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,53.88,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,42.13,100,,,fee schedule,100% of CMS 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,51.31,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.18,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,39.18,450,
SCABIES EXAMINATION CHARGE,300087169,CDM,300,RC,87169,HCPCS,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,4.31,100,,,fee schedule,100% of CMS fee schedule,6.9,160,,,fee schedule,160% of CMS fee schedule,5.6,130,,,fee schedule,130% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,5.63,105,,,fee schedule,105% of GA fee schedule,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,4.31,100,,,fee schedule,100% of CMS fee schedule,5.36,100,,,fee schedule,100% of GA fee schedule,4.31,100,,,fee schedule,100% of CMS 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,5.36,100,,,fee schedule,100% of GA fee schedule,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.01,93,,,fee schedule,93% of CMS fee schedule,79,79,,63.2,percent of total billed charges,79% of total billed charges,4.31,100,,,fee schedule,100% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,4.01,450,
BARTONELLA DNA PCR,300087471,CDM,300,RC,87471,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,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,24.67,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
COVIGM,300186769,CDM,300,RC,86769,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,67.41,160,,,fee schedule,160% of CMS fee schedule,54.77,130,,,fee schedule,130% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,53.88,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,42.13,100,,,fee schedule,100% of CMS 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,51.31,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.18,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,39.18,450,
COVIGA,300286769,CDM,300,RC,86769,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,67.41,160,,,fee schedule,160% of CMS fee schedule,54.77,130,,,fee schedule,130% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,53.88,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,42.13,100,,,fee schedule,100% of CMS 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,51.31,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.18,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,39.18,450,
COVIDGG,300386769,CDM,300,RC,86769,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,67.41,160,,,fee schedule,160% of CMS fee schedule,54.77,130,,,fee schedule,130% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,53.88,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,42.13,100,,,fee schedule,100% of CMS 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,51.31,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.18,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,39.18,450,
SARS COV2 SEMI-QUANTITATIVE,300486769,CDM,300,RC,86769,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,67.41,160,,,fee schedule,160% of CMS fee schedule,54.77,130,,,fee schedule,130% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,53.88,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,42.13,100,,,fee schedule,100% of CMS 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,51.31,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.18,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,42.13,100,,,fee schedule,100% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,39.18,450,
PPD SKIN TEST,300800405,CDM,300,RC,,,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.8,450,
WELLNESS PROFILE,300900150,CDM,300,RC,,,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,5.95,66.1,,4.76,percent of total billed charges,66.1% of total billed charges,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,5.67,63,,4.54,percent of total billed charges,63% of total billed charges,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.67,450,
MUSCLE BIOPSY CP,300900152,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INSECTICIDE EXPOSURE CP,300900153,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
THYROID PROFILE CP,300900155,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHLAMYDIA ANTIBODY PANEL CP,300900156,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PRO-PREDICT CP,300900157,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DRUG SCREEN COMPREHENSIVE CP,300900158,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHROMOSONE POC CP,300900159,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
IGE RECEPTOR    CP,300900160,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LIGHT CHAIN TYPING CP,300900161,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INFLAMMATORY BOWEL DISEASE CP,300900162,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BCR ABL QUALT CP,300900164,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
GC/CHLAMYDIA CP,306008770,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ERA PROFILE CP,310000310,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NER2/NEU FISH MANUAL CP,310000313,CDM,300,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RH,390000022,CDM,300,RC,86900,HCPCS,outpatient,,,246,172.2,,194.34,79,,155.47,percent of total billed charges,79% of total billed charges,221.4,90,,177.12,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,3.75,100,,,fee schedule,100% of GA fee schedule,189.96,77.22,,151.97,percent of total billed charges,77.22% of total billed charges,3.94,105,,,fee schedule,105% of GA fee schedule,204.18,83,,163.34,percent of total billed charges,83% of total,233.7,95,,186.96,percent of total billed charges ,95% of total billed charges,196.8,80,,157.44,percent of total billed charges,78% of total billed charges,191.88,78,,153.504,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,3.75,100,,,fee schedule,100% of GA fee schedule,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,3.75,100,,,fee schedule,100% of GA fee schedule,209.1,85,,167.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,194.34,79,,155.47,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,3.75,450,
X-MATCH PER UNIT,390000027,CDM,300,RC,86920,HCPCS,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,142.12,66.1,,113.7,percent of total billed charges,66.1% of total billed charges,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,132.82,450,
SCREENING UNITS,390000141,CDM,300,RC,86904,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,11.95,100,,,fee schedule,100% of GA fee schedule,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,12.55,105,,,fee schedule,105% of GA fee schedule,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,11.95,100,,,fee schedule,100% of GA fee schedule,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,11.95,100,,,fee schedule,100% of GA fee schedule,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,11.95,450,
TYPE & HOLD,390000371,CDM,300,RC,,,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,118.98,66.1,,95.18,percent of total billed charges,66.1% of total billed charges,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,113.4,63,,90.72,percent of total billed charges,63% of total billed charges,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.4,450,
ABO,390000508,CDM,300,RC,86901,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,53.65,160,,,Fee Schedule,160% of CMS OPPS rate,43.59,130,,,Fee Schedule,130% of CMS OPPS rate,14.51,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,15.24,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,14.51,100,,,fee schedule,100% of GA fee schedule,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,14.51,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.18,93,,,fee schedule,93% of CMS OPPS rate,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,14.51,450,
BLOOD TYPE AND RH  CP,390000600,CDM,300,RC,86900,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,3.75,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,3.94,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,3.75,100,,,fee schedule,100% of GA fee schedule,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,3.75,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,3.75,450,
ER URINE SPEC COLL STRAIT CATH,4500P9612,CDM,300,RC,P9612,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,14.13,160,,,fee schedule,160% of CMS fee schedule,11.48,130,,,fee schedule,130% of CMS fee schedule,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,8.83,100,,,fee schedule ,100% of CMS 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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.21,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.21,450,
CORNEAL PACHYMETRY OFFICE,CORNEAL,CDM,300,RC,76514,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,54.2,66.1,,43.36,percent of total billed charges,66.1% of total billed charges,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,51.66,63,,41.33,percent of total billed charges,63% of total billed charges,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,23.15,450,
"CATECHOLAMINE,TOTAL URINE",300000007,CDM,301,RC,82382,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,27.3,100,,,fee schedule,100% of CMS fee schedule,43.68,160,,,fee schedule,160% of CMS fee schedule,35.49,130,,,fee schedule,130% of CMS fee schedule,21.62,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,22.7,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,27.3,100,,,fee schedule,100% of CMS fee schedule,21.62,100,,,fee schedule,100% of GA fee schedule,27.3,100,,,fee schedule,100% of CMS 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,21.62,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.39,93,,,fee schedule,93% of CMS fee schedule,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,27.3,100,,,fee schedule,100% of CMS fee schedule,27.3,100,,,fee schedule,100% of CMS fee schedule,21.62,450,
MONOTEST,300000031,CDM,301,RC,83519,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
"PROTEIN,TOTAL BODY FLUID",300000037,CDM,301,RC,84157,HCPCS,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,4,100,,,fee schedule,100% of CMS fee schedule,6.4,160,,,fee schedule,160% of CMS fee schedule,5.2,130,,,fee schedule,130% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,4.84,105,,,fee schedule,105% of GA fee schedule,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,4,100,,,fee schedule,100% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,4,100,,,fee schedule,100% of CMS 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,4.61,100,,,fee schedule,100% of GA fee schedule,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.72,93,,,fee schedule,93% of CMS fee schedule,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,4,100,,,fee schedule,100% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,3.72,450,
GLUCOSE (BODY FLUID),300000038,CDM,301,RC,82945,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,6.29,160,,,fee schedule,160% of CMS fee schedule,5.11,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.93,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
CHLORIDE,300000039,CDM,301,RC,82435,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,4.6,100,,,fee schedule,100% of CMS fee schedule,7.36,160,,,fee schedule,160% of CMS fee schedule,5.98,130,,,fee schedule,130% of CMS fee schedule,5.78,100,,,fee schedule,100% of GA fee schedule,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,6.07,105,,,fee schedule,105% of GA fee schedule,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,4.6,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of GA fee schedule,4.6,100,,,fee schedule,100% of CMS 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,5.78,100,,,fee schedule,100% of GA fee schedule,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.28,93,,,fee schedule,93% of CMS fee schedule,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,4.6,100,,,fee schedule,100% of CMS fee schedule,4.6,100,,,fee schedule,100% of CMS fee schedule,4.28,450,
CREATININE CLEARANCE,300000054,CDM,301,RC,82575,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,9.46,100,,,fee schedule,100% of CMS fee schedule,15.14,160,,,fee schedule,160% of CMS fee schedule,12.3,130,,,fee schedule,130% of CMS fee schedule,11.88,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,12.47,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,9.46,100,,,fee schedule,100% of CMS fee schedule,11.88,100,,,fee schedule,100% of GA fee schedule,9.46,100,,,fee schedule,100% of CMS 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,11.88,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.8,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,9.46,100,,,fee schedule,100% of CMS fee schedule,9.46,100,,,fee schedule,100% of CMS fee schedule,8.8,450,
AMYLASE,300000061,CDM,301,RC,82150,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,10.37,160,,,fee schedule,160% of CMS fee schedule,8.42,130,,,fee schedule,130% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,8.56,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,6.48,100,,,fee schedule,100% of CMS 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,8.15,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.03,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,6.03,450,
CKMB ISOENZMES CP,300000066,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
IRON (FE),300000075,CDM,301,RC,83540,HCPCS,outpatient,,,130,91,,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,10.35,160,,,fee schedule,160% of CMS fee schedule,8.41,130,,,fee schedule,130% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,100.39,77.22,,80.31,percent of total billed charges,77.22% of total billed charges,8.56,105,,,fee schedule,105% of GA fee schedule,107.9,83,,86.32,percent of total billed charges,83% of total,123.5,95,,98.8,percent of total billed charges ,95% of total billed charges,104,80,,83.2,percent of total billed charges,78% of total billed charges,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,6.47,100,,,fee schedule,100% of CMS 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,8.15,100,,,fee schedule,100% of GA fee schedule,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.02,93,,,fee schedule,93% of CMS fee schedule,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.02,450,
LIPASE,300000076,CDM,301,RC,83690,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,11.02,160,,,fee schedule,160% of CMS fee schedule,8.96,130,,,fee schedule,130% of CMS fee schedule,8.66,100,,,fee schedule,100% of GA fee schedule,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,9.09,105,,,fee schedule,105% of GA fee schedule,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,8.66,100,,,fee schedule,100% of GA fee schedule,6.89,100,,,fee schedule,100% of CMS 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,8.66,100,,,fee schedule,100% of GA fee schedule,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.41,93,,,fee schedule,93% of CMS fee schedule,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,6.41,450,
TIBC (BINDING CAPACITY),300000077,CDM,301,RC,83550,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,13.98,160,,,fee schedule,160% of CMS fee schedule,11.36,130,,,fee schedule,130% of CMS fee schedule,10.99,100,,,fee schedule,100% of GA fee schedule,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,11.54,105,,,fee schedule,105% of GA fee schedule,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,10.99,100,,,fee schedule,100% of GA fee schedule,8.74,100,,,fee schedule,100% of CMS 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,10.99,100,,,fee schedule,100% of GA fee schedule,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.13,93,,,fee schedule,93% of CMS fee schedule,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,8.74,100,,,fee schedule,100% of CMS fee schedule,8.74,100,,,fee schedule,100% of CMS fee schedule,8.13,450,
ACID PHOSPHATASE,300000083,CDM,301,RC,84060,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,7.64,100,,,fee schedule,100% of CMS fee schedule,12.22,160,,,fee schedule,160% of CMS fee schedule,9.93,130,,,fee schedule,130% of CMS fee schedule,9.29,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,9.75,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,7.64,100,,,fee schedule,100% of CMS fee schedule,9.29,100,,,fee schedule,100% of GA fee schedule,7.64,100,,,fee schedule,100% of CMS 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,9.29,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.11,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,7.64,100,,,fee schedule,100% of CMS fee schedule,7.64,100,,,fee schedule,100% of CMS fee schedule,7.11,450,
CPK,300000084,CDM,301,RC,82550,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,10.42,160,,,fee schedule,160% of CMS fee schedule,8.46,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,6.51,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.05,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of CMS fee schedule,6.05,450,
PKU,300000095,CDM,301,RC,84030,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,5.5,100,,,fee schedule,100% of CMS fee schedule,8.8,160,,,fee schedule,160% of CMS fee schedule,7.15,130,,,fee schedule,130% of CMS fee schedule,6.92,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,7.27,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,5.5,100,,,fee schedule,100% of CMS fee schedule,6.92,100,,,fee schedule,100% of GA fee schedule,5.5,100,,,fee schedule,100% of CMS 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,6.92,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.12,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,5.5,100,,,fee schedule,100% of CMS fee schedule,5.5,100,,,fee schedule,100% of CMS fee schedule,5.12,450,
VANCOMYCIN PEAK,300000101,CDM,301,RC,80202,HCPCS,outpatient,,,163,114.1,,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,21.66,160,,,fee schedule,160% of CMS fee schedule,17.6,130,,,fee schedule,130% of CMS fee schedule,14.27,100,,,fee schedule,100% of GA fee schedule,125.87,77.22,,100.7,percent of total billed charges,77.22% of total billed charges,14.98,105,,,fee schedule,105% of GA fee schedule,135.29,83,,108.23,percent of total billed charges,83% of total,154.85,95,,123.88,percent of total billed charges ,95% of total billed charges,130.4,80,,104.32,percent of total billed charges,78% of total billed charges,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,14.27,100,,,fee schedule,100% of GA fee schedule,13.54,100,,,fee schedule,100% of CMS 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,14.27,100,,,fee schedule,100% of GA fee schedule,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.59,93,,,fee schedule,93% of CMS fee schedule,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,12.59,450,
ALCOHOL BLOOD,300000103,CDM,301,RC,80320,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.59,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,14.27,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.59,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,13.59,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.59,450,
ALKALINE PHOS. ISOENZMES,300000105,CDM,301,RC,84080,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,23.65,160,,,fee schedule,160% of CMS fee schedule,19.21,130,,,fee schedule,130% of CMS fee schedule,18.59,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,19.52,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,18.59,100,,,fee schedule,100% of GA fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,18.59,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.75,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,13.75,450,
VANCOMYCIN TROUG,300000107,CDM,301,RC,80202,HCPCS,outpatient,,,163,114.1,,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,21.66,160,,,fee schedule,160% of CMS fee schedule,17.6,130,,,fee schedule,130% of CMS fee schedule,14.27,100,,,fee schedule,100% of GA fee schedule,125.87,77.22,,100.7,percent of total billed charges,77.22% of total billed charges,14.98,105,,,fee schedule,105% of GA fee schedule,135.29,83,,108.23,percent of total billed charges,83% of total,154.85,95,,123.88,percent of total billed charges ,95% of total billed charges,130.4,80,,104.32,percent of total billed charges,78% of total billed charges,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,14.27,100,,,fee schedule,100% of GA fee schedule,13.54,100,,,fee schedule,100% of CMS 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,14.27,100,,,fee schedule,100% of GA fee schedule,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.59,93,,,fee schedule,93% of CMS fee schedule,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,12.59,450,
LITHIUM,300000108,CDM,301,RC,80178,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,10.58,160,,,fee schedule,160% of CMS fee schedule,8.59,130,,,fee schedule,130% of CMS fee schedule,8.32,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,8.74,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,8.32,100,,,fee schedule,100% of GA fee schedule,6.61,100,,,fee schedule,100% of CMS 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,8.32,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.15,93,,,fee schedule,93% of CMS fee schedule,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,6.15,450,
DIGOXIN-REA,300000109,CDM,301,RC,80162,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,13.28,100,,,fee schedule,100% of CMS fee schedule,21.25,160,,,fee schedule,160% of CMS fee schedule,17.26,130,,,fee schedule,130% of CMS fee schedule,16.7,100,,,fee schedule,100% of GA fee schedule,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,17.54,105,,,fee schedule,105% of GA fee schedule,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,13.28,100,,,fee schedule,100% of CMS fee schedule,16.7,100,,,fee schedule,100% of GA fee schedule,13.28,100,,,fee schedule,100% of CMS 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,16.7,100,,,fee schedule,100% of GA fee schedule,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.35,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,13.28,100,,,fee schedule,100% of CMS fee schedule,13.28,100,,,fee schedule,100% of CMS fee schedule,12.35,450,
PROTEIN ELECTROPHORESIS,300000111,CDM,301,RC,84165,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,17.18,160,,,fee schedule,160% of CMS fee schedule,13.96,130,,,fee schedule,130% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,14.19,105,,,fee schedule,105% of GA fee schedule,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,10.74,100,,,fee schedule,100% of CMS 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,13.51,100,,,fee schedule,100% of GA fee schedule,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.99,93,,,fee schedule,93% of CMS fee schedule,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,9.99,450,
ASSAY OF INSULIN,300000112,CDM,301,RC,83525,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,11.43,100,,,fee schedule,100% of CMS fee schedule,18.29,160,,,fee schedule,160% of CMS fee schedule,14.86,130,,,fee schedule,130% of CMS fee schedule,14.38,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,15.1,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,11.43,100,,,fee schedule,100% of CMS fee schedule,14.38,100,,,fee schedule,100% of GA fee schedule,11.43,100,,,fee schedule,100% of CMS 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,14.38,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.63,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,11.43,100,,,fee schedule,100% of CMS fee schedule,11.43,100,,,fee schedule,100% of CMS fee schedule,10.63,450,
DILANTIN LEVEL PHENYTOIN,300000114,CDM,301,RC,80185,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,16.67,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,17.5,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,16.67,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS 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,16.67,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
HEMOGLOBIN ELECTROPHORESIS,300000116,CDM,301,RC,83020,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,20.59,160,,,fee schedule,160% of CMS fee schedule,16.73,130,,,fee schedule,130% of CMS fee schedule,12.29,100,,,fee schedule,100% of GA fee schedule,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,12.9,105,,,fee schedule,105% of GA fee schedule,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,12.29,100,,,fee schedule,100% of GA fee schedule,12.87,100,,,fee schedule,100% of CMS 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,12.29,100,,,fee schedule,100% of GA fee schedule,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.97,93,,,fee schedule,93% of CMS fee schedule,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,11.97,450,
PROSTATIC ACID PHOSPHATE (PAP),300000117,CDM,301,RC,84066,HCPCS,outpatient,,,121,84.7,,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,108.9,90,,87.12,percent of total billed charges,90% of total billed charges,9.66,100,,,fee schedule,100% of CMS fee schedule,15.46,160,,,fee schedule,160% of CMS fee schedule,12.56,130,,,fee schedule,130% of CMS fee schedule,12.15,100,,,fee schedule,100% of GA fee schedule,93.44,77.22,,74.75,percent of total billed charges,77.22% of total billed charges,12.76,105,,,fee schedule,105% of GA fee schedule,100.43,83,,80.34,percent of total billed charges,83% of total,114.95,95,,91.96,percent of total billed charges ,95% of total billed charges,96.8,80,,77.44,percent of total billed charges,78% of total billed charges,94.38,78,,75.504,percent of total billed charges,78% of total billed charges,9.66,100,,,fee schedule,100% of CMS fee schedule,12.15,100,,,fee schedule,100% of GA fee schedule,9.66,100,,,fee schedule,100% of CMS 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,12.15,100,,,fee schedule,100% of GA fee schedule,102.85,85,,82.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.98,93,,,fee schedule,93% of CMS fee schedule,95.59,79,,76.47,percent of total billed charges,79% of total billed charges,9.66,100,,,fee schedule,100% of CMS fee schedule,9.66,100,,,fee schedule,100% of CMS fee schedule,8.98,450,
VITAMIN B12,300000118,CDM,301,RC,82607,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,24.13,160,,,fee schedule,160% of CMS fee schedule,19.6,130,,,fee schedule,130% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,19.9,105,,,fee schedule,105% of GA fee schedule,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,15.08,100,,,fee schedule,100% of CMS 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,18.95,100,,,fee schedule,100% of GA fee schedule,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.02,93,,,fee schedule,93% of CMS fee schedule,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,14.02,450,
24 HR URINE PROTEIN,300000119,CDM,301,RC,84156,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,5.87,160,,,fee schedule,160% of CMS fee schedule,4.77,130,,,fee schedule,130% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,4.84,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,3.67,100,,,fee schedule,100% of CMS 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,4.61,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.41,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.41,450,
KIDNEY STONE ANALYSIS,300000120,CDM,301,RC,82360,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,20.59,160,,,fee schedule,160% of CMS fee schedule,16.73,130,,,fee schedule,130% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,168.34,77.22,,134.67,percent of total billed charges,77.22% of total billed charges,17,105,,,fee schedule,105% of GA fee schedule,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,12.87,100,,,fee schedule,100% of CMS 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,16.19,100,,,fee schedule,100% of GA fee schedule,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.97,93,,,fee schedule,93% of CMS fee schedule,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,11.97,450,
CORTISOL STIMULATION,300000124,CDM,301,RC,80400,HCPCS,outpatient,,,293,205.1,,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,32.62,100,,,fee schedule,100% of CMS fee schedule,52.19,160,,,fee schedule,160% of CMS fee schedule,42.41,130,,,fee schedule,130% of CMS fee schedule,41,100,,,fee schedule,100% of GA fee schedule,226.25,77.22,,181,percent of total billed charges,77.22% of total billed charges,43.05,105,,,fee schedule,105% of GA fee schedule,243.19,83,,194.55,percent of total billed charges,83% of total,278.35,95,,222.68,percent of total billed charges ,95% of total billed charges,234.4,80,,187.52,percent of total billed charges,78% of total billed charges,228.54,78,,182.832,percent of total billed charges,78% of total billed charges,32.62,100,,,fee schedule,100% of CMS fee schedule,41,100,,,fee schedule,100% of GA fee schedule,32.62,100,,,fee schedule,100% of CMS fee schedule,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,41,100,,,fee schedule,100% of GA fee schedule,249.05,85,,199.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,30.34,93,,,fee schedule,93% of CMS fee schedule,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,32.62,100,,,fee schedule,100% of CMS fee schedule,32.62,100,,,fee schedule,100% of CMS fee schedule,30.34,450,
C E A,300000125,CDM,301,RC,82378,HCPCS,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,18.96,100,,,fee schedule,100% of CMS fee schedule,30.34,160,,,fee schedule,160% of CMS fee schedule,24.65,130,,,fee schedule,130% of CMS fee schedule,23.86,100,,,fee schedule,100% of GA fee schedule,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,25.05,105,,,fee schedule,105% of GA fee schedule,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,18.96,100,,,fee schedule,100% of CMS fee schedule,23.86,100,,,fee schedule,100% of GA fee schedule,18.96,100,,,fee schedule,100% of CMS 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,23.86,100,,,fee schedule,100% of GA fee schedule,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.63,93,,,fee schedule,93% of CMS fee schedule,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,18.96,100,,,fee schedule,100% of CMS fee schedule,18.96,100,,,fee schedule,100% of CMS fee schedule,17.63,450,
PREGANCY TEST (SERUM) HCVQUANT,300000126,CDM,301,RC,84702,HCPCS,outpatient,,,355,248.5,,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,274.13,77.22,,219.3,percent of total billed charges,77.22% of total billed charges,8.47,105,,,fee schedule,105% of GA fee schedule,294.65,83,,235.72,percent of total billed charges,83% of total,337.25,95,,269.8,percent of total billed charges ,95% of total billed charges,284,80,,227.2,percent of total billed charges,78% of total billed charges,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,8.07,100,,,fee schedule,100% of GA fee schedule,301.75,85,,241.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,8.07,450,
PRENATAL PANEL,300000127,CDM,301,RC,80055,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,47.81,100,,,fee schedule,100% of CMS fee schedule,76.5,160,,,fee schedule,160% of CMS fee schedule,62.15,130,,,fee schedule,130% of CMS fee schedule,28.08,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,29.48,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,47.81,100,,,fee schedule,100% of CMS fee schedule,28.08,100,,,fee schedule,100% of GA fee schedule,47.81,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,28.08,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,44.46,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,47.81,100,,,fee schedule,100% of CMS fee schedule,47.81,100,,,fee schedule,100% of CMS fee schedule,28.08,450,
"PORPHOBILINO,URINE QUANTI",300000128,CDM,301,RC,84110,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,8.44,100,,,fee schedule,100% of CMS fee schedule,13.5,160,,,fee schedule,160% of CMS fee schedule,10.97,130,,,fee schedule,130% of CMS fee schedule,10.62,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,11.15,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,8.44,100,,,fee schedule,100% of CMS fee schedule,10.62,100,,,fee schedule,100% of GA fee schedule,8.44,100,,,fee schedule,100% of CMS 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,10.62,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.85,93,,,fee schedule,93% of CMS fee schedule,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,8.44,100,,,fee schedule,100% of CMS fee schedule,8.44,100,,,fee schedule,100% of CMS fee schedule,7.85,450,
17 KETOSTEROIDS,300000131,CDM,301,RC,83586,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,12.8,100,,,fee schedule,100% of CMS fee schedule,20.48,160,,,fee schedule,160% of CMS fee schedule,16.64,130,,,fee schedule,130% of CMS fee schedule,15.8,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,16.59,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,12.8,100,,,fee schedule,100% of CMS fee schedule,15.8,100,,,fee schedule,100% of GA fee schedule,12.8,100,,,fee schedule,100% of CMS 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,15.8,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.9,93,,,fee schedule,93% of CMS fee schedule,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,12.8,100,,,fee schedule,100% of CMS fee schedule,12.8,100,,,fee schedule,100% of CMS fee schedule,11.9,450,
URIC ACID OTHER THAN BLOOD,300000134,CDM,301,RC,84560,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,8.13,160,,,fee schedule,160% of CMS fee schedule,6.6,130,,,fee schedule,130% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,6.28,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,5.08,100,,,fee schedule,100% of CMS 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,5.98,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.72,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,5.08,100,,,fee schedule,100% of CMS fee schedule,4.72,450,
5' NUCLEOTIDASE,300000135,CDM,301,RC,83915,HCPCS,outpatient,,,136,95.2,,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,11.15,100,,,fee schedule,100% of CMS fee schedule,17.84,160,,,fee schedule,160% of CMS fee schedule,14.5,130,,,fee schedule,130% of CMS fee schedule,14.02,100,,,fee schedule,100% of GA fee schedule,105.02,77.22,,84.02,percent of total billed charges,77.22% of total billed charges,14.72,105,,,fee schedule,105% of GA fee schedule,112.88,83,,90.3,percent of total billed charges,83% of total,129.2,95,,103.36,percent of total billed charges ,95% of total billed charges,108.8,80,,87.04,percent of total billed charges,78% of total billed charges,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,11.15,100,,,fee schedule,100% of CMS fee schedule,14.02,100,,,fee schedule,100% of GA fee schedule,11.15,100,,,fee schedule,100% of CMS 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,14.02,100,,,fee schedule,100% of GA fee schedule,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.37,93,,,fee schedule,93% of CMS fee schedule,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,11.15,100,,,fee schedule,100% of CMS fee schedule,11.15,100,,,fee schedule,100% of CMS fee schedule,10.37,450,
ALPHA FETOPROTEIN,300000136,CDM,301,RC,82105,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,26.83,160,,,fee schedule,160% of CMS fee schedule,21.8,130,,,fee schedule,130% of CMS fee schedule,21.1,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,22.16,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,21.1,100,,,fee schedule,100% of GA fee schedule,16.77,100,,,fee schedule,100% of CMS 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,21.1,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.6,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,15.6,450,
THEOPHYLLINE,300000137,CDM,301,RC,80198,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,14.14,100,,,fee schedule,100% of CMS fee schedule,22.62,160,,,fee schedule,160% of CMS fee schedule,18.38,130,,,fee schedule,130% of CMS fee schedule,17.79,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,18.68,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,14.14,100,,,fee schedule,100% of CMS fee schedule,17.79,100,,,fee schedule,100% of GA fee schedule,14.14,100,,,fee schedule,100% of CMS 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,17.79,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.15,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,14.14,100,,,fee schedule,100% of CMS fee schedule,14.14,100,,,fee schedule,100% of CMS fee schedule,13.15,450,
PTH  OR PTH INTACT,300000138,CDM,301,RC,83970,HCPCS,outpatient,,,223,156.1,,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,41.28,100,,,fee schedule,100% of CMS fee schedule,66.05,160,,,fee schedule,160% of CMS fee schedule,53.66,130,,,fee schedule,130% of CMS fee schedule,51.9,100,,,fee schedule,100% of GA fee schedule,172.2,77.22,,137.76,percent of total billed charges,77.22% of total billed charges,54.5,105,,,fee schedule,105% of GA fee schedule,185.09,83,,148.07,percent of total billed charges,83% of total,211.85,95,,169.48,percent of total billed charges ,95% of total billed charges,178.4,80,,142.72,percent of total billed charges,78% of total billed charges,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,41.28,100,,,fee schedule,100% of CMS fee schedule,51.9,100,,,fee schedule,100% of GA fee schedule,41.28,100,,,fee schedule,100% of CMS fee schedule,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,51.9,100,,,fee schedule,100% of GA fee schedule,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,38.39,93,,,fee schedule,93% of CMS fee schedule,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,41.28,100,,,fee schedule,100% of CMS fee schedule,41.28,100,,,fee schedule,100% of CMS fee schedule,38.39,450,
FOLIC ACID,300000144,CDM,301,RC,82746,HCPCS,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,14.7,100,,,fee schedule,100% of CMS fee schedule,23.52,160,,,fee schedule,160% of CMS fee schedule,19.11,130,,,fee schedule,130% of CMS fee schedule,18.49,100,,,fee schedule,100% of GA fee schedule,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,19.41,105,,,fee schedule,105% of GA fee schedule,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,14.7,100,,,fee schedule,100% of CMS fee schedule,18.49,100,,,fee schedule,100% of GA fee schedule,14.7,100,,,fee schedule,100% of CMS 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,18.49,100,,,fee schedule,100% of GA fee schedule,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.67,93,,,fee schedule,93% of CMS fee schedule,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,14.7,100,,,fee schedule,100% of CMS fee schedule,14.7,100,,,fee schedule,100% of CMS fee schedule,13.67,450,
FSH,300000145,CDM,301,RC,83001,HCPCS,outpatient,,,211,147.7,,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,29.73,160,,,fee schedule,160% of CMS fee schedule,24.15,130,,,fee schedule,130% of CMS fee schedule,23.37,100,,,fee schedule,100% of GA fee schedule,162.93,77.22,,130.34,percent of total billed charges,77.22% of total billed charges,24.54,105,,,fee schedule,105% of GA fee schedule,175.13,83,,140.1,percent of total billed charges,83% of total,200.45,95,,160.36,percent of total billed charges ,95% of total billed charges,168.8,80,,135.04,percent of total billed charges,78% of total billed charges,164.58,78,,131.664,percent of total billed charges,78% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,23.37,100,,,fee schedule,100% of GA fee schedule,18.58,100,,,fee schedule,100% of CMS 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,23.37,100,,,fee schedule,100% of GA fee schedule,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.28,93,,,fee schedule,93% of CMS fee schedule,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,17.28,450,
PSEUDOCHOLINESTERASE,300000150,CDM,301,RC,82480,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,12.59,160,,,fee schedule,160% of CMS fee schedule,10.23,130,,,fee schedule,130% of CMS fee schedule,9.91,100,,,fee schedule,100% of GA fee schedule,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,10.41,105,,,fee schedule,105% of GA fee schedule,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,9.91,100,,,fee schedule,100% of GA fee schedule,7.87,100,,,fee schedule,100% of CMS 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,9.91,100,,,fee schedule,100% of GA fee schedule,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.32,93,,,fee schedule,93% of CMS fee schedule,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,7.87,100,,,fee schedule,100% of CMS fee schedule,7.32,450,
AMYLASE URINE,300000151,CDM,301,RC,82150,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,10.37,160,,,fee schedule,160% of CMS fee schedule,8.42,130,,,fee schedule,130% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,8.56,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,6.48,100,,,fee schedule,100% of CMS 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,8.15,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.03,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,6.03,450,
"PH,URINE OR BODY FLUID",300000155,CDM,301,RC,83986,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,5.73,160,,,fee schedule,160% of CMS fee schedule,4.65,130,,,fee schedule,130% of CMS fee schedule,4.5,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,4.73,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,4.5,100,,,fee schedule,100% of GA fee schedule,3.58,100,,,fee schedule,100% of CMS 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,4.5,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.33,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,3.33,450,
17 HYDROXY/PROG,300000157,CDM,301,RC,83498,HCPCS,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,27.17,100,,,fee schedule,100% of CMS fee schedule,43.47,160,,,fee schedule,160% of CMS fee schedule,35.32,130,,,fee schedule,130% of CMS fee schedule,34.16,100,,,fee schedule,100% of GA fee schedule,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,35.87,105,,,fee schedule,105% of GA fee schedule,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,27.17,100,,,fee schedule,100% of CMS fee schedule,34.16,100,,,fee schedule,100% of GA fee schedule,27.17,100,,,fee schedule,100% of CMS 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,34.16,100,,,fee schedule,100% of GA fee schedule,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.27,93,,,fee schedule,93% of CMS fee schedule,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,27.17,100,,,fee schedule,100% of CMS fee schedule,27.17,100,,,fee schedule,100% of CMS fee schedule,25.27,450,
GLUCOSE TOLERANCE TEST 2HR,300000163,CDM,301,RC,82951,HCPCS,outpatient,,,211,147.7,,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,20.59,160,,,fee schedule,160% of CMS fee schedule,16.73,130,,,fee schedule,130% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,162.93,77.22,,130.34,percent of total billed charges,77.22% of total billed charges,17,105,,,fee schedule,105% of GA fee schedule,175.13,83,,140.1,percent of total billed charges,83% of total,200.45,95,,160.36,percent of total billed charges ,95% of total billed charges,168.8,80,,135.04,percent of total billed charges,78% of total billed charges,164.58,78,,131.664,percent of total billed charges,78% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,12.87,100,,,fee schedule,100% of CMS 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,16.19,100,,,fee schedule,100% of GA fee schedule,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.97,93,,,fee schedule,93% of CMS fee schedule,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,11.97,450,
GLUCOSE URINE QUANTITATIVE,300000166,CDM,301,RC,82947,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,6.29,160,,,fee schedule,160% of CMS fee schedule,5.11,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.93,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
IMMUNOGLOBULIN IGE,300000169,CDM,301,RC,82785,HCPCS,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,26.34,160,,,fee schedule,160% of CMS fee schedule,21.4,130,,,fee schedule,130% of CMS fee schedule,20.71,100,,,fee schedule,100% of GA fee schedule,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,21.75,105,,,fee schedule,105% of GA fee schedule,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,20.71,100,,,fee schedule,100% of GA fee schedule,16.46,100,,,fee schedule,100% of CMS 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,20.71,100,,,fee schedule,100% of GA fee schedule,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.31,93,,,fee schedule,93% of CMS fee schedule,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,16.46,100,,,fee schedule,100% of CMS fee schedule,15.31,450,
MERCURY URINE,300000173,CDM,301,RC,83825,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,26.02,160,,,fee schedule,160% of CMS fee schedule,21.14,130,,,fee schedule,130% of CMS fee schedule,20.45,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,21.47,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,20.45,100,,,fee schedule,100% of GA fee schedule,16.26,100,,,fee schedule,100% of CMS 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,20.45,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.12,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,16.26,100,,,fee schedule,100% of CMS fee schedule,15.12,450,
BLOOD GLUCOSE CHECK,300000175,CDM,301,RC,82962,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,5.25,160,,,fee schedule,160% of CMS fee schedule,4.26,130,,,fee schedule,130% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,3.09,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,3.28,100,,,fee schedule,100% of CMS 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,2.94,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.05,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,450,
MYOGLOBIN,300000176,CDM,301,RC,83874,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,20.67,160,,,fee schedule,160% of CMS fee schedule,16.8,130,,,fee schedule,130% of CMS fee schedule,16.24,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,17.05,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,16.24,100,,,fee schedule,100% of GA fee schedule,12.92,100,,,fee schedule,100% of CMS 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,16.24,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.02,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,12.02,450,
CLONAZEPAM (CLONOPIN),300000178,CDM,301,RC,80299,HCPCS,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,15.14,100,,,fee schedule,100% of GA fee schedule,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
FRUCTOSAMINE,300000179,CDM,301,RC,82985,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,16.76,100,,,fee schedule,100% of CMS fee schedule,26.82,160,,,fee schedule,160% of CMS fee schedule,21.79,130,,,fee schedule,130% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,19.9,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,16.76,100,,,fee schedule,100% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,16.76,100,,,fee schedule,100% of CMS 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,18.95,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.59,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,16.76,100,,,fee schedule,100% of CMS fee schedule,16.76,100,,,fee schedule,100% of CMS fee schedule,15.59,450,
"COPPER,BLOOD OR URINE",300000180,CDM,301,RC,82525,HCPCS,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,19.86,160,,,fee schedule,160% of CMS fee schedule,16.13,130,,,fee schedule,130% of CMS fee schedule,15.61,100,,,fee schedule,100% of GA fee schedule,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,16.39,105,,,fee schedule,105% of GA fee schedule,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,15.61,100,,,fee schedule,100% of GA fee schedule,12.41,100,,,fee schedule,100% of CMS 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,15.61,100,,,fee schedule,100% of GA fee schedule,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.54,93,,,fee schedule,93% of CMS fee schedule,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,12.41,100,,,fee schedule,100% of CMS fee schedule,12.41,100,,,fee schedule,100% of CMS fee schedule,11.54,450,
DRUG ABUSE PROFILE SERUM,300000181,CDM,301,RC,80306,HCPCS,outpatient,,,290,203,,229.1,79,,183.28,percent of total billed charges,79% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,17.14,100,,,fee schedule,100% of CMS fee schedule,27.42,160,,,fee schedule,160% of CMS fee schedule,22.28,130,,,fee schedule,130% of CMS fee schedule,15.29,100,,,fee schedule,100% of GA fee schedule,223.94,77.22,,179.15,percent of total billed charges,77.22% of total billed charges,16.05,105,,,fee schedule,105% of GA fee schedule,240.7,83,,192.56,percent of total billed charges,83% of total,275.5,95,,220.4,percent of total billed charges ,95% of total billed charges,232,80,,185.6,percent of total billed charges,78% of total billed charges,226.2,78,,180.96,percent of total billed charges,78% of total billed charges,17.14,100,,,fee schedule,100% of CMS fee schedule,15.29,100,,,fee schedule,100% of GA fee schedule,17.14,100,,,fee schedule,100% of CMS 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,15.29,100,,,fee schedule,100% of GA fee schedule,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.94,93,,,fee schedule,93% of CMS fee schedule,229.1,79,,183.28,percent of total billed charges,79% of total billed charges,17.14,100,,,fee schedule,100% of CMS fee schedule,17.14,100,,,fee schedule,100% of CMS fee schedule,15.29,450,
HEMOGLOBIN A1C,300000183,CDM,301,RC,83036,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,15.54,160,,,fee schedule,160% of CMS fee schedule,12.62,130,,,fee schedule,130% of CMS fee schedule,12.2,100,,,fee schedule,100% of GA fee schedule,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,12.81,105,,,fee schedule,105% of GA fee schedule,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,12.2,100,,,fee schedule,100% of GA fee schedule,9.71,100,,,fee schedule,100% of CMS 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,12.2,100,,,fee schedule,100% of GA fee schedule,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.03,93,,,fee schedule,93% of CMS fee schedule,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,9.03,450,
ESTROGENS TOTAL SERUM,300000189,CDM,301,RC,82672,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,21.7,100,,,fee schedule,100% of CMS fee schedule,34.72,160,,,fee schedule,160% of CMS fee schedule,28.21,130,,,fee schedule,130% of CMS fee schedule,20.94,100,,,fee schedule,100% of GA fee schedule,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,21.99,105,,,fee schedule,105% of GA fee schedule,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,21.7,100,,,fee schedule,100% of CMS fee schedule,20.94,100,,,fee schedule,100% of GA fee schedule,21.7,100,,,fee schedule,100% of CMS fee schedule,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,20.94,100,,,fee schedule,100% of GA fee schedule,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.18,93,,,fee schedule,93% of CMS fee schedule,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,21.7,100,,,fee schedule,100% of CMS fee schedule,21.7,100,,,fee schedule,100% of CMS fee schedule,20.18,450,
FERRITIN/RIA,300000196,CDM,301,RC,82728,HCPCS,outpatient,,,199,139.3,,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,21.81,160,,,fee schedule,160% of CMS fee schedule,17.72,130,,,fee schedule,130% of CMS fee schedule,17.13,100,,,fee schedule,100% of GA fee schedule,153.67,77.22,,122.94,percent of total billed charges,77.22% of total billed charges,17.99,105,,,fee schedule,105% of GA fee schedule,165.17,83,,132.14,percent of total billed charges,83% of total,189.05,95,,151.24,percent of total billed charges ,95% of total billed charges,159.2,80,,127.36,percent of total billed charges,78% of total billed charges,155.22,78,,124.176,percent of total billed charges,78% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,17.13,100,,,fee schedule,100% of GA fee schedule,13.63,100,,,fee schedule,100% of CMS fee schedule,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,17.13,100,,,fee schedule,100% of GA fee schedule,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.68,93,,,fee schedule,93% of CMS fee schedule,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,13.63,100,,,fee schedule,100% of CMS fee schedule,13.63,100,,,fee schedule,100% of CMS fee schedule,12.68,450,
IND DRUG SCREEN,300000197,CDM,301,RC,80101,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
L/S RATIO,300000200,CDM,301,RC,83661,HCPCS,outpatient,,,290,203,,229.1,79,,183.28,percent of total billed charges,79% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,35.18,160,,,fee schedule,160% of CMS fee schedule,28.59,130,,,fee schedule,130% of CMS fee schedule,27.64,100,,,fee schedule,100% of GA fee schedule,223.94,77.22,,179.15,percent of total billed charges,77.22% of total billed charges,29.02,105,,,fee schedule,105% of GA fee schedule,240.7,83,,192.56,percent of total billed charges,83% of total,275.5,95,,220.4,percent of total billed charges ,95% of total billed charges,232,80,,185.6,percent of total billed charges,78% of total billed charges,226.2,78,,180.96,percent of total billed charges,78% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,27.64,100,,,fee schedule,100% of GA fee schedule,21.99,100,,,fee schedule,100% of CMS 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,27.64,100,,,fee schedule,100% of GA fee schedule,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.45,93,,,fee schedule,93% of CMS fee schedule,229.1,79,,183.28,percent of total billed charges,79% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,20.45,450,
DHEAS,300000203,CDM,301,RC,82627,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,35.57,160,,,fee schedule,160% of CMS fee schedule,28.9,130,,,fee schedule,130% of CMS fee schedule,27.96,100,,,fee schedule,100% of GA fee schedule,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,29.36,105,,,fee schedule,105% of GA fee schedule,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,27.96,100,,,fee schedule,100% of GA fee schedule,22.23,100,,,fee schedule,100% of CMS 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,27.96,100,,,fee schedule,100% of GA fee schedule,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.67,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,20.67,450,
GLUCOSE-6-PDH,300000205,CDM,301,RC,82955,HCPCS,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,9.7,100,,,fee schedule,100% of CMS fee schedule,15.52,160,,,fee schedule,160% of CMS fee schedule,12.61,130,,,fee schedule,130% of CMS fee schedule,9.82,100,,,fee schedule,100% of GA fee schedule,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,10.31,105,,,fee schedule,105% of GA fee schedule,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,9.7,100,,,fee schedule,100% of CMS fee schedule,9.82,100,,,fee schedule,100% of GA fee schedule,9.7,100,,,fee schedule,100% of CMS 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,9.82,100,,,fee schedule,100% of GA fee schedule,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.02,93,,,fee schedule,93% of CMS fee schedule,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,9.7,100,,,fee schedule,100% of CMS fee schedule,9.7,100,,,fee schedule,100% of CMS fee schedule,9.02,450,
GENTAMYCIN PEAK,300000206,CDM,301,RC,80170,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,26.21,160,,,fee schedule,160% of CMS fee schedule,21.29,130,,,fee schedule,130% of CMS fee schedule,20.61,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,21.64,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,20.61,100,,,fee schedule,100% of GA fee schedule,16.38,100,,,fee schedule,100% of CMS 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,20.61,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.23,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,15.23,450,
PSA,300000208,CDM,301,RC,84153,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,29.42,160,,,fee schedule,160% of CMS fee schedule,23.91,130,,,fee schedule,130% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,24.29,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,18.39,100,,,fee schedule,100% of CMS 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,23.13,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.1,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,17.1,450,
GLUCOSE (URINE-QUANT) 24HR,300000215,CDM,301,RC,82947,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,6.29,160,,,fee schedule,160% of CMS fee schedule,5.11,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.93,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
CANNABINOIDS,300000218,CDM,301,RC,80100,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
TOBRAMYCIN PEAK,300000221,CDM,301,RC,80200,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,25.81,160,,,fee schedule,160% of CMS fee schedule,20.97,130,,,fee schedule,130% of CMS fee schedule,18.84,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,19.78,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,18.84,100,,,fee schedule,100% of GA fee schedule,16.13,100,,,fee schedule,100% of CMS 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,18.84,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,15,450,
GENTAMYCIN TROUGH,300000223,CDM,301,RC,80170,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,26.21,160,,,fee schedule,160% of CMS fee schedule,21.29,130,,,fee schedule,130% of CMS fee schedule,20.61,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,21.64,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,20.61,100,,,fee schedule,100% of GA fee schedule,16.38,100,,,fee schedule,100% of CMS 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,20.61,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.23,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,16.38,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,15.23,450,
AMIKACIN PEAK,300000224,CDM,301,RC,80150,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,24.13,160,,,fee schedule,160% of CMS fee schedule,19.6,130,,,fee schedule,130% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,19.9,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,15.08,100,,,fee schedule,100% of CMS 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,18.95,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.02,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,14.02,450,
AMIKACIN TRGH,300000225,CDM,301,RC,80150,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,24.13,160,,,fee schedule,160% of CMS fee schedule,19.6,130,,,fee schedule,130% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,19.9,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,15.08,100,,,fee schedule,100% of CMS 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,18.95,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.02,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,14.02,450,
HEPATITIS PROFILE PANEL,300000230,CDM,301,RC,80074,HCPCS,outpatient,,,291,203.7,,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,76.21,160,,,fee schedule,160% of CMS fee schedule,61.92,130,,,fee schedule,130% of CMS fee schedule,59.89,100,,,fee schedule,100% of GA fee schedule,224.71,77.22,,179.77,percent of total billed charges,77.22% of total billed charges,62.88,105,,,fee schedule,105% of GA fee schedule,241.53,83,,193.22,percent of total billed charges,83% of total,276.45,95,,221.16,percent of total billed charges ,95% of total billed charges,232.8,80,,186.24,percent of total billed charges,78% of total billed charges,226.98,78,,181.584,percent of total billed charges,78% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,59.89,100,,,fee schedule,100% of GA fee schedule,47.63,100,,,fee schedule,100% of CMS 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,59.89,100,,,fee schedule,100% of GA fee schedule,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,44.3,93,,,fee schedule,93% of CMS fee schedule,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,47.63,100,,,fee schedule,100% of CMS fee schedule,44.3,450,
LACTIC ACID,300000242,CDM,301,RC,83605,HCPCS,outpatient,,,112,78.4,,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,18.51,160,,,fee schedule,160% of CMS fee schedule,15.04,130,,,fee schedule,130% of CMS fee schedule,13.43,100,,,fee schedule,100% of GA fee schedule,86.49,77.22,,69.19,percent of total billed charges,77.22% of total billed charges,14.1,105,,,fee schedule,105% of GA fee schedule,92.96,83,,74.37,percent of total billed charges,83% of total,106.4,95,,85.12,percent of total billed charges ,95% of total billed charges,89.6,80,,71.68,percent of total billed charges,78% of total billed charges,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,13.43,100,,,fee schedule,100% of GA fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,13.43,100,,,fee schedule,100% of GA fee schedule,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.76,93,,,fee schedule,93% of CMS fee schedule,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,10.76,450,
LDH ISONEZYMES,300000243,CDM,301,RC,83625,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,12.79,100,,,fee schedule,100% of CMS fee schedule,20.46,160,,,fee schedule,160% of CMS fee schedule,16.63,130,,,fee schedule,130% of CMS fee schedule,14.55,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,15.28,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,12.79,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of GA fee schedule,12.79,100,,,fee schedule,100% of CMS 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,14.55,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.89,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,12.79,100,,,fee schedule,100% of CMS fee schedule,12.79,100,,,fee schedule,100% of CMS fee schedule,11.89,450,
LEAD/BLOOD OR URINE SCREEN,300000244,CDM,301,RC,83655,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,19.38,160,,,fee schedule,160% of CMS fee schedule,15.74,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,12.11,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.26,93,,,fee schedule,93% of CMS fee schedule,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,10,450,
LH (LUTENIZING HORMINE),300000251,CDM,301,RC,83002,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,29.63,160,,,fee schedule,160% of CMS fee schedule,24.08,130,,,fee schedule,130% of CMS fee schedule,23.29,100,,,fee schedule,100% of GA fee schedule,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,24.45,105,,,fee schedule,105% of GA fee schedule,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,23.29,100,,,fee schedule,100% of GA fee schedule,18.52,100,,,fee schedule,100% of CMS 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,23.29,100,,,fee schedule,100% of GA fee schedule,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.22,93,,,fee schedule,93% of CMS fee schedule,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,17.22,450,
MAGNESIUM,300000254,CDM,301,RC,83735,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,10.72,160,,,fee schedule,160% of CMS fee schedule,8.71,130,,,fee schedule,130% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,8.84,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,6.7,100,,,fee schedule,100% of CMS 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,8.42,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.23,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.23,450,
MAGNESIUM URINE,300000255,CDM,301,RC,83735,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,10.72,160,,,fee schedule,160% of CMS fee schedule,8.71,130,,,fee schedule,130% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,8.84,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,6.7,100,,,fee schedule,100% of CMS 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,8.42,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.23,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.23,450,
"METANEPHRINES, URINE",300000258,CDM,301,RC,83835,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,27.1,160,,,fee schedule,160% of CMS fee schedule,22.02,130,,,fee schedule,130% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,22.37,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,16.94,100,,,fee schedule,100% of CMS 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,21.3,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.75,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,15.75,450,
OSMOLALITY SERUM,300000269,CDM,301,RC,83930,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,10.58,160,,,fee schedule,160% of CMS fee schedule,8.59,130,,,fee schedule,130% of CMS fee schedule,8.32,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,8.74,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,8.32,100,,,fee schedule,100% of GA fee schedule,6.61,100,,,fee schedule,100% of CMS 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,8.32,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.15,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,6.61,100,,,fee schedule,100% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,6.15,450,
PHENOBARBITAL,300000273,CDM,301,RC,80184,HCPCS,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,24.48,160,,,fee schedule,160% of CMS fee schedule,19.89,130,,,fee schedule,130% of CMS fee schedule,14.41,100,,,fee schedule,100% of GA fee schedule,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,15.13,105,,,fee schedule,105% of GA fee schedule,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,14.41,100,,,fee schedule,100% of GA fee schedule,15.3,100,,,fee schedule,100% of CMS 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,14.41,100,,,fee schedule,100% of GA fee schedule,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.23,93,,,fee schedule,93% of CMS fee schedule,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,14.23,450,
"PORPHYRINS,24HR URINE",300000277,CDM,301,RC,84120,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,14.71,100,,,fee schedule,100% of CMS fee schedule,23.54,160,,,fee schedule,160% of CMS fee schedule,19.12,130,,,fee schedule,130% of CMS fee schedule,18.5,100,,,fee schedule,100% of GA fee schedule,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,19.43,105,,,fee schedule,105% of GA fee schedule,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,14.71,100,,,fee schedule,100% of CMS fee schedule,18.5,100,,,fee schedule,100% of GA fee schedule,14.71,100,,,fee schedule,100% of CMS 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,18.5,100,,,fee schedule,100% of GA fee schedule,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.68,93,,,fee schedule,93% of CMS fee schedule,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,14.71,100,,,fee schedule,100% of CMS fee schedule,14.71,100,,,fee schedule,100% of CMS fee schedule,13.68,450,
POTASSIUM URINE,300000278,CDM,301,RC,84133,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,7.57,160,,,fee schedule,160% of CMS fee schedule,6.15,130,,,fee schedule,130% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,5.68,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,4.73,100,,,fee schedule,100% of CMS 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,5.41,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.4,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,4.73,100,,,fee schedule,100% of CMS fee schedule,4.4,450,
PREGANCY TEST (SERUM) QUAL,300000279,CDM,301,RC,84703,HCPCS,outpatient,,,234,163.8,,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,12.03,160,,,fee schedule,160% of CMS fee schedule,9.78,130,,,fee schedule,130% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,180.69,77.22,,144.55,percent of total billed charges,77.22% of total billed charges,8.47,105,,,fee schedule,105% of GA fee schedule,194.22,83,,155.38,percent of total billed charges,83% of total,222.3,95,,177.84,percent of total billed charges ,95% of total billed charges,187.2,80,,149.76,percent of total billed charges,78% of total billed charges,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,7.52,100,,,fee schedule,100% of CMS fee schedule,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,8.07,100,,,fee schedule,100% of GA fee schedule,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.99,93,,,fee schedule,93% of CMS fee schedule,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,7.52,100,,,fee schedule,100% of CMS fee schedule,6.99,450,
PRIMIDONE (MYSOLINE & PHENB),300000280,CDM,301,RC,80188,HCPCS,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,16.59,100,,,fee schedule,100% of CMS fee schedule,26.54,160,,,fee schedule,160% of CMS fee schedule,21.57,130,,,fee schedule,130% of CMS fee schedule,20.86,100,,,fee schedule,100% of GA fee schedule,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,21.9,105,,,fee schedule,105% of GA fee schedule,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,16.59,100,,,fee schedule,100% of CMS fee schedule,20.86,100,,,fee schedule,100% of GA fee schedule,16.59,100,,,fee schedule,100% of CMS 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,20.86,100,,,fee schedule,100% of GA fee schedule,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.43,93,,,fee schedule,93% of CMS fee schedule,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,16.59,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of CMS fee schedule,15.43,450,
ACETAMINOPHEN,300000282,CDM,301,RC,G0480,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,26.25,450,
PREGNANTRIOL,300000287,CDM,301,RC,84138,HCPCS,outpatient,,,603,422.1,,476.37,79,,381.1,percent of total billed charges,79% of total billed charges,542.7,90,,434.16,percent of total billed charges,90% of total billed charges,21.05,100,,,fee schedule,100% of CMS fee schedule,33.68,160,,,fee schedule,160% of CMS fee schedule,27.37,130,,,fee schedule,130% of CMS fee schedule,23.81,100,,,fee schedule,100% of GA fee schedule,465.64,77.22,,372.51,percent of total billed charges,77.22% of total billed charges,25,105,,,fee schedule,105% of GA fee schedule,500.49,83,,400.39,percent of total billed charges,83% of total,572.85,95,,458.28,percent of total billed charges ,95% of total billed charges,482.4,80,,385.92,percent of total billed charges,78% of total billed charges,470.34,78,,376.272,percent of total billed charges,78% of total billed charges,21.05,100,,,fee schedule,100% of CMS fee schedule,23.81,100,,,fee schedule,100% of GA fee schedule,21.05,100,,,fee schedule,100% of CMS fee schedule,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,23.81,100,,,fee schedule,100% of GA fee schedule,512.55,85,,410.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.58,93,,,fee schedule,93% of CMS fee schedule,476.37,79,,381.1,percent of total billed charges,79% of total billed charges,21.05,100,,,fee schedule,100% of CMS fee schedule,21.05,100,,,fee schedule,100% of CMS fee schedule,19.58,572.85,
"PROGESTERONE, ANY METHOD",300000288,CDM,301,RC,84144,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,20.86,100,,,fee schedule,100% of CMS fee schedule,33.38,160,,,fee schedule,160% of CMS fee schedule,27.12,130,,,fee schedule,130% of CMS fee schedule,25.61,100,,,fee schedule,100% of GA fee schedule,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,26.89,105,,,fee schedule,105% of GA fee schedule,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,20.86,100,,,fee schedule,100% of CMS fee schedule,25.61,100,,,fee schedule,100% of GA fee schedule,20.86,100,,,fee schedule,100% of CMS fee schedule,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,25.61,100,,,fee schedule,100% of GA fee schedule,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.4,93,,,fee schedule,93% of CMS fee schedule,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,20.86,100,,,fee schedule,100% of CMS fee schedule,20.86,100,,,fee schedule,100% of CMS fee schedule,19.4,450,
PROLACTIN (MAMOTHROPHIN),300000289,CDM,301,RC,84146,HCPCS,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,31.01,160,,,fee schedule,160% of CMS fee schedule,25.19,130,,,fee schedule,130% of CMS fee schedule,24.37,100,,,fee schedule,100% of GA fee schedule,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,25.59,105,,,fee schedule,105% of GA fee schedule,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,24.37,100,,,fee schedule,100% of GA fee schedule,19.38,100,,,fee schedule,100% of CMS 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,24.37,100,,,fee schedule,100% of GA fee schedule,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.02,93,,,fee schedule,93% of CMS fee schedule,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,18.02,450,
"TESTOSTERONE,TOTAL",300000298,CDM,301,RC,84403,HCPCS,outpatient,,,263,184.1,,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,41.3,160,,,fee schedule,160% of CMS fee schedule,33.55,130,,,fee schedule,130% of CMS fee schedule,32.47,100,,,fee schedule,100% of GA fee schedule,203.09,77.22,,162.47,percent of total billed charges,77.22% of total billed charges,34.09,105,,,fee schedule,105% of GA fee schedule,218.29,83,,174.63,percent of total billed charges,83% of total,249.85,95,,199.88,percent of total billed charges ,95% of total billed charges,210.4,80,,168.32,percent of total billed charges,78% of total billed charges,205.14,78,,164.112,percent of total billed charges,78% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,32.47,100,,,fee schedule,100% of GA fee schedule,25.81,100,,,fee schedule,100% of CMS 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,32.47,100,,,fee schedule,100% of GA fee schedule,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24,93,,,fee schedule,93% of CMS fee schedule,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,24,450,
TSH THYROID STIM. HORMONE,300000299,CDM,301,RC,84443,HCPCS,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,26.88,160,,,fee schedule,160% of CMS fee schedule,21.84,130,,,fee schedule,130% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,22.18,105,,,fee schedule,105% of GA fee schedule,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,16.8,100,,,fee schedule,100% of CMS 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,21.12,100,,,fee schedule,100% of GA fee schedule,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.62,93,,,fee schedule,93% of CMS fee schedule,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,15.62,450,
THYROID HORMONE THBR(T3 OR T4),300000301,CDM,301,RC,84479,HCPCS,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,10.35,160,,,fee schedule,160% of CMS fee schedule,8.41,130,,,fee schedule,130% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,8.55,105,,,fee schedule,105% of GA fee schedule,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,6.47,100,,,fee schedule,100% of CMS 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,8.14,100,,,fee schedule,100% of GA fee schedule,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.02,93,,,fee schedule,93% of CMS fee schedule,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.02,450,
THYROXIN TOTAL,300000302,CDM,301,RC,84436,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,6.87,100,,,fee schedule,100% of CMS fee schedule,10.99,160,,,fee schedule,160% of CMS fee schedule,8.93,130,,,fee schedule,130% of CMS fee schedule,8.65,100,,,fee schedule,100% of GA fee schedule,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,9.08,105,,,fee schedule,105% of GA fee schedule,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,6.87,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of GA fee schedule,6.87,100,,,fee schedule,100% of CMS 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,8.65,100,,,fee schedule,100% of GA fee schedule,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.39,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,6.87,100,,,fee schedule,100% of CMS fee schedule,6.87,100,,,fee schedule,100% of CMS fee schedule,6.39,450,
T3 (RIA),300000303,CDM,301,RC,84480,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,22.69,160,,,fee schedule,160% of CMS fee schedule,18.43,130,,,fee schedule,130% of CMS fee schedule,16.03,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,16.83,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,16.03,100,,,fee schedule,100% of GA fee schedule,14.18,100,,,fee schedule,100% of CMS 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,16.03,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.19,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,13.19,450,
GASTRIN,300000304,CDM,301,RC,82938,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,17.69,100,,,fee schedule,100% of CMS fee schedule,28.3,160,,,fee schedule,160% of CMS fee schedule,23,130,,,fee schedule,130% of CMS fee schedule,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,144.76,66.1,,115.81,percent of total billed charges,66.1% of total billed charges,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,17.69,100,,,fee schedule,100% of CMS fee schedule,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,17.69,100,,,fee schedule,100% of CMS 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,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.45,93,,,fee schedule,93% of CMS fee schedule,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,17.69,100,,,fee schedule,100% of CMS fee schedule,17.69,100,,,fee schedule,100% of CMS fee schedule,16.45,450,
TEGRETOL,300000305,CDM,301,RC,80156,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,23.31,160,,,fee schedule,160% of CMS fee schedule,18.94,130,,,fee schedule,130% of CMS fee schedule,18.31,100,,,fee schedule,100% of GA fee schedule,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,19.23,105,,,fee schedule,105% of GA fee schedule,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,18.31,100,,,fee schedule,100% of GA fee schedule,14.57,100,,,fee schedule,100% of CMS 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,18.31,100,,,fee schedule,100% of GA fee schedule,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.55,93,,,fee schedule,93% of CMS fee schedule,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,13.55,450,
UREA NITROGEN URINE CLEARANCE,300000310,CDM,301,RC,84540,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,5.56,100,,,fee schedule,100% of CMS fee schedule,8.9,160,,,fee schedule,160% of CMS fee schedule,7.23,130,,,fee schedule,130% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,6.28,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,5.56,100,,,fee schedule,100% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,5.56,100,,,fee schedule,100% of CMS 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,5.98,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.17,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,5.56,100,,,fee schedule,100% of CMS fee schedule,5.56,100,,,fee schedule,100% of CMS fee schedule,5.17,450,
VMA,300000312,CDM,301,RC,84585,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,15.5,100,,,fee schedule,100% of CMS fee schedule,24.8,160,,,fee schedule,160% of CMS fee schedule,20.15,130,,,fee schedule,130% of CMS fee schedule,19.49,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,20.46,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,15.5,100,,,fee schedule,100% of CMS fee schedule,19.49,100,,,fee schedule,100% of GA fee schedule,15.5,100,,,fee schedule,100% of CMS 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,19.49,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,15.5,100,,,fee schedule,100% of CMS fee schedule,15.5,100,,,fee schedule,100% of CMS fee schedule,14.42,450,
"ZINC,URINE OR BLOOD",300000318,CDM,301,RC,84630,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,18.22,160,,,fee schedule,160% of CMS fee schedule,14.81,130,,,fee schedule,130% of CMS fee schedule,14.32,100,,,fee schedule,100% of GA fee schedule,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,15.04,105,,,fee schedule,105% of GA fee schedule,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,14.32,100,,,fee schedule,100% of GA fee schedule,11.39,100,,,fee schedule,100% of CMS 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,14.32,100,,,fee schedule,100% of GA fee schedule,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.59,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,11.39,100,,,fee schedule,100% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,10.59,450,
5-HIAA,300000332,CDM,301,RC,83497,HCPCS,outpatient,,,142,99.4,,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,20.64,160,,,fee schedule,160% of CMS fee schedule,16.77,130,,,fee schedule,130% of CMS fee schedule,16.21,100,,,fee schedule,100% of GA fee schedule,109.65,77.22,,87.72,percent of total billed charges,77.22% of total billed charges,17.02,105,,,fee schedule,105% of GA fee schedule,117.86,83,,94.29,percent of total billed charges,83% of total,134.9,95,,107.92,percent of total billed charges ,95% of total billed charges,113.6,80,,90.88,percent of total billed charges,78% of total billed charges,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,16.21,100,,,fee schedule,100% of GA fee schedule,12.9,100,,,fee schedule,100% of CMS 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,16.21,100,,,fee schedule,100% of GA fee schedule,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12,93,,,fee schedule,93% of CMS fee schedule,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,12,450,
GROWTH HORMONE,300000339,CDM,301,RC,83003,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,16.67,100,,,fee schedule,100% of CMS fee schedule,26.67,160,,,fee schedule,160% of CMS fee schedule,21.67,130,,,fee schedule,130% of CMS fee schedule,17.9,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,18.8,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,16.67,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of GA fee schedule,16.67,100,,,fee schedule,100% of CMS 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,17.9,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.5,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,16.67,100,,,fee schedule,100% of CMS fee schedule,16.67,100,,,fee schedule,100% of CMS fee schedule,15.5,450,
AMMONIA,300000340,CDM,301,RC,82140,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,23.31,160,,,fee schedule,160% of CMS fee schedule,18.94,130,,,fee schedule,130% of CMS fee schedule,12.44,100,,,fee schedule,100% of GA fee schedule,168.34,77.22,,134.67,percent of total billed charges,77.22% of total billed charges,13.06,105,,,fee schedule,105% of GA fee schedule,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,12.44,100,,,fee schedule,100% of GA fee schedule,14.57,100,,,fee schedule,100% of CMS 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,12.44,100,,,fee schedule,100% of GA fee schedule,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.55,93,,,fee schedule,93% of CMS fee schedule,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,12.44,450,
QUINIDINE,300000343,CDM,301,RC,80194,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,23.36,160,,,fee schedule,160% of CMS fee schedule,18.98,130,,,fee schedule,130% of CMS fee schedule,18.35,100,,,fee schedule,100% of GA fee schedule,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,19.27,105,,,fee schedule,105% of GA fee schedule,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,18.35,100,,,fee schedule,100% of GA fee schedule,14.6,100,,,fee schedule,100% of CMS 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,18.35,100,,,fee schedule,100% of GA fee schedule,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.58,93,,,fee schedule,93% of CMS fee schedule,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,13.58,450,
HEPATITIS B PRO PANEL,300000345,CDM,301,RC,80074,HCPCS,outpatient,,,291,203.7,,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,76.21,160,,,fee schedule,160% of CMS fee schedule,61.92,130,,,fee schedule,130% of CMS fee schedule,59.89,100,,,fee schedule,100% of GA fee schedule,224.71,77.22,,179.77,percent of total billed charges,77.22% of total billed charges,62.88,105,,,fee schedule,105% of GA fee schedule,241.53,83,,193.22,percent of total billed charges,83% of total,276.45,95,,221.16,percent of total billed charges ,95% of total billed charges,232.8,80,,186.24,percent of total billed charges,78% of total billed charges,226.98,78,,181.584,percent of total billed charges,78% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,59.89,100,,,fee schedule,100% of GA fee schedule,47.63,100,,,fee schedule,100% of CMS 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,59.89,100,,,fee schedule,100% of GA fee schedule,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,44.3,93,,,fee schedule,93% of CMS fee schedule,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,47.63,100,,,fee schedule,100% of CMS fee schedule,47.63,100,,,fee schedule,100% of CMS fee schedule,44.3,450,
"RENIN,RIA",300000346,CDM,301,RC,84244,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,35.18,160,,,fee schedule,160% of CMS fee schedule,28.59,130,,,fee schedule,130% of CMS fee schedule,27.66,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,29.04,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,27.66,100,,,fee schedule,100% of GA fee schedule,21.99,100,,,fee schedule,100% of CMS 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,27.66,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.45,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,20.45,450,
SALICYLATE LEVEL,300000351,CDM,301,RC,G0480,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,26.25,450,
SODIUM URINE,300000353,CDM,301,RC,84300,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.06,100,,,fee schedule,100% of CMS fee schedule,8.1,160,,,fee schedule,160% of CMS fee schedule,6.58,130,,,fee schedule,130% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,4.57,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.06,100,,,fee schedule,100% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,5.06,100,,,fee schedule,100% of CMS 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,4.35,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.71,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.06,100,,,fee schedule,100% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,4.35,450,
TRANSFERRIN,300000362,CDM,301,RC,84466,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,12.76,100,,,fee schedule,100% of CMS fee schedule,20.42,160,,,fee schedule,160% of CMS fee schedule,16.59,130,,,fee schedule,130% of CMS fee schedule,16.06,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,16.86,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,12.76,100,,,fee schedule,100% of CMS fee schedule,16.06,100,,,fee schedule,100% of GA fee schedule,12.76,100,,,fee schedule,100% of CMS 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,16.06,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.87,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,12.76,100,,,fee schedule,100% of CMS fee schedule,12.76,100,,,fee schedule,100% of CMS fee schedule,11.87,450,
PRE ALBUMIN,300000363,CDM,301,RC,84134,HCPCS,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,14.59,100,,,fee schedule,100% of CMS fee schedule,23.34,160,,,fee schedule,160% of CMS fee schedule,18.97,130,,,fee schedule,130% of CMS fee schedule,18.34,100,,,fee schedule,100% of GA fee schedule,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,19.26,105,,,fee schedule,105% of GA fee schedule,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,14.59,100,,,fee schedule,100% of CMS fee schedule,18.34,100,,,fee schedule,100% of GA fee schedule,14.59,100,,,fee schedule,100% of CMS 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,18.34,100,,,fee schedule,100% of GA fee schedule,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.57,93,,,fee schedule,93% of CMS fee schedule,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,14.59,100,,,fee schedule,100% of CMS fee schedule,14.59,100,,,fee schedule,100% of CMS fee schedule,13.57,450,
ANGIOTENSIN CONVERTING ENZYME,300000364,CDM,301,RC,82164,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,23.36,160,,,fee schedule,160% of CMS fee schedule,18.98,130,,,fee schedule,130% of CMS fee schedule,18.35,100,,,fee schedule,100% of GA fee schedule,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,19.27,105,,,fee schedule,105% of GA fee schedule,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,18.35,100,,,fee schedule,100% of GA fee schedule,14.6,100,,,fee schedule,100% of CMS 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,18.35,100,,,fee schedule,100% of GA fee schedule,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.58,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,14.6,100,,,fee schedule,100% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,13.58,450,
CREATININE URINE,300000378,CDM,301,RC,82570,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,8.29,160,,,fee schedule,160% of CMS fee schedule,6.73,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,5.18,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.82,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,4.82,450,
DEPAKENE (VALOPRIC ACID),300000381,CDM,301,RC,80164,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,21.66,160,,,fee schedule,160% of CMS fee schedule,17.6,130,,,fee schedule,130% of CMS fee schedule,14.27,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,14.98,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,14.27,100,,,fee schedule,100% of GA fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,14.27,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.59,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,13.54,100,,,fee schedule,100% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,12.59,450,
TOBRAMYCIN TROUGH,300000388,CDM,301,RC,80200,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,25.81,160,,,fee schedule,160% of CMS fee schedule,20.97,130,,,fee schedule,130% of CMS fee schedule,18.84,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,19.78,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,18.84,100,,,fee schedule,100% of GA fee schedule,16.13,100,,,fee schedule,100% of CMS 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,18.84,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,16.13,100,,,fee schedule,100% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,15,450,
IMMUNOGLOBULIN IGA,300000389,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
IMMUNOGLOBULIN IGG,300000390,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
IMMUNOGLOBULIN IGM,300000391,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
NIDA DRUG TESTING,300000395,CDM,301,RC,80307,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
HYPERTHYROID,300000409,CDM,301,RC,84439,HCPCS,outpatient,,,155,108.5,,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,14.43,160,,,fee schedule,160% of CMS fee schedule,11.73,130,,,fee schedule,130% of CMS fee schedule,11.34,100,,,fee schedule,100% of GA fee schedule,119.69,77.22,,95.75,percent of total billed charges,77.22% of total billed charges,11.91,105,,,fee schedule,105% of GA fee schedule,128.65,83,,102.92,percent of total billed charges,83% of total,147.25,95,,117.8,percent of total billed charges ,95% of total billed charges,124,80,,99.2,percent of total billed charges,78% of total billed charges,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,11.34,100,,,fee schedule,100% of GA fee schedule,9.02,100,,,fee schedule,100% of CMS 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,11.34,100,,,fee schedule,100% of GA fee schedule,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.39,93,,,fee schedule,93% of CMS fee schedule,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,9.02,100,,,fee schedule,100% of CMS fee schedule,8.39,450,
CK TOTAL,300000421,CDM,301,RC,82550,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,10.42,160,,,fee schedule,160% of CMS fee schedule,8.46,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,6.51,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.05,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of CMS fee schedule,6.05,450,
OCCULT BLOOD,300000430,CDM,301,RC,82270,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,4.38,100,,,fee schedule,100% of CMS fee schedule,7.01,160,,,fee schedule,160% of CMS fee schedule,5.69,130,,,fee schedule,130% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,4.24,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,4.38,100,,,fee schedule,100% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,4.38,100,,,fee schedule,100% of CMS 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,4.04,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.07,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,4.38,100,,,fee schedule,100% of CMS fee schedule,4.38,100,,,fee schedule,100% of CMS fee schedule,4.04,450,
GLUCOSE TOL EA ADDL 3>1ST,300000438,CDM,301,RC,82952,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,6.27,160,,,fee schedule,160% of CMS fee schedule,5.1,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.92,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,3.92,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
GLUCOSE TOL EA ADD'L 3>2ND,300000439,CDM,301,RC,82952,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,6.27,160,,,fee schedule,160% of CMS fee schedule,5.1,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.92,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,3.92,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
GLUCOSE TOL EA ADD'L 3>3RD,300000440,CDM,301,RC,82952,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,6.27,160,,,fee schedule,160% of CMS fee schedule,5.1,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.92,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,3.92,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
GLUCOSE TOL EA ADD'L 3>4TH,300000441,CDM,301,RC,82952,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,6.27,160,,,fee schedule,160% of CMS fee schedule,5.1,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.92,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,3.92,100,,,fee schedule,100% of CMS fee schedule,3.92,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
TOLERANCE GTT 3 SPECIMENS,300000442,CDM,301,RC,82951,HCPCS,outpatient,,,211,147.7,,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,20.59,160,,,fee schedule,160% of CMS fee schedule,16.73,130,,,fee schedule,130% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,162.93,77.22,,130.34,percent of total billed charges,77.22% of total billed charges,17,105,,,fee schedule,105% of GA fee schedule,175.13,83,,140.1,percent of total billed charges,83% of total,200.45,95,,160.36,percent of total billed charges ,95% of total billed charges,168.8,80,,135.04,percent of total billed charges,78% of total billed charges,164.58,78,,131.664,percent of total billed charges,78% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,12.87,100,,,fee schedule,100% of CMS 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,16.19,100,,,fee schedule,100% of GA fee schedule,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.97,93,,,fee schedule,93% of CMS fee schedule,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,11.97,450,
DRUG DEFINITIVE 1-7 CLASSES,300000480,CDM,301,RC,G0480,HCPCS,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,90.35,450,
DRUG DEFINITIVE 8-14,300000481,CDM,301,RC,80307,HCPCS,outpatient,,,361,252.7,,285.19,79,,228.15,percent of total billed charges,79% of total billed charges,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,278.76,77.22,,223.01,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,299.63,83,,239.7,percent of total billed charges,83% of total,342.95,95,,274.36,percent of total billed charges ,95% of total billed charges,288.8,80,,231.04,percent of total billed charges,78% of total billed charges,281.58,78,,225.264,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,285.19,79,,228.15,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
MED DRUG PLUS ALC ACE SAL CP,300000482,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CALCIUM IONIZED,300000489,CDM,301,RC,82330,HCPCS,outpatient,,,142,99.4,,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,13.68,100,,,fee schedule,100% of CMS fee schedule,21.89,160,,,fee schedule,160% of CMS fee schedule,17.78,130,,,fee schedule,130% of CMS fee schedule,17.18,100,,,fee schedule,100% of GA fee schedule,109.65,77.22,,87.72,percent of total billed charges,77.22% of total billed charges,18.04,105,,,fee schedule,105% of GA fee schedule,117.86,83,,94.29,percent of total billed charges,83% of total,134.9,95,,107.92,percent of total billed charges ,95% of total billed charges,113.6,80,,90.88,percent of total billed charges,78% of total billed charges,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,13.68,100,,,fee schedule,100% of CMS fee schedule,17.18,100,,,fee schedule,100% of GA fee schedule,13.68,100,,,fee schedule,100% of CMS 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,17.18,100,,,fee schedule,100% of GA fee schedule,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.72,93,,,fee schedule,93% of CMS fee schedule,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,13.68,100,,,fee schedule,100% of CMS fee schedule,13.68,100,,,fee schedule,100% of CMS fee schedule,12.72,450,
ADALIMUMAB COMPONENT,300000500,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ALPHA FETO PROTEIN,300000510,CDM,301,RC,82105,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,26.83,160,,,fee schedule,160% of CMS fee schedule,21.8,130,,,fee schedule,130% of CMS fee schedule,21.1,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,22.16,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,21.1,100,,,fee schedule,100% of GA fee schedule,16.77,100,,,fee schedule,100% of CMS 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,21.1,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.6,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,16.77,100,,,fee schedule,100% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,15.6,450,
HCG REFERENCE OUT,300000511,CDM,301,RC,84702,HCPCS,outpatient,,,355,248.5,,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,274.13,77.22,,219.3,percent of total billed charges,77.22% of total billed charges,8.47,105,,,fee schedule,105% of GA fee schedule,294.65,83,,235.72,percent of total billed charges,83% of total,337.25,95,,269.8,percent of total billed charges ,95% of total billed charges,284,80,,227.2,percent of total billed charges,78% of total billed charges,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,8.07,100,,,fee schedule,100% of GA fee schedule,301.75,85,,241.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,8.07,450,
ESTRIOL,300000512,CDM,301,RC,82677,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,38.69,160,,,fee schedule,160% of CMS fee schedule,31.43,130,,,fee schedule,130% of CMS fee schedule,30.41,100,,,fee schedule,100% of GA fee schedule,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,31.93,105,,,fee schedule,105% of GA fee schedule,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,30.41,100,,,fee schedule,100% of GA fee schedule,24.18,100,,,fee schedule,100% of CMS 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,30.41,100,,,fee schedule,100% of GA fee schedule,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.49,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,24.18,100,,,fee schedule,100% of CMS fee schedule,22.49,450,
SUDAN STAIN FECES QUALITATIVE,300000522,CDM,301,RC,82705,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,5.1,100,,,fee schedule,100% of CMS fee schedule,8.16,160,,,fee schedule,160% of CMS fee schedule,6.63,130,,,fee schedule,130% of CMS fee schedule,6.4,100,,,fee schedule,100% of GA fee schedule,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,6.72,105,,,fee schedule,105% of GA fee schedule,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,5.1,100,,,fee schedule,100% of CMS fee schedule,6.4,100,,,fee schedule,100% of GA fee schedule,5.1,100,,,fee schedule,100% of CMS 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,6.4,100,,,fee schedule,100% of GA fee schedule,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.74,93,,,fee schedule,93% of CMS fee schedule,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,5.1,100,,,fee schedule,100% of CMS fee schedule,5.1,100,,,fee schedule,100% of CMS fee schedule,4.74,450,
T4 FREE (FT4),300000524,CDM,301,RC,84439,HCPCS,outpatient,,,155,108.5,,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,14.43,160,,,fee schedule,160% of CMS fee schedule,11.73,130,,,fee schedule,130% of CMS fee schedule,11.34,100,,,fee schedule,100% of GA fee schedule,119.69,77.22,,95.75,percent of total billed charges,77.22% of total billed charges,11.91,105,,,fee schedule,105% of GA fee schedule,128.65,83,,102.92,percent of total billed charges,83% of total,147.25,95,,117.8,percent of total billed charges ,95% of total billed charges,124,80,,99.2,percent of total billed charges,78% of total billed charges,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,11.34,100,,,fee schedule,100% of GA fee schedule,9.02,100,,,fee schedule,100% of CMS 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,11.34,100,,,fee schedule,100% of GA fee schedule,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.39,93,,,fee schedule,93% of CMS fee schedule,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,9.02,100,,,fee schedule,100% of CMS fee schedule,9.02,100,,,fee schedule,100% of CMS fee schedule,8.39,450,
AMITRIPTYLINE,300000526,CDM,301,RC,80335,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,23.64,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.51,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.51,450,
CYCLOSPORIN,300000528,CDM,301,RC,80158,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,28.88,160,,,fee schedule,160% of CMS fee schedule,23.47,130,,,fee schedule,130% of CMS fee schedule,7.5,100,,,fee schedule,100% of GA fee schedule,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,7.88,105,,,fee schedule,105% of GA fee schedule,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,7.5,100,,,fee schedule,100% of GA fee schedule,18.05,100,,,fee schedule,100% of CMS 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,7.5,100,,,fee schedule,100% of GA fee schedule,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.79,93,,,fee schedule,93% of CMS fee schedule,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,18.05,100,,,fee schedule,100% of CMS fee schedule,7.5,450,
"AMYLASE,FRACTIONATED",300000536,CDM,301,RC,82150,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,10.37,160,,,fee schedule,160% of CMS fee schedule,8.42,130,,,fee schedule,130% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,8.56,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,6.48,100,,,fee schedule,100% of CMS 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,8.15,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.03,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,6.03,450,
T3 FREE (FT3),300000538,CDM,301,RC,84481,HCPCS,outpatient,,,178,124.6,,140.62,79,,112.5,percent of total billed charges,79% of total billed charges,160.2,90,,128.16,percent of total billed charges,90% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,27.1,160,,,fee schedule,160% of CMS fee schedule,22.02,130,,,fee schedule,130% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,137.45,77.22,,109.96,percent of total billed charges,77.22% of total billed charges,22.37,105,,,fee schedule,105% of GA fee schedule,147.74,83,,118.19,percent of total billed charges,83% of total,169.1,95,,135.28,percent of total billed charges ,95% of total billed charges,142.4,80,,113.92,percent of total billed charges,78% of total billed charges,138.84,78,,111.072,percent of total billed charges,78% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,16.94,100,,,fee schedule,100% of CMS 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,21.3,100,,,fee schedule,100% of GA fee schedule,151.3,85,,121.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.75,93,,,fee schedule,93% of CMS fee schedule,140.62,79,,112.5,percent of total billed charges,79% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,15.75,450,
LIPID PANEL,300000539,CDM,301,RC,80061,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,21.42,160,,,fee schedule,160% of CMS fee schedule,17.41,130,,,fee schedule,130% of CMS fee schedule,16.85,100,,,fee schedule,100% of GA fee schedule,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,17.69,105,,,fee schedule,105% of GA fee schedule,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of GA fee schedule,13.39,100,,,fee schedule,100% of CMS 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,16.85,100,,,fee schedule,100% of GA fee schedule,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.45,93,,,fee schedule,93% of CMS fee schedule,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,13.39,100,,,fee schedule,100% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,12.45,450,
RBC FOLATE,300000551,CDM,301,RC,82747,HCPCS,outpatient,,,204,142.8,,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,17.65,100,,,fee schedule,100% of CMS fee schedule,28.24,160,,,fee schedule,160% of CMS fee schedule,22.95,130,,,fee schedule,130% of CMS fee schedule,21.78,100,,,fee schedule,100% of GA fee schedule,157.53,77.22,,126.02,percent of total billed charges,77.22% of total billed charges,22.87,105,,,fee schedule,105% of GA fee schedule,169.32,83,,135.46,percent of total billed charges,83% of total,193.8,95,,155.04,percent of total billed charges ,95% of total billed charges,163.2,80,,130.56,percent of total billed charges,78% of total billed charges,159.12,78,,127.296,percent of total billed charges,78% of total billed charges,17.65,100,,,fee schedule,100% of CMS fee schedule,21.78,100,,,fee schedule,100% of GA fee schedule,17.65,100,,,fee schedule,100% of CMS 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,21.78,100,,,fee schedule,100% of GA fee schedule,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.41,93,,,fee schedule,93% of CMS fee schedule,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,17.65,100,,,fee schedule,100% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,16.41,450,
TROPONIN I,300000563,CDM,301,RC,84484,HCPCS,outpatient,,,208,145.6,,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,19.95,160,,,fee schedule,160% of CMS fee schedule,16.21,130,,,fee schedule,130% of CMS fee schedule,12.38,100,,,fee schedule,100% of GA fee schedule,160.62,77.22,,128.5,percent of total billed charges,77.22% of total billed charges,13,105,,,fee schedule,105% of GA fee schedule,172.64,83,,138.11,percent of total billed charges,83% of total,197.6,95,,158.08,percent of total billed charges ,95% of total billed charges,166.4,80,,133.12,percent of total billed charges,78% of total billed charges,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,12.38,100,,,fee schedule,100% of GA fee schedule,12.47,100,,,fee schedule,100% of CMS 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,12.38,100,,,fee schedule,100% of GA fee schedule,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.6,93,,,fee schedule,93% of CMS fee schedule,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,12.47,100,,,fee schedule,100% of CMS fee schedule,11.6,450,
DIABETIC PRENATAL SCREENING,300000564,CDM,301,RC,82950,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,7.6,160,,,fee schedule,160% of CMS fee schedule,6.18,130,,,fee schedule,130% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,6.28,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,4.75,100,,,fee schedule,100% of CMS 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,5.98,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.42,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,4.42,450,
CALCIUM URINE,300000565,CDM,301,RC,82340,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,9.65,160,,,fee schedule,160% of CMS fee schedule,7.84,130,,,fee schedule,130% of CMS fee schedule,7.59,100,,,fee schedule,100% of GA fee schedule,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,7.97,105,,,fee schedule,105% of GA fee schedule,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,7.59,100,,,fee schedule,100% of GA fee schedule,6.03,100,,,fee schedule,100% of CMS 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,7.59,100,,,fee schedule,100% of GA fee schedule,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.61,93,,,fee schedule,93% of CMS fee schedule,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,5.61,450,
"OXALATE,24HR URINE",300000566,CDM,301,RC,83945,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,23.12,160,,,fee schedule,160% of CMS fee schedule,18.79,130,,,fee schedule,130% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,17,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,14.45,100,,,fee schedule,100% of CMS 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,16.19,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.44,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,14.45,100,,,fee schedule,100% of CMS fee schedule,13.44,450,
CITRIC ACID  24 HR URINE,300000567,CDM,301,RC,82507,HCPCS,outpatient,,,369,258.3,,291.51,79,,233.21,percent of total billed charges,79% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,44.48,160,,,fee schedule,160% of CMS fee schedule,36.14,130,,,fee schedule,130% of CMS fee schedule,34.97,100,,,fee schedule,100% of GA fee schedule,284.94,77.22,,227.95,percent of total billed charges,77.22% of total billed charges,36.72,105,,,fee schedule,105% of GA fee schedule,306.27,83,,245.02,percent of total billed charges,83% of total,350.55,95,,280.44,percent of total billed charges ,95% of total billed charges,295.2,80,,236.16,percent of total billed charges,78% of total billed charges,287.82,78,,230.256,percent of total billed charges,78% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,34.97,100,,,fee schedule,100% of GA fee schedule,27.8,100,,,fee schedule,100% of CMS 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,34.97,100,,,fee schedule,100% of GA fee schedule,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.85,93,,,fee schedule,93% of CMS fee schedule,291.51,79,,233.21,percent of total billed charges,79% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,27.8,100,,,fee schedule,100% of CMS fee schedule,25.85,450,
"PHOSPHORUS,24HR URINE",300000568,CDM,301,RC,84105,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,9.25,160,,,fee schedule,160% of CMS fee schedule,7.51,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,5.78,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.38,93,,,fee schedule,93% of CMS fee schedule,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,5.38,450,
TOPAMAX,300000570,CDM,301,RC,80201,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,11.92,100,,,fee schedule,100% of CMS fee schedule,19.07,160,,,fee schedule,160% of CMS fee schedule,15.5,130,,,fee schedule,130% of CMS fee schedule,14.99,100,,,fee schedule,100% of GA fee schedule,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,15.74,105,,,fee schedule,105% of GA fee schedule,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,11.92,100,,,fee schedule,100% of CMS fee schedule,14.99,100,,,fee schedule,100% of GA fee schedule,11.92,100,,,fee schedule,100% of CMS 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,14.99,100,,,fee schedule,100% of GA fee schedule,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.09,93,,,fee schedule,93% of CMS fee schedule,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,11.92,100,,,fee schedule,100% of CMS fee schedule,11.92,100,,,fee schedule,100% of CMS fee schedule,11.09,450,
CP CARDIO IQ PANEL,300000600,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
TROPONIN T,300000601,CDM,301,RC,84484,HCPCS,outpatient,,,208,145.6,,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,19.95,160,,,fee schedule,160% of CMS fee schedule,16.21,130,,,fee schedule,130% of CMS fee schedule,12.38,100,,,fee schedule,100% of GA fee schedule,160.62,77.22,,128.5,percent of total billed charges,77.22% of total billed charges,13,105,,,fee schedule,105% of GA fee schedule,172.64,83,,138.11,percent of total billed charges,83% of total,197.6,95,,158.08,percent of total billed charges ,95% of total billed charges,166.4,80,,133.12,percent of total billed charges,78% of total billed charges,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,12.38,100,,,fee schedule,100% of GA fee schedule,12.47,100,,,fee schedule,100% of CMS 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,12.38,100,,,fee schedule,100% of GA fee schedule,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.6,93,,,fee schedule,93% of CMS fee schedule,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,12.47,100,,,fee schedule,100% of CMS fee schedule,12.47,100,,,fee schedule,100% of CMS fee schedule,11.6,450,
ABG ANALYSIS,300000654,CDM,301,RC,82803,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,41.71,160,,,fee schedule,160% of CMS fee schedule,33.89,130,,,fee schedule,130% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,25.56,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,26.07,100,,,fee schedule,100% of CMS 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,24.34,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.25,93,,,fee schedule,93% of CMS fee schedule,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,24.25,450,
ABG ANALYSIS W CARBOXY HEMOGLO,300000655,CDM,301,RC,82375,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,19.71,160,,,fee schedule,160% of CMS fee schedule,16.02,130,,,fee schedule,130% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,3.8,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,12.32,100,,,fee schedule,100% of CMS 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,3.62,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.46,93,,,fee schedule,93% of CMS fee schedule,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,12.32,100,,,fee schedule,100% of CMS fee schedule,3.62,450,
PSA SCREENING TOTAL,300003071,CDM,301,RC,84153,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,29.42,160,,,fee schedule,160% of CMS fee schedule,23.91,130,,,fee schedule,130% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,24.29,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,18.39,100,,,fee schedule,100% of CMS 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,23.13,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.1,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,17.1,450,
PSA HEALTH FAIR TOTAL,300003072,CDM,301,RC,84153,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,29.42,160,,,fee schedule,160% of CMS fee schedule,23.91,130,,,fee schedule,130% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,24.29,105,,,fee schedule,105% of GA fee schedule,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,18.39,100,,,fee schedule,100% of CMS 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,23.13,100,,,fee schedule,100% of GA fee schedule,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.1,93,,,fee schedule,93% of CMS fee schedule,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,17.1,450,
21 HYDRO XYLAS ANTIBODIES,300003518,CDM,301,RC,83519,HCPCS,outpatient,,,130,91,,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,100.39,77.22,,80.31,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,107.9,83,,86.32,percent of total billed charges,83% of total,123.5,95,,98.8,percent of total billed charges ,95% of total billed charges,104,80,,83.2,percent of total billed charges,78% of total billed charges,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
"VITAMIN D 1,25",300008000,CDM,301,RC,82652,HCPCS,outpatient,,,298,208.6,,235.42,79,,188.34,percent of total billed charges,79% of total billed charges,268.2,90,,214.56,percent of total billed charges,90% of total billed charges,38.5,100,,,fee schedule,100% of CMS fee schedule,61.6,160,,,fee schedule,160% of CMS fee schedule,50.05,130,,,fee schedule,130% of CMS fee schedule,48.4,100,,,fee schedule,100% of GA fee schedule,230.12,77.22,,184.1,percent of total billed charges,77.22% of total billed charges,50.82,105,,,fee schedule,105% of GA fee schedule,247.34,83,,197.87,percent of total billed charges,83% of total,283.1,95,,226.48,percent of total billed charges ,95% of total billed charges,238.4,80,,190.72,percent of total billed charges,78% of total billed charges,232.44,78,,185.952,percent of total billed charges,78% of total billed charges,38.5,100,,,fee schedule,100% of CMS fee schedule,48.4,100,,,fee schedule,100% of GA fee schedule,38.5,100,,,fee schedule,100% of CMS fee schedule,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,48.4,100,,,fee schedule,100% of GA fee schedule,253.3,85,,202.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.81,93,,,fee schedule,93% of CMS fee schedule,235.42,79,,188.34,percent of total billed charges,79% of total billed charges,38.5,100,,,fee schedule,100% of CMS fee schedule,38.5,100,,,fee schedule,100% of CMS fee schedule,35.81,450,
SEROTONIN,300008002,CDM,301,RC,84260,HCPCS,outpatient,,,363,254.1,,286.77,79,,229.42,percent of total billed charges,79% of total billed charges,326.7,90,,261.36,percent of total billed charges,90% of total billed charges,30.98,100,,,fee schedule,100% of CMS fee schedule,49.57,160,,,fee schedule,160% of CMS fee schedule,40.27,130,,,fee schedule,130% of CMS fee schedule,38.95,100,,,fee schedule,100% of GA fee schedule,280.31,77.22,,224.25,percent of total billed charges,77.22% of total billed charges,40.9,105,,,fee schedule,105% of GA fee schedule,301.29,83,,241.03,percent of total billed charges,83% of total,344.85,95,,275.88,percent of total billed charges ,95% of total billed charges,290.4,80,,232.32,percent of total billed charges,78% of total billed charges,283.14,78,,226.512,percent of total billed charges,78% of total billed charges,30.98,100,,,fee schedule,100% of CMS fee schedule,38.95,100,,,fee schedule,100% of GA fee schedule,30.98,100,,,fee schedule,100% of CMS 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,38.95,100,,,fee schedule,100% of GA fee schedule,308.55,85,,246.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,28.81,93,,,fee schedule,93% of CMS fee schedule,286.77,79,,229.42,percent of total billed charges,79% of total billed charges,30.98,100,,,fee schedule,100% of CMS fee schedule,30.98,100,,,fee schedule,100% of CMS fee schedule,28.81,450,
CRYOGLOBULINS,300008006,CDM,301,RC,82595,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,10.35,160,,,fee schedule,160% of CMS fee schedule,8.41,130,,,fee schedule,130% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,8.55,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,6.47,100,,,fee schedule,100% of CMS 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,8.14,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.02,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.02,450,
HAPTOGLOBIN,300008007,CDM,301,RC,83010,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,12.58,100,,,fee schedule,100% of CMS fee schedule,20.13,160,,,fee schedule,160% of CMS fee schedule,16.35,130,,,fee schedule,130% of CMS fee schedule,4.69,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,4.92,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,12.58,100,,,fee schedule,100% of CMS fee schedule,4.69,100,,,fee schedule,100% of GA fee schedule,12.58,100,,,fee schedule,100% of CMS 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,4.69,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.7,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,12.58,100,,,fee schedule,100% of CMS fee schedule,12.58,100,,,fee schedule,100% of CMS fee schedule,4.69,450,
ESTRADIOL TOTAL,300008011,CDM,301,RC,82670,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,44.7,160,,,fee schedule,160% of CMS fee schedule,36.32,130,,,fee schedule,130% of CMS fee schedule,35.14,100,,,fee schedule,100% of GA fee schedule,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,36.9,105,,,fee schedule,105% of GA fee schedule,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,35.14,100,,,fee schedule,100% of GA fee schedule,27.94,100,,,fee schedule,100% of CMS 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,35.14,100,,,fee schedule,100% of GA fee schedule,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.98,93,,,fee schedule,93% of CMS fee schedule,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,25.98,450,
FREE PSA,300008012,CDM,301,RC,84154,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,29.42,160,,,fee schedule,160% of CMS fee schedule,23.91,130,,,fee schedule,130% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,24.29,105,,,fee schedule,105% of GA fee schedule,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,23.13,100,,,fee schedule,100% of GA fee schedule,18.39,100,,,fee schedule,100% of CMS 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,23.13,100,,,fee schedule,100% of GA fee schedule,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.1,93,,,fee schedule,93% of CMS fee schedule,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,18.39,100,,,fee schedule,100% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,17.1,450,
ENDOMYSIAL ANTIBODY,300008013,CDM,301,RC,86231,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,19.34,160,,,fee schedule,160% of CMS fee schedule,15.72,130,,,fee schedule,130% of CMS fee schedule,9.67,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,10.15,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,9.67,100,,,fee schedule,100% of GA fee schedule,12.09,100,,,fee schedule,100% of CMS 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,9.67,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.24,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,9.67,450,
NTX URINE,300008022,CDM,301,RC,82150,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,10.37,160,,,fee schedule,160% of CMS fee schedule,8.42,130,,,fee schedule,130% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,8.56,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,6.48,100,,,fee schedule,100% of CMS 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,8.15,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.03,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,6.03,450,
"CATECHOLAMINE,FRACT BLD OR UR",300008023,CDM,301,RC,82384,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,25.25,100,,,fee schedule,100% of CMS fee schedule,40.4,160,,,fee schedule,160% of CMS fee schedule,32.83,130,,,fee schedule,130% of CMS fee schedule,31.75,100,,,fee schedule,100% of GA fee schedule,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,33.34,105,,,fee schedule,105% of GA fee schedule,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,25.25,100,,,fee schedule,100% of CMS fee schedule,31.75,100,,,fee schedule,100% of GA fee schedule,25.25,100,,,fee schedule,100% of CMS fee schedule,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,31.75,100,,,fee schedule,100% of GA fee schedule,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.48,93,,,fee schedule,93% of CMS fee schedule,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,25.25,100,,,fee schedule,100% of CMS fee schedule,25.25,100,,,fee schedule,100% of CMS fee schedule,23.48,450,
GIARDIA ANTIGEN,300008025,CDM,301,RC,83520,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
DISOPYRAMIDE,300008028,CDM,301,RC,80299,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
SOTALOL,300008030,CDM,301,RC,80299,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
OSMOLALITY URINE,300008031,CDM,301,RC,83935,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,10.91,160,,,fee schedule,160% of CMS fee schedule,8.87,130,,,fee schedule,130% of CMS fee schedule,8.57,100,,,fee schedule,100% of GA fee schedule,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,9,105,,,fee schedule,105% of GA fee schedule,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,8.57,100,,,fee schedule,100% of GA fee schedule,6.82,100,,,fee schedule,100% of CMS 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,8.57,100,,,fee schedule,100% of GA fee schedule,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.34,93,,,fee schedule,93% of CMS fee schedule,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,6.82,100,,,fee schedule,100% of CMS fee schedule,6.34,450,
BETA 2 MICROGLOBULIN,300008032,CDM,301,RC,82232,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,16.18,100,,,fee schedule,100% of CMS fee schedule,25.89,160,,,fee schedule,160% of CMS fee schedule,21.03,130,,,fee schedule,130% of CMS fee schedule,20.35,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,21.37,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,16.18,100,,,fee schedule,100% of CMS fee schedule,20.35,100,,,fee schedule,100% of GA fee schedule,16.18,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,20.35,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.05,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,16.18,100,,,fee schedule,100% of CMS fee schedule,16.18,100,,,fee schedule,100% of CMS fee schedule,15.05,450,
AMIODARONE,300008034,CDM,301,RC,80299,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
24 HR UA CALCIUM,300008038,CDM,301,RC,82340,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,9.65,160,,,fee schedule,160% of CMS fee schedule,7.84,130,,,fee schedule,130% of CMS fee schedule,7.59,100,,,fee schedule,100% of GA fee schedule,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,7.97,105,,,fee schedule,105% of GA fee schedule,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,7.59,100,,,fee schedule,100% of GA fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,7.59,100,,,fee schedule,100% of GA fee schedule,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.61,93,,,fee schedule,93% of CMS fee schedule,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,5.61,450,
LEGAL ALCOHOL,300008041,CDM,301,RC,82055,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
CERULOPLASMIN,300008042,CDM,301,RC,82390,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,17.18,160,,,fee schedule,160% of CMS fee schedule,13.96,130,,,fee schedule,130% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,14.19,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,13.51,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.99,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,9.99,450,
ERYTHROPOIETIN,300008046,CDM,301,RC,82668,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,18.79,100,,,fee schedule,100% of CMS fee schedule,30.06,160,,,fee schedule,160% of CMS fee schedule,24.43,130,,,fee schedule,130% of CMS fee schedule,23.63,100,,,fee schedule,100% of GA fee schedule,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,24.81,105,,,fee schedule,105% of GA fee schedule,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,18.79,100,,,fee schedule,100% of CMS fee schedule,23.63,100,,,fee schedule,100% of GA fee schedule,18.79,100,,,fee schedule,100% of CMS 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,23.63,100,,,fee schedule,100% of GA fee schedule,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.47,93,,,fee schedule,93% of CMS fee schedule,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,18.79,100,,,fee schedule,100% of CMS fee schedule,18.79,100,,,fee schedule,100% of CMS fee schedule,17.47,450,
HOMOCYSTEINE,300008051,CDM,301,RC,82131,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,36.77,160,,,fee schedule,160% of CMS fee schedule,29.87,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,22.98,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.37,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,450,
"XANTHINE,URINE",300008052,CDM,301,RC,83789,HCPCS,outpatient,,,338,236.6,,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,38.58,160,,,fee schedule,160% of CMS fee schedule,31.34,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,261,77.22,,208.8,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,280.54,83,,224.43,percent of total billed charges,83% of total,321.1,95,,256.88,percent of total billed charges ,95% of total billed charges,270.4,80,,216.32,percent of total billed charges,78% of total billed charges,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.42,93,,,fee schedule,93% of CMS fee schedule,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
"MUMPS,IGG",300008057,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
"MUMPS,IGM",300008058,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
VASOPRESSIN,300008060,CDM,301,RC,84588,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,54.3,160,,,fee schedule,160% of CMS fee schedule,44.12,130,,,fee schedule,130% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,44.82,105,,,fee schedule,105% of GA fee schedule,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,33.94,100,,,fee schedule,100% of CMS 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,42.69,100,,,fee schedule,100% of GA fee schedule,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.56,93,,,fee schedule,93% of CMS fee schedule,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,33.94,100,,,fee schedule,100% of CMS fee schedule,31.56,450,
ACETYLCHOLINE,300008061,CDM,301,RC,86042,HCPCS,outpatient,,,323,226.1,,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,249.42,77.22,,199.54,percent of total billed charges,77.22% of total billed charges,15.46,105,,,fee schedule,105% of GA fee schedule,268.09,83,,214.47,percent of total billed charges,83% of total,306.85,95,,245.48,percent of total billed charges ,95% of total billed charges,258.4,80,,206.72,percent of total billed charges,78% of total billed charges,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,14.72,100,,,fee schedule,100% of GA fee schedule,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,14.72,450,
NEURONTIN,300008063,CDM,301,RC,80171,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,34.67,160,,,fee schedule,160% of CMS fee schedule,28.17,130,,,fee schedule,130% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,15.19,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,21.67,100,,,fee schedule,100% of CMS 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,14.47,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.15,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,21.67,100,,,fee schedule,100% of CMS fee schedule,14.47,450,
SOMATOMEDIN-C,300008067,CDM,301,RC,84305,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,34.02,160,,,fee schedule,160% of CMS fee schedule,27.64,130,,,fee schedule,130% of CMS fee schedule,26.73,100,,,fee schedule,100% of GA fee schedule,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,28.07,105,,,fee schedule,105% of GA fee schedule,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,26.73,100,,,fee schedule,100% of GA fee schedule,21.26,100,,,fee schedule,100% of CMS 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,26.73,100,,,fee schedule,100% of GA fee schedule,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.77,93,,,fee schedule,93% of CMS fee schedule,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,19.77,450,
"FECAL FAT,QUAL",300008069,CDM,301,RC,82705,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,5.1,100,,,fee schedule,100% of CMS fee schedule,8.16,160,,,fee schedule,160% of CMS fee schedule,6.63,130,,,fee schedule,130% of CMS fee schedule,6.4,100,,,fee schedule,100% of GA fee schedule,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,6.72,105,,,fee schedule,105% of GA fee schedule,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,5.1,100,,,fee schedule,100% of CMS fee schedule,6.4,100,,,fee schedule,100% of GA fee schedule,5.1,100,,,fee schedule,100% of CMS 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,6.4,100,,,fee schedule,100% of GA fee schedule,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.74,93,,,fee schedule,93% of CMS fee schedule,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,5.1,100,,,fee schedule,100% of CMS fee schedule,5.1,100,,,fee schedule,100% of CMS fee schedule,4.74,450,
FDS-22B,300008071,CDM,301,RC,80307,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,50.19,450,
FDS-13 (ADMINISTRATION),300008073,CDM,301,RC,80307,HCPCS,outpatient,,,417,291.9,,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,322.01,77.22,,257.61,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,346.11,83,,276.89,percent of total billed charges,83% of total,396.15,95,,316.92,percent of total billed charges ,95% of total billed charges,333.6,80,,266.88,percent of total billed charges,78% of total billed charges,325.26,78,,260.208,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,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,61.16,100,,,fee schedule,100% of GA fee schedule,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
METANEPHRINE PLASMA,300008074,CDM,301,RC,83835,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,27.1,160,,,fee schedule,160% of CMS fee schedule,22.02,130,,,fee schedule,130% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,22.37,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,16.94,100,,,fee schedule,100% of CMS 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,21.3,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.75,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,15.75,450,
PHYTANIC ACID,300008075,CDM,301,RC,82726,HCPCS,outpatient,,,388,271.6,,306.52,79,,245.22,percent of total billed charges,79% of total billed charges,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,19.75,100,,,fee schedule,100% of CMS fee schedule,31.6,160,,,fee schedule,160% of CMS fee schedule,25.68,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,299.61,77.22,,239.69,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,322.04,83,,257.63,percent of total billed charges,83% of total,368.6,95,,294.88,percent of total billed charges ,95% of total billed charges,310.4,80,,248.32,percent of total billed charges,78% of total billed charges,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,19.75,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,19.75,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.37,93,,,fee schedule,93% of CMS fee schedule,306.52,79,,245.22,percent of total billed charges,79% of total billed charges,19.75,100,,,fee schedule,100% of CMS fee schedule,19.75,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
C-PEPTIDE,300008076,CDM,301,RC,84681,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,19.98,100,,,fee schedule,100% of GA fee schedule,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,20.98,105,,,fee schedule,105% of GA fee schedule,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,19.98,100,,,fee schedule,100% of GA fee schedule,20.81,100,,,fee schedule,100% of CMS 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,19.98,100,,,fee schedule,100% of GA fee schedule,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,450,
IMMUNOGLOBULIN IGA,300008077,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
INTERLEUKIN 2 RECEPTOR IL2R,300008096,CDM,301,RC,83520,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,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,16.28,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
ANTI-GLIADIN IgG,300008202,CDM,301,RC,86258,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,9.68,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.22,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.22,450,
ANTI-GLIADIN-IGM,300008203,CDM,301,RC,86258,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,9.68,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.22,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.22,450,
ALIUMINUM LEVEL,300008204,CDM,301,RC,82108,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,25.48,100,,,fee schedule,100% of CMS fee schedule,40.77,160,,,fee schedule,160% of CMS fee schedule,33.12,130,,,fee schedule,130% of CMS fee schedule,21.2,100,,,fee schedule,100% of GA fee schedule,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,22.26,105,,,fee schedule,105% of GA fee schedule,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,25.48,100,,,fee schedule,100% of CMS fee schedule,21.2,100,,,fee schedule,100% of GA fee schedule,25.48,100,,,fee schedule,100% of CMS 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,21.2,100,,,fee schedule,100% of GA fee schedule,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.7,93,,,fee schedule,93% of CMS fee schedule,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,25.48,100,,,fee schedule,100% of CMS fee schedule,25.48,100,,,fee schedule,100% of CMS fee schedule,21.2,450,
AMOXAPINE LEVEL,300008207,CDM,301,RC,80335,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,23.64,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.51,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.51,450,
ANDROSTENEDIONE,300008209,CDM,301,RC,82157,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,46.85,160,,,fee schedule,160% of CMS fee schedule,38.06,130,,,fee schedule,130% of CMS fee schedule,36.81,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,38.65,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,36.81,100,,,fee schedule,100% of GA fee schedule,29.28,100,,,fee schedule,100% of CMS 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,36.81,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.23,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,27.23,450,
ACETYLCHOLINE BINDING AB,300008211,CDM,301,RC,86041,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,15.46,105,,,fee schedule,105% of GA fee schedule,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,14.72,100,,,fee schedule,100% of GA fee schedule,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,14.72,450,
"ARSENIC,URINE OR BLOOD",300008212,CDM,301,RC,83018,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,35.14,160,,,fee schedule,160% of CMS fee schedule,28.55,130,,,fee schedule,130% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,28.99,105,,,fee schedule,105% of GA fee schedule,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,21.96,100,,,fee schedule,100% of CMS 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,27.61,100,,,fee schedule,100% of GA fee schedule,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.42,93,,,fee schedule,93% of CMS fee schedule,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,20.42,450,
BROMIDE LEVEL,300008216,CDM,301,RC,84311,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,12.96,160,,,fee schedule,160% of CMS fee schedule,10.53,130,,,fee schedule,130% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,9.23,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,8.1,100,,,fee schedule,100% of CMS 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,8.79,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.53,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,8.1,100,,,fee schedule,100% of CMS fee schedule,7.53,450,
"CADMIUM,URINE OR BLOOD",300008221,CDM,301,RC,82300,HCPCS,outpatient,,,214,149.8,,169.06,79,,135.25,percent of total billed charges,79% of total billed charges,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,23.64,100,,,fee schedule,100% of CMS fee schedule,37.82,160,,,fee schedule,160% of CMS fee schedule,30.73,130,,,fee schedule,130% of CMS fee schedule,29.1,100,,,fee schedule,100% of GA fee schedule,165.25,77.22,,132.2,percent of total billed charges,77.22% of total billed charges,30.56,105,,,fee schedule,105% of GA fee schedule,177.62,83,,142.1,percent of total billed charges,83% of total,203.3,95,,162.64,percent of total billed charges ,95% of total billed charges,171.2,80,,136.96,percent of total billed charges,78% of total billed charges,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,23.64,100,,,fee schedule,100% of CMS fee schedule,29.1,100,,,fee schedule,100% of GA fee schedule,23.64,100,,,fee schedule,100% of CMS fee schedule,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,29.1,100,,,fee schedule,100% of GA fee schedule,181.9,85,,145.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.99,93,,,fee schedule,93% of CMS fee schedule,169.06,79,,135.25,percent of total billed charges,79% of total billed charges,23.64,100,,,fee schedule,100% of CMS fee schedule,23.64,100,,,fee schedule,100% of CMS fee schedule,21.99,450,
CAFFEINE LEVEL,300008222,CDM,301,RC,80155,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,61.71,160,,,fee schedule,160% of CMS fee schedule,50.14,130,,,fee schedule,130% of CMS fee schedule,15.44,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,16.21,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,15.44,100,,,fee schedule,100% of GA fee schedule,38.57,100,,,fee schedule,100% of CMS 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,15.44,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.87,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,38.57,100,,,fee schedule,100% of CMS fee schedule,15.44,450,
CAROTENE,300008224,CDM,301,RC,82380,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,9.22,100,,,fee schedule,100% of CMS fee schedule,14.75,160,,,fee schedule,160% of CMS fee schedule,11.99,130,,,fee schedule,130% of CMS fee schedule,11.6,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,12.18,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,9.22,100,,,fee schedule,100% of CMS fee schedule,11.6,100,,,fee schedule,100% of GA fee schedule,9.22,100,,,fee schedule,100% of CMS 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,11.6,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.57,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,9.22,100,,,fee schedule,100% of CMS fee schedule,9.22,100,,,fee schedule,100% of CMS fee schedule,8.57,450,
CHLORAMPHENICOL/CHLOROLYCETIN,300008225,CDM,301,RC,82415,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,12.67,100,,,fee schedule,100% of CMS fee schedule,20.27,160,,,fee schedule,160% of CMS fee schedule,16.47,130,,,fee schedule,130% of CMS fee schedule,15.93,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,16.73,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,12.67,100,,,fee schedule,100% of CMS fee schedule,15.93,100,,,fee schedule,100% of GA fee schedule,12.67,100,,,fee schedule,100% of CMS 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,15.93,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.78,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,12.67,100,,,fee schedule,100% of CMS fee schedule,12.67,100,,,fee schedule,100% of CMS fee schedule,11.78,450,
LIBRIUM (CHLORDIAZEPOXIDE),300008226,CDM,301,RC,G0480,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
CHLORPROMAZINE (THORAZINE),300008227,CDM,301,RC,84022,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
"CHLORIDE,URINE",300008228,CDM,301,RC,82436,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,9.2,160,,,fee schedule,160% of CMS fee schedule,7.48,130,,,fee schedule,130% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,6.64,105,,,fee schedule,105% of GA fee schedule,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,5.75,100,,,fee schedule,100% of CMS 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,6.32,100,,,fee schedule,100% of GA fee schedule,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.35,93,,,fee schedule,93% of CMS fee schedule,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,5.35,450,
CARBOXYHEMOGLOBIN PROFILE,300008231,CDM,301,RC,82375,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,19.71,160,,,fee schedule,160% of CMS fee schedule,16.02,130,,,fee schedule,130% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,3.8,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,12.32,100,,,fee schedule,100% of CMS 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,3.62,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.46,93,,,fee schedule,93% of CMS fee schedule,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,12.32,100,,,fee schedule,100% of CMS fee schedule,3.62,450,
CYANIDE,300008233,CDM,301,RC,82600,HCPCS,outpatient,,,102,71.4,,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,19.4,100,,,fee schedule,100% of CMS fee schedule,31.04,160,,,fee schedule,160% of CMS fee schedule,25.22,130,,,fee schedule,130% of CMS fee schedule,24.4,100,,,fee schedule,100% of GA fee schedule,78.76,77.22,,63.01,percent of total billed charges,77.22% of total billed charges,25.62,105,,,fee schedule,105% of GA fee schedule,84.66,83,,67.73,percent of total billed charges,83% of total,96.9,95,,77.52,percent of total billed charges ,95% of total billed charges,81.6,80,,65.28,percent of total billed charges,78% of total billed charges,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,19.4,100,,,fee schedule,100% of CMS fee schedule,24.4,100,,,fee schedule,100% of GA fee schedule,19.4,100,,,fee schedule,100% of CMS 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,24.4,100,,,fee schedule,100% of GA fee schedule,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.04,93,,,fee schedule,93% of CMS fee schedule,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,19.4,100,,,fee schedule,100% of CMS fee schedule,19.4,100,,,fee schedule,100% of CMS fee schedule,18.04,450,
"DELTA AMINOLEVULINIC ACID,URIN",300008234,CDM,301,RC,82135,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,16.45,100,,,fee schedule,100% of CMS fee schedule,26.32,160,,,fee schedule,160% of CMS fee schedule,21.39,130,,,fee schedule,130% of CMS fee schedule,20.7,100,,,fee schedule,100% of GA fee schedule,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,21.74,105,,,fee schedule,105% of GA fee schedule,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,16.45,100,,,fee schedule,100% of CMS fee schedule,20.7,100,,,fee schedule,100% of GA fee schedule,16.45,100,,,fee schedule,100% of CMS 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,20.7,100,,,fee schedule,100% of GA fee schedule,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.3,93,,,fee schedule,93% of CMS fee schedule,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,16.45,100,,,fee schedule,100% of CMS fee schedule,16.45,100,,,fee schedule,100% of CMS fee schedule,15.3,450,
DESIPRAMINE LEVEL (NORPRAMIN),300008235,CDM,301,RC,G0480,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,77.99,450,
DEHYDROEPIANDROSTERONE,300008236,CDM,301,RC,82626,HCPCS,outpatient,,,197,137.9,,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,177.3,90,,141.84,percent of total billed charges,90% of total billed charges,25.27,100,,,fee schedule,100% of CMS fee schedule,40.43,160,,,fee schedule,160% of CMS fee schedule,32.85,130,,,fee schedule,130% of CMS fee schedule,31.78,100,,,fee schedule,100% of GA fee schedule,152.12,77.22,,121.7,percent of total billed charges,77.22% of total billed charges,33.37,105,,,fee schedule,105% of GA fee schedule,163.51,83,,130.81,percent of total billed charges,83% of total,187.15,95,,149.72,percent of total billed charges ,95% of total billed charges,157.6,80,,126.08,percent of total billed charges,78% of total billed charges,153.66,78,,122.928,percent of total billed charges,78% of total billed charges,25.27,100,,,fee schedule,100% of CMS fee schedule,31.78,100,,,fee schedule,100% of GA fee schedule,25.27,100,,,fee schedule,100% of CMS 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,31.78,100,,,fee schedule,100% of GA fee schedule,167.45,85,,133.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.5,93,,,fee schedule,93% of CMS fee schedule,155.63,79,,124.5,percent of total billed charges,79% of total billed charges,25.27,100,,,fee schedule,100% of CMS fee schedule,25.27,100,,,fee schedule,100% of CMS fee schedule,23.5,450,
DIAZEPAN (VALUIM),300008237,CDM,301,RC,G0480,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,91.89,450,
DYPHYLLINE (LUFFYLIN),300008238,CDM,301,RC,82542,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,38.54,160,,,fee schedule,160% of CMS fee schedule,31.32,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.09,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.4,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
ESTRONE,300008239,CDM,301,RC,82679,HCPCS,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,24.95,100,,,fee schedule,100% of CMS fee schedule,39.92,160,,,fee schedule,160% of CMS fee schedule,32.44,130,,,fee schedule,130% of CMS fee schedule,31.39,100,,,fee schedule,100% of GA fee schedule,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,32.96,105,,,fee schedule,105% of GA fee schedule,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,24.95,100,,,fee schedule,100% of CMS fee schedule,31.39,100,,,fee schedule,100% of GA fee schedule,24.95,100,,,fee schedule,100% of CMS 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,31.39,100,,,fee schedule,100% of GA fee schedule,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.2,93,,,fee schedule,93% of CMS fee schedule,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,24.95,100,,,fee schedule,100% of CMS fee schedule,24.95,100,,,fee schedule,100% of CMS fee schedule,23.2,450,
ENCAINIDE LEVEL,300008243,CDM,301,RC,82542,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,38.54,160,,,fee schedule,160% of CMS fee schedule,31.32,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.09,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.4,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
ETHYLENE CLYCOL,300008245,CDM,301,RC,82693,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,14.9,100,,,fee schedule,100% of CMS fee schedule,23.84,160,,,fee schedule,160% of CMS fee schedule,19.37,130,,,fee schedule,130% of CMS fee schedule,18.74,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,19.68,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,14.9,100,,,fee schedule,100% of CMS fee schedule,18.74,100,,,fee schedule,100% of GA fee schedule,14.9,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,18.74,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.86,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,14.9,100,,,fee schedule,100% of CMS fee schedule,14.9,100,,,fee schedule,100% of CMS fee schedule,13.86,450,
ESTHOSUXIMIDE (ZARONTIN) LEVEL,300008246,CDM,301,RC,80168,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,26.14,160,,,fee schedule,160% of CMS fee schedule,21.24,130,,,fee schedule,130% of CMS fee schedule,20.55,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,21.58,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,20.55,100,,,fee schedule,100% of GA fee schedule,16.34,100,,,fee schedule,100% of CMS 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,20.55,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.2,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,16.34,100,,,fee schedule,100% of CMS fee schedule,16.34,100,,,fee schedule,100% of CMS fee schedule,15.2,450,
FLECAINIDE LEVEL,300008248,CDM,301,RC,80299,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
FLUPHENAZINE LEVEL,300008249,CDM,301,RC,G0480,HCPCS,outpatient,,,268,187.6,,211.72,79,,169.38,percent of total billed charges,79% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,206.95,77.22,,165.56,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,222.44,83,,177.95,percent of total billed charges,83% of total,254.6,95,,203.68,percent of total billed charges ,95% of total billed charges,214.4,80,,171.52,percent of total billed charges,78% of total billed charges,209.04,78,,167.232,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,211.72,79,,169.38,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
"FRUCTOSE,SEMEN",300008250,CDM,301,RC,82757,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,17.34,100,,,fee schedule,100% of CMS fee schedule,27.74,160,,,fee schedule,160% of CMS fee schedule,22.54,130,,,fee schedule,130% of CMS fee schedule,21.82,100,,,fee schedule,100% of GA fee schedule,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,22.91,105,,,fee schedule,105% of GA fee schedule,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,17.34,100,,,fee schedule,100% of CMS fee schedule,21.82,100,,,fee schedule,100% of GA fee schedule,17.34,100,,,fee schedule,100% of CMS 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,21.82,100,,,fee schedule,100% of GA fee schedule,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.13,93,,,fee schedule,93% of CMS fee schedule,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,17.34,100,,,fee schedule,100% of CMS fee schedule,17.34,100,,,fee schedule,100% of CMS fee schedule,16.13,450,
GABAPENTIN (NEUTRONTIN),300008251,CDM,301,RC,80171,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,34.67,160,,,fee schedule,160% of CMS fee schedule,28.17,130,,,fee schedule,130% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,15.19,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,21.67,100,,,fee schedule,100% of CMS 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,14.47,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.15,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,21.67,100,,,fee schedule,100% of CMS fee schedule,21.67,100,,,fee schedule,100% of CMS fee schedule,14.47,450,
HEMOSIDERIN URINE,300008255,CDM,301,RC,83070,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,7.6,160,,,fee schedule,160% of CMS fee schedule,6.18,130,,,fee schedule,130% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,6.28,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,4.75,100,,,fee schedule,100% of CMS 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,5.98,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,4.75,100,,,fee schedule,100% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,4.42,450,
HEMOGLOBIN A2,300008256,CDM,301,RC,83021,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,18.06,100,,,fee schedule,100% of CMS fee schedule,28.9,160,,,fee schedule,160% of CMS fee schedule,23.48,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,18.06,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,18.06,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.8,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,18.06,100,,,fee schedule,100% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
"HEMOGLOBIN,PLASMA",300008257,CDM,301,RC,83051,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,7.31,100,,,fee schedule,100% of CMS fee schedule,11.7,160,,,fee schedule,160% of CMS fee schedule,9.5,130,,,fee schedule,130% of CMS fee schedule,9.19,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,9.65,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,7.31,100,,,fee schedule,100% of CMS fee schedule,9.19,100,,,fee schedule,100% of GA fee schedule,7.31,100,,,fee schedule,100% of CMS 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,9.19,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.8,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,7.31,100,,,fee schedule,100% of CMS fee schedule,7.31,100,,,fee schedule,100% of CMS fee schedule,6.8,450,
HISTAMINE URINE OR BLOOD,300008259,CDM,301,RC,83088,HCPCS,outpatient,,,522,365.4,,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,29.53,100,,,fee schedule,100% of CMS fee schedule,47.25,160,,,fee schedule,160% of CMS fee schedule,38.39,130,,,fee schedule,130% of CMS fee schedule,37.13,100,,,fee schedule,100% of GA fee schedule,403.09,77.22,,322.47,percent of total billed charges,77.22% of total billed charges,38.99,105,,,fee schedule,105% of GA fee schedule,433.26,83,,346.61,percent of total billed charges,83% of total,495.9,95,,396.72,percent of total billed charges ,95% of total billed charges,417.6,80,,334.08,percent of total billed charges,78% of total billed charges,407.16,78,,325.728,percent of total billed charges,78% of total billed charges,29.53,100,,,fee schedule,100% of CMS fee schedule,37.13,100,,,fee schedule,100% of GA fee schedule,29.53,100,,,fee schedule,100% of CMS 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,37.13,100,,,fee schedule,100% of GA fee schedule,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.46,93,,,fee schedule,93% of CMS fee schedule,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,29.53,100,,,fee schedule,100% of CMS fee schedule,29.53,100,,,fee schedule,100% of CMS fee schedule,27.46,495.9,
LAMOTRIGINE (LAMICTAL) LEVEL,300008261,CDM,301,RC,80175,HCPCS,outpatient,,,41,28.7,,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,36.9,90,,29.52,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,31.66,77.22,,25.33,percent of total billed charges,77.22% of total billed charges,15.19,105,,,fee schedule,105% of GA fee schedule,34.03,83,,27.22,percent of total billed charges,83% of total,38.95,95,,31.16,percent of total billed charges ,95% of total billed charges,32.8,80,,26.24,percent of total billed charges,78% of total billed charges,31.98,78,,25.584,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS 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,14.47,100,,,fee schedule,100% of GA fee schedule,34.85,85,,27.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,32.39,79,,25.91,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
LEUCINE AMINOPEPTIDASE,300008263,CDM,301,RC,83670,HCPCS,outpatient,,,171,119.7,,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,153.9,90,,123.12,percent of total billed charges,90% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,15.7,160,,,fee schedule,160% of CMS fee schedule,12.75,130,,,fee schedule,130% of CMS fee schedule,11.52,100,,,fee schedule,100% of GA fee schedule,132.05,77.22,,105.64,percent of total billed charges,77.22% of total billed charges,12.1,105,,,fee schedule,105% of GA fee schedule,141.93,83,,113.54,percent of total billed charges,83% of total,162.45,95,,129.96,percent of total billed charges ,95% of total billed charges,136.8,80,,109.44,percent of total billed charges,78% of total billed charges,133.38,78,,106.704,percent of total billed charges,78% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,11.52,100,,,fee schedule,100% of GA fee schedule,9.81,100,,,fee schedule,100% of CMS 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,11.52,100,,,fee schedule,100% of GA fee schedule,145.35,85,,116.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.12,93,,,fee schedule,93% of CMS fee schedule,135.09,79,,108.07,percent of total billed charges,79% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,9.81,100,,,fee schedule,100% of CMS fee schedule,9.12,450,
LIDOCAINE LEVEL,300008264,CDM,301,RC,80176,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,14.69,100,,,fee schedule,100% of CMS fee schedule,23.5,160,,,fee schedule,160% of CMS fee schedule,19.1,130,,,fee schedule,130% of CMS fee schedule,18.47,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,19.39,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,14.69,100,,,fee schedule,100% of CMS fee schedule,18.47,100,,,fee schedule,100% of GA fee schedule,14.69,100,,,fee schedule,100% of CMS 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,18.47,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.66,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,14.69,100,,,fee schedule,100% of CMS fee schedule,14.69,100,,,fee schedule,100% of CMS fee schedule,13.66,450,
MAPROTILINE (LUDIOMIL) LEVEL,300008265,CDM,301,RC,80335,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,23.64,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.51,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.51,450,
METHSUXIMIDE (CELONTIN) LEVEL,300008266,CDM,301,RC,G0480,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,94.12,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,83.4,450,
MEPERIDIME (DEMEROL) LEVEL,300008269,CDM,301,RC,G0480,HCPCS,outpatient,,,201,140.7,,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,155.21,77.22,,124.17,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,166.83,83,,133.46,percent of total billed charges,83% of total,190.95,95,,152.76,percent of total billed charges ,95% of total billed charges,160.8,80,,128.64,percent of total billed charges,78% of total billed charges,156.78,78,,125.424,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
MEPROBAMATE LEVEL,300008270,CDM,301,RC,G0480,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,70.27,450,
MERCURY (BLOOD),300008271,CDM,301,RC,83825,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,26.02,160,,,fee schedule,160% of CMS fee schedule,21.14,130,,,fee schedule,130% of CMS fee schedule,20.45,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,21.47,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,20.45,100,,,fee schedule,100% of GA fee schedule,16.26,100,,,fee schedule,100% of CMS 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,20.45,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.12,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,16.26,100,,,fee schedule,100% of CMS fee schedule,16.26,100,,,fee schedule,100% of CMS fee schedule,15.12,450,
METHEMOGLOBIN,300008272,CDM,301,RC,83050,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,8.2,100,,,fee schedule,100% of CMS fee schedule,13.12,160,,,fee schedule,160% of CMS fee schedule,10.66,130,,,fee schedule,130% of CMS fee schedule,9.21,100,,,fee schedule,100% of GA fee schedule,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,9.67,105,,,fee schedule,105% of GA fee schedule,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,8.2,100,,,fee schedule,100% of CMS fee schedule,9.21,100,,,fee schedule,100% of GA fee schedule,8.2,100,,,fee schedule,100% of CMS 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,9.21,100,,,fee schedule,100% of GA fee schedule,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.63,93,,,fee schedule,93% of CMS fee schedule,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,8.2,100,,,fee schedule,100% of CMS fee schedule,8.2,100,,,fee schedule,100% of CMS fee schedule,7.63,450,
METHOTREXATE LEVEL,300008273,CDM,301,RC,83520,HCPCS,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
MEXILETINE LEVEL,300008274,CDM,301,RC,80299,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
METHYLMALONIC ACID,300008275,CDM,301,RC,82131,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,36.77,160,,,fee schedule,160% of CMS fee schedule,29.87,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,22.98,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.37,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,450,
MEPHABARBITAL (MEBARAL) LEVEL,300008276,CDM,301,RC,80345,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.41,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,15.13,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.41,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,14.41,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.41,450,
MYOGLOBIN URINE,300008279,CDM,301,RC,83874,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,20.67,160,,,fee schedule,160% of CMS fee schedule,16.8,130,,,fee schedule,130% of CMS fee schedule,16.24,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,17.05,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,16.24,100,,,fee schedule,100% of GA fee schedule,12.92,100,,,fee schedule,100% of CMS 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,16.24,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.02,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,12.92,100,,,fee schedule,100% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,12.02,450,
NICOTINE URINE OR BLOOD,300008280,CDM,301,RC,80307,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,32.43,450,
NORTRIPTYLINE (AVENTYL) LEVEL,300008281,CDM,301,RC,G0480,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,77.99,450,
OLIGOCLONAL BANDS CSF,300008282,CDM,301,RC,83916,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,43.82,160,,,fee schedule,160% of CMS fee schedule,35.61,130,,,fee schedule,130% of CMS fee schedule,25.28,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,26.54,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,25.28,100,,,fee schedule,100% of GA fee schedule,27.39,100,,,fee schedule,100% of CMS 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,25.28,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.47,93,,,fee schedule,93% of CMS fee schedule,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,27.39,100,,,fee schedule,100% of CMS fee schedule,27.39,100,,,fee schedule,100% of CMS fee schedule,25.28,450,
PROC/NAPA PROFILE,300008284,CDM,301,RC,80192,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,16.75,100,,,fee schedule,100% of CMS fee schedule,26.8,160,,,fee schedule,160% of CMS fee schedule,21.78,130,,,fee schedule,130% of CMS fee schedule,21.07,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,22.12,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,16.75,100,,,fee schedule,100% of CMS fee schedule,21.07,100,,,fee schedule,100% of GA fee schedule,16.75,100,,,fee schedule,100% of CMS 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,21.07,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.58,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,16.75,100,,,fee schedule,100% of CMS fee schedule,16.75,100,,,fee schedule,100% of CMS fee schedule,15.58,450,
FLUPHENAZINE LEVEL,300008286,CDM,301,RC,84022,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
SELENIUM LEVEL,300008289,CDM,301,RC,84255,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,25.53,100,,,fee schedule,100% of CMS fee schedule,40.85,160,,,fee schedule,160% of CMS fee schedule,33.19,130,,,fee schedule,130% of CMS fee schedule,32.1,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,33.71,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,25.53,100,,,fee schedule,100% of CMS fee schedule,32.1,100,,,fee schedule,100% of GA fee schedule,25.53,100,,,fee schedule,100% of CMS 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,32.1,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.74,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,25.53,100,,,fee schedule,100% of CMS fee schedule,25.53,100,,,fee schedule,100% of CMS fee schedule,23.74,450,
SEX HORMONE BINDING GLOBULIN,300008290,CDM,301,RC,84270,HCPCS,outpatient,,,257,179.9,,203.03,79,,162.42,percent of total billed charges,79% of total billed charges,231.3,90,,185.04,percent of total billed charges,90% of total billed charges,21.73,100,,,fee schedule,100% of CMS fee schedule,34.77,160,,,fee schedule,160% of CMS fee schedule,28.25,130,,,fee schedule,130% of CMS fee schedule,27.32,100,,,fee schedule,100% of GA fee schedule,198.46,77.22,,158.77,percent of total billed charges,77.22% of total billed charges,28.69,105,,,fee schedule,105% of GA fee schedule,213.31,83,,170.65,percent of total billed charges,83% of total,244.15,95,,195.32,percent of total billed charges ,95% of total billed charges,205.6,80,,164.48,percent of total billed charges,78% of total billed charges,200.46,78,,160.368,percent of total billed charges,78% of total billed charges,21.73,100,,,fee schedule,100% of CMS fee schedule,27.32,100,,,fee schedule,100% of GA fee schedule,21.73,100,,,fee schedule,100% of CMS 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,27.32,100,,,fee schedule,100% of GA fee schedule,218.45,85,,174.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.21,93,,,fee schedule,93% of CMS fee schedule,203.03,79,,162.42,percent of total billed charges,79% of total billed charges,21.73,100,,,fee schedule,100% of CMS fee schedule,21.73,100,,,fee schedule,100% of CMS fee schedule,20.21,450,
THYROXIN BINDING GLOBULIN,300008292,CDM,301,RC,84442,HCPCS,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,23.65,160,,,fee schedule,160% of CMS fee schedule,19.21,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.78,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.75,93,,,fee schedule,93% of CMS fee schedule,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,13.75,450,
"TESTOSTERONE,FREE",300008293,CDM,301,RC,84402,HCPCS,outpatient,,,165,115.5,,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,25.47,100,,,fee schedule,100% of CMS fee schedule,40.75,160,,,fee schedule,160% of CMS fee schedule,33.11,130,,,fee schedule,130% of CMS fee schedule,32.01,100,,,fee schedule,100% of GA fee schedule,127.41,77.22,,101.93,percent of total billed charges,77.22% of total billed charges,33.61,105,,,fee schedule,105% of GA fee schedule,136.95,83,,109.56,percent of total billed charges,83% of total,156.75,95,,125.4,percent of total billed charges ,95% of total billed charges,132,80,,105.6,percent of total billed charges,78% of total billed charges,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,25.47,100,,,fee schedule,100% of CMS fee schedule,32.01,100,,,fee schedule,100% of GA fee schedule,25.47,100,,,fee schedule,100% of CMS 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,32.01,100,,,fee schedule,100% of GA fee schedule,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.69,93,,,fee schedule,93% of CMS fee schedule,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,25.47,100,,,fee schedule,100% of CMS fee schedule,25.47,100,,,fee schedule,100% of CMS fee schedule,23.69,450,
THIORIDAZINE (MELLARIL) LEVEL,300008295,CDM,301,RC,80342,HCPCS,outpatient,,,268,187.6,,211.72,79,,169.38,percent of total billed charges,79% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.58,100,,,fee schedule,100% of GA fee schedule,206.95,77.22,,165.56,percent of total billed charges,77.22% of total billed charges,20.56,105,,,fee schedule,105% of GA fee schedule,222.44,83,,177.95,percent of total billed charges,83% of total,254.6,95,,203.68,percent of total billed charges ,95% of total billed charges,214.4,80,,171.52,percent of total billed charges,78% of total billed charges,209.04,78,,167.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.58,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,19.58,100,,,fee schedule,100% of GA fee schedule,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,211.72,79,,169.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.58,450,
THIOCYANATE LEVEL,300008296,CDM,301,RC,84430,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,11.63,100,,,fee schedule,100% of CMS fee schedule,18.61,160,,,fee schedule,160% of CMS fee schedule,15.12,130,,,fee schedule,130% of CMS fee schedule,7.25,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,7.61,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,11.63,100,,,fee schedule,100% of CMS fee schedule,7.25,100,,,fee schedule,100% of GA fee schedule,11.63,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,7.25,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.82,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,11.63,100,,,fee schedule,100% of CMS fee schedule,11.63,100,,,fee schedule,100% of CMS fee schedule,7.25,450,
TOCAINIDE LEVEL,300008298,CDM,301,RC,G0480,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,88.03,450,
TRAZODONE LEVEL,300008301,CDM,301,RC,G0480,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,91.89,450,
VITAMIN D 25-HYDROXY,300008302,CDM,301,RC,82306,HCPCS,outpatient,,,221,154.7,,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,47.36,160,,,fee schedule,160% of CMS fee schedule,38.48,130,,,fee schedule,130% of CMS fee schedule,37.22,100,,,fee schedule,100% of GA fee schedule,170.66,77.22,,136.53,percent of total billed charges,77.22% of total billed charges,39.08,105,,,fee schedule,105% of GA fee schedule,183.43,83,,146.74,percent of total billed charges,83% of total,209.95,95,,167.96,percent of total billed charges ,95% of total billed charges,176.8,80,,141.44,percent of total billed charges,78% of total billed charges,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,37.22,100,,,fee schedule,100% of GA fee schedule,29.6,100,,,fee schedule,100% of CMS 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,37.22,100,,,fee schedule,100% of GA fee schedule,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.53,93,,,fee schedule,93% of CMS fee schedule,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,27.53,450,
VASOINTESTIONAL POLYPEPTIDE,300008303,CDM,301,RC,84586,HCPCS,outpatient,,,287,200.9,,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,56.53,160,,,fee schedule,160% of CMS fee schedule,45.93,130,,,fee schedule,130% of CMS fee schedule,44.43,100,,,fee schedule,100% of GA fee schedule,221.62,77.22,,177.3,percent of total billed charges,77.22% of total billed charges,46.65,105,,,fee schedule,105% of GA fee schedule,238.21,83,,190.57,percent of total billed charges,83% of total,272.65,95,,218.12,percent of total billed charges ,95% of total billed charges,229.6,80,,183.68,percent of total billed charges,78% of total billed charges,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,44.43,100,,,fee schedule,100% of GA fee schedule,35.33,100,,,fee schedule,100% of CMS 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,44.43,100,,,fee schedule,100% of GA fee schedule,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.86,93,,,fee schedule,93% of CMS fee schedule,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,35.33,100,,,fee schedule,100% of CMS fee schedule,32.86,450,
VITAMIN A LEVEL,300008304,CDM,301,RC,84590,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,18.58,160,,,fee schedule,160% of CMS fee schedule,15.09,130,,,fee schedule,130% of CMS fee schedule,14.58,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,15.31,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,14.58,100,,,fee schedule,100% of GA fee schedule,11.61,100,,,fee schedule,100% of CMS 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,14.58,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.8,93,,,fee schedule,93% of CMS fee schedule,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,10.8,450,
VITAMIN B1 LEVEL,300008305,CDM,301,RC,84425,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,21.23,100,,,fee schedule,100% of CMS fee schedule,33.97,160,,,fee schedule,160% of CMS fee schedule,27.6,130,,,fee schedule,130% of CMS fee schedule,26.7,100,,,fee schedule,100% of GA fee schedule,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,28.04,105,,,fee schedule,105% of GA fee schedule,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,21.23,100,,,fee schedule,100% of CMS fee schedule,26.7,100,,,fee schedule,100% of GA fee schedule,21.23,100,,,fee schedule,100% of CMS 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,26.7,100,,,fee schedule,100% of GA fee schedule,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.74,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,21.23,100,,,fee schedule,100% of CMS fee schedule,21.23,100,,,fee schedule,100% of CMS fee schedule,19.74,450,
VITAMIN B6 LEVEL,300008306,CDM,301,RC,84207,HCPCS,outpatient,,,242,169.4,,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,28.1,100,,,fee schedule,100% of CMS fee schedule,44.96,160,,,fee schedule,160% of CMS fee schedule,36.53,130,,,fee schedule,130% of CMS fee schedule,35.33,100,,,fee schedule,100% of GA fee schedule,186.87,77.22,,149.5,percent of total billed charges,77.22% of total billed charges,37.1,105,,,fee schedule,105% of GA fee schedule,200.86,83,,160.69,percent of total billed charges,83% of total,229.9,95,,183.92,percent of total billed charges ,95% of total billed charges,193.6,80,,154.88,percent of total billed charges,78% of total billed charges,188.76,78,,151.008,percent of total billed charges,78% of total billed charges,28.1,100,,,fee schedule,100% of CMS fee schedule,35.33,100,,,fee schedule,100% of GA fee schedule,28.1,100,,,fee schedule,100% of CMS 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,35.33,100,,,fee schedule,100% of GA fee schedule,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,26.13,93,,,fee schedule,93% of CMS fee schedule,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,28.1,100,,,fee schedule,100% of CMS fee schedule,28.1,100,,,fee schedule,100% of CMS fee schedule,26.13,450,
VITAMIN C,300008307,CDM,301,RC,82180,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,9.89,100,,,fee schedule,100% of CMS fee schedule,15.82,160,,,fee schedule,160% of CMS fee schedule,12.86,130,,,fee schedule,130% of CMS fee schedule,11.11,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,11.67,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,9.89,100,,,fee schedule,100% of CMS fee schedule,11.11,100,,,fee schedule,100% of GA fee schedule,9.89,100,,,fee schedule,100% of CMS 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,11.11,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.2,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,9.89,100,,,fee schedule,100% of CMS fee schedule,9.89,100,,,fee schedule,100% of CMS fee schedule,9.2,450,
ALPHA-1-ANTITRYPSIN,300008309,CDM,301,RC,82103,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,21.5,160,,,fee schedule,160% of CMS fee schedule,17.47,130,,,fee schedule,130% of CMS fee schedule,16.89,100,,,fee schedule,100% of GA fee schedule,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,17.73,105,,,fee schedule,105% of GA fee schedule,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,16.89,100,,,fee schedule,100% of GA fee schedule,13.44,100,,,fee schedule,100% of CMS 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,16.89,100,,,fee schedule,100% of GA fee schedule,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.5,93,,,fee schedule,93% of CMS fee schedule,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,13.44,100,,,fee schedule,100% of CMS fee schedule,12.5,450,
ALPHA-1-ANTITRYPSIN PHENOTYPE,300008310,CDM,301,RC,82104,HCPCS,outpatient,,,199,139.3,,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,14.46,100,,,fee schedule,100% of CMS fee schedule,23.14,160,,,fee schedule,160% of CMS fee schedule,18.8,130,,,fee schedule,130% of CMS fee schedule,18.18,100,,,fee schedule,100% of GA fee schedule,153.67,77.22,,122.94,percent of total billed charges,77.22% of total billed charges,19.09,105,,,fee schedule,105% of GA fee schedule,165.17,83,,132.14,percent of total billed charges,83% of total,189.05,95,,151.24,percent of total billed charges ,95% of total billed charges,159.2,80,,127.36,percent of total billed charges,78% of total billed charges,155.22,78,,124.176,percent of total billed charges,78% of total billed charges,14.46,100,,,fee schedule,100% of CMS fee schedule,18.18,100,,,fee schedule,100% of GA fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,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,18.18,100,,,fee schedule,100% of GA fee schedule,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.45,93,,,fee schedule,93% of CMS fee schedule,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,14.46,100,,,fee schedule,100% of CMS fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,13.45,450,
AMINO ACID SCREEN UR OR PLASMA,300008311,CDM,301,RC,82128,HCPCS,outpatient,,,416,291.2,,328.64,79,,262.91,percent of total billed charges,79% of total billed charges,374.4,90,,299.52,percent of total billed charges,90% of total billed charges,13.87,100,,,fee schedule,100% of CMS fee schedule,22.19,160,,,fee schedule,160% of CMS fee schedule,18.03,130,,,fee schedule,130% of CMS fee schedule,17.43,100,,,fee schedule,100% of GA fee schedule,321.24,77.22,,256.99,percent of total billed charges,77.22% of total billed charges,18.3,105,,,fee schedule,105% of GA fee schedule,345.28,83,,276.22,percent of total billed charges,83% of total,395.2,95,,316.16,percent of total billed charges ,95% of total billed charges,332.8,80,,266.24,percent of total billed charges,78% of total billed charges,324.48,78,,259.584,percent of total billed charges,78% of total billed charges,13.87,100,,,fee schedule,100% of CMS fee schedule,17.43,100,,,fee schedule,100% of GA fee schedule,13.87,100,,,fee schedule,100% of CMS fee schedule,374.4,90,,299.52,percent of total billed charges,90% of total billed charges,332.8,80,,266.24,percent of total billed charges,80% of total billed charges,17.43,100,,,fee schedule,100% of GA fee schedule,353.6,85,,282.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.9,93,,,fee schedule,93% of CMS fee schedule,328.64,79,,262.91,percent of total billed charges,79% of total billed charges,13.87,100,,,fee schedule,100% of CMS fee schedule,13.87,100,,,fee schedule,100% of CMS fee schedule,12.9,450,
APOLIPOPROTEIN A-1,300008312,CDM,301,RC,82172,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,33.74,160,,,fee schedule,160% of CMS fee schedule,27.42,130,,,fee schedule,130% of CMS fee schedule,19.49,100,,,fee schedule,100% of GA fee schedule,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,20.46,105,,,fee schedule,105% of GA fee schedule,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,19.49,100,,,fee schedule,100% of GA fee schedule,21.09,100,,,fee schedule,100% of CMS 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,19.49,100,,,fee schedule,100% of GA fee schedule,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.61,93,,,fee schedule,93% of CMS fee schedule,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,19.49,450,
"CORTISOL,24 HOUR URINE",300008315,CDM,301,RC,82530,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,26.74,160,,,fee schedule,160% of CMS fee schedule,21.72,130,,,fee schedule,130% of CMS fee schedule,21.02,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,22.07,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,21.02,100,,,fee schedule,100% of GA fee schedule,16.71,100,,,fee schedule,100% of CMS 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,21.02,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.54,93,,,fee schedule,93% of CMS fee schedule,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,16.71,100,,,fee schedule,100% of CMS fee schedule,15.54,450,
AMPHETAMINES,300008317,CDM,301,RC,G0480,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,36.29,450,
COCAINE METABOLITE,300008318,CDM,301,RC,G0480,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,36.29,450,
OPIATE SCREEN,300008319,CDM,301,RC,G0480,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,36.29,450,
PHENCYCLIDINE,300008320,CDM,301,RC,G0480,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,36.29,450,
CANNABINOIDS,300008321,CDM,301,RC,G0480,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,36.29,450,
ANTI-ENDOMYSICAL ANTIBODY,300008322,CDM,301,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
CREATINE (FETAL LUNG),300008332,CDM,301,RC,82565,HCPCS,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,8.19,160,,,fee schedule,160% of CMS fee schedule,6.66,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.12,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.76,93,,,fee schedule,93% of CMS fee schedule,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,4.76,450,
L/S RATIO,300008333,CDM,301,RC,83661,HCPCS,outpatient,,,290,203,,229.1,79,,183.28,percent of total billed charges,79% of total billed charges,261,90,,208.8,percent of total billed charges,90% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,35.18,160,,,fee schedule,160% of CMS fee schedule,28.59,130,,,fee schedule,130% of CMS fee schedule,27.64,100,,,fee schedule,100% of GA fee schedule,223.94,77.22,,179.15,percent of total billed charges,77.22% of total billed charges,29.02,105,,,fee schedule,105% of GA fee schedule,240.7,83,,192.56,percent of total billed charges,83% of total,275.5,95,,220.4,percent of total billed charges ,95% of total billed charges,232,80,,185.6,percent of total billed charges,78% of total billed charges,226.2,78,,180.96,percent of total billed charges,78% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,27.64,100,,,fee schedule,100% of GA fee schedule,21.99,100,,,fee schedule,100% of CMS 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,27.64,100,,,fee schedule,100% of GA fee schedule,246.5,85,,197.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.45,93,,,fee schedule,93% of CMS fee schedule,229.1,79,,183.28,percent of total billed charges,79% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,20.45,450,
PHOSHPATIDYLGLYCECOL,300008334,CDM,301,RC,84081,HCPCS,outpatient,,,237,165.9,,187.23,79,,149.78,percent of total billed charges,79% of total billed charges,213.3,90,,170.64,percent of total billed charges,90% of total billed charges,16.52,100,,,fee schedule,100% of CMS fee schedule,26.43,160,,,fee schedule,160% of CMS fee schedule,21.48,130,,,fee schedule,130% of CMS fee schedule,20.78,100,,,fee schedule,100% of GA fee schedule,183.01,77.22,,146.41,percent of total billed charges,77.22% of total billed charges,21.82,105,,,fee schedule,105% of GA fee schedule,196.71,83,,157.37,percent of total billed charges,83% of total,225.15,95,,180.12,percent of total billed charges ,95% of total billed charges,189.6,80,,151.68,percent of total billed charges,78% of total billed charges,184.86,78,,147.888,percent of total billed charges,78% of total billed charges,16.52,100,,,fee schedule,100% of CMS fee schedule,20.78,100,,,fee schedule,100% of GA fee schedule,16.52,100,,,fee schedule,100% of CMS 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,20.78,100,,,fee schedule,100% of GA fee schedule,201.45,85,,161.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.36,93,,,fee schedule,93% of CMS fee schedule,187.23,79,,149.78,percent of total billed charges,79% of total billed charges,16.52,100,,,fee schedule,100% of CMS fee schedule,16.52,100,,,fee schedule,100% of CMS fee schedule,15.36,450,
GLIADIN ANTIBODIES IGG & IGA,300008339,CDM,301,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
STOOL REDUCING SUBSTANCES,300008352,CDM,301,RC,84376,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,5.5,100,,,fee schedule,100% of CMS fee schedule,8.8,160,,,fee schedule,160% of CMS fee schedule,7.15,130,,,fee schedule,130% of CMS fee schedule,6.92,100,,,fee schedule,100% of GA fee schedule,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,7.27,105,,,fee schedule,105% of GA fee schedule,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,5.5,100,,,fee schedule,100% of CMS fee schedule,6.92,100,,,fee schedule,100% of GA fee schedule,5.5,100,,,fee schedule,100% of CMS 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,6.92,100,,,fee schedule,100% of GA fee schedule,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.12,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,5.5,100,,,fee schedule,100% of CMS fee schedule,5.5,100,,,fee schedule,100% of CMS fee schedule,5.12,450,
SPECIFIC GRAVITY BODY FLUID,300008357,CDM,301,RC,84315,HCPCS,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,5.25,160,,,fee schedule,160% of CMS fee schedule,4.26,130,,,fee schedule,130% of CMS fee schedule,3.15,100,,,fee schedule,100% of GA fee schedule,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,3.31,105,,,fee schedule,105% of GA fee schedule,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,3.15,100,,,fee schedule,100% of GA fee schedule,3.28,100,,,fee schedule,100% of CMS 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,3.15,100,,,fee schedule,100% of GA fee schedule,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.05,93,,,fee schedule,93% of CMS fee schedule,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.05,450,
ALUMINUM LEVEL,300008358,CDM,301,RC,82108,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,25.48,100,,,fee schedule,100% of CMS fee schedule,40.77,160,,,fee schedule,160% of CMS fee schedule,33.12,130,,,fee schedule,130% of CMS fee schedule,21.2,100,,,fee schedule,100% of GA fee schedule,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,22.26,105,,,fee schedule,105% of GA fee schedule,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,25.48,100,,,fee schedule,100% of CMS fee schedule,21.2,100,,,fee schedule,100% of GA fee schedule,25.48,100,,,fee schedule,100% of CMS 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,21.2,100,,,fee schedule,100% of GA fee schedule,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.7,93,,,fee schedule,93% of CMS fee schedule,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,25.48,100,,,fee schedule,100% of CMS fee schedule,25.48,100,,,fee schedule,100% of CMS fee schedule,21.2,450,
TRANSGLUTAMINASE,300008369,CDM,301,RC,86364,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,9.68,105,,,fee schedule,105% of GA fee schedule,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,9.22,100,,,fee schedule,100% of GA fee schedule,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,9.22,450,
ANTI-THYROTROPIN,300008381,CDM,301,RC,83519,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,16.99,100,,,fee schedule,100% of GA fee schedule,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
IMMUNOGLOBULIN SUBCLASSES IGG,300008387,CDM,301,RC,82787,HCPCS,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,12.83,160,,,fee schedule,160% of CMS fee schedule,10.43,130,,,fee schedule,130% of CMS fee schedule,10.08,100,,,fee schedule,100% of GA fee schedule,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,10.58,105,,,fee schedule,105% of GA fee schedule,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,10.08,100,,,fee schedule,100% of GA fee schedule,8.02,100,,,fee schedule,100% of CMS 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,10.08,100,,,fee schedule,100% of GA fee schedule,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.46,93,,,fee schedule,93% of CMS fee schedule,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,8.02,100,,,fee schedule,100% of CMS fee schedule,7.46,450,
ORGANIC ACID URINE OR PLASMA,300008392,CDM,301,RC,83918,HCPCS,outpatient,,,645,451.5,,509.55,79,,407.64,percent of total billed charges,79% of total billed charges,580.5,90,,464.4,percent of total billed charges,90% of total billed charges,23.6,100,,,fee schedule,100% of CMS fee schedule,37.76,160,,,fee schedule,160% of CMS fee schedule,30.68,130,,,fee schedule,130% of CMS fee schedule,20.7,100,,,fee schedule,100% of GA fee schedule,498.07,77.22,,398.46,percent of total billed charges,77.22% of total billed charges,21.74,105,,,fee schedule,105% of GA fee schedule,535.35,83,,428.28,percent of total billed charges,83% of total,612.75,95,,490.2,percent of total billed charges ,95% of total billed charges,516,80,,412.8,percent of total billed charges,78% of total billed charges,503.1,78,,402.48,percent of total billed charges,78% of total billed charges,23.6,100,,,fee schedule,100% of CMS fee schedule,20.7,100,,,fee schedule,100% of GA fee schedule,23.6,100,,,fee schedule,100% of CMS fee schedule,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,20.7,100,,,fee schedule,100% of GA fee schedule,548.25,85,,438.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.95,93,,,fee schedule,93% of CMS fee schedule,509.55,79,,407.64,percent of total billed charges,79% of total billed charges,23.6,100,,,fee schedule,100% of CMS fee schedule,23.6,100,,,fee schedule,100% of CMS fee schedule,20.7,612.75,
IBUPROFEN LEVEL,300008393,CDM,301,RC,G0480,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,26.25,450,
MACRO AMYLASE,300008394,CDM,301,RC,82150,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,10.37,160,,,fee schedule,160% of CMS fee schedule,8.42,130,,,fee schedule,130% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,8.56,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,8.15,100,,,fee schedule,100% of GA fee schedule,6.48,100,,,fee schedule,100% of CMS 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,8.15,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.03,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,6.48,100,,,fee schedule,100% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,6.03,450,
PHENOLPHTHALEIN,300008395,CDM,301,RC,84311,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,12.96,160,,,fee schedule,160% of CMS fee schedule,10.53,130,,,fee schedule,130% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,9.23,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,8.1,100,,,fee schedule,100% of CMS 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,8.79,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.53,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,8.1,100,,,fee schedule,100% of CMS fee schedule,7.53,450,
RENAL FUNCTION PANEL,300008400,CDM,301,RC,80069,HCPCS,outpatient,,,313,219.1,,247.27,79,,197.82,percent of total billed charges,79% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,8.68,100,,,fee schedule,100% of CMS fee schedule,13.89,160,,,fee schedule,160% of CMS fee schedule,11.28,130,,,fee schedule,130% of CMS fee schedule,10.92,100,,,fee schedule,100% of GA fee schedule,241.7,77.22,,193.36,percent of total billed charges,77.22% of total billed charges,11.47,105,,,fee schedule,105% of GA fee schedule,259.79,83,,207.83,percent of total billed charges,83% of total,297.35,95,,237.88,percent of total billed charges ,95% of total billed charges,250.4,80,,200.32,percent of total billed charges,78% of total billed charges,244.14,78,,195.312,percent of total billed charges,78% of total billed charges,8.68,100,,,fee schedule,100% of CMS fee schedule,10.92,100,,,fee schedule,100% of GA fee schedule,8.68,100,,,fee schedule,100% of CMS 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,10.92,100,,,fee schedule,100% of GA fee schedule,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.07,93,,,fee schedule,93% of CMS fee schedule,247.27,79,,197.82,percent of total billed charges,79% of total billed charges,8.68,100,,,fee schedule,100% of CMS fee schedule,8.68,100,,,fee schedule,100% of CMS fee schedule,8.07,450,
CALCITONIN,300008405,CDM,301,RC,82308,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,26.79,100,,,fee schedule,100% of CMS fee schedule,42.86,160,,,fee schedule,160% of CMS fee schedule,34.83,130,,,fee schedule,130% of CMS fee schedule,33.67,100,,,fee schedule,100% of GA fee schedule,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,35.35,105,,,fee schedule,105% of GA fee schedule,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,26.79,100,,,fee schedule,100% of CMS fee schedule,33.67,100,,,fee schedule,100% of GA fee schedule,26.79,100,,,fee schedule,100% of CMS 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,33.67,100,,,fee schedule,100% of GA fee schedule,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.91,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,26.79,100,,,fee schedule,100% of CMS fee schedule,26.79,100,,,fee schedule,100% of CMS fee schedule,24.91,450,
REVERSE T3,300008406,CDM,301,RC,84482,HCPCS,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,15.76,100,,,fee schedule,100% of CMS fee schedule,25.22,160,,,fee schedule,160% of CMS fee schedule,20.49,130,,,fee schedule,130% of CMS fee schedule,19.82,100,,,fee schedule,100% of GA fee schedule,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,20.81,105,,,fee schedule,105% of GA fee schedule,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,15.76,100,,,fee schedule,100% of CMS fee schedule,19.82,100,,,fee schedule,100% of GA fee schedule,15.76,100,,,fee schedule,100% of CMS 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,19.82,100,,,fee schedule,100% of GA fee schedule,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.66,93,,,fee schedule,93% of CMS fee schedule,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,15.76,100,,,fee schedule,100% of CMS fee schedule,15.76,100,,,fee schedule,100% of CMS fee schedule,14.66,450,
DIURETIC PANEL,300008415,CDM,301,RC,82542,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,38.54,160,,,fee schedule,160% of CMS fee schedule,31.32,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.09,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.4,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
OXALATE SERUM,300008416,CDM,301,RC,83945,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,23.12,160,,,fee schedule,160% of CMS fee schedule,18.79,130,,,fee schedule,130% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,17,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,14.45,100,,,fee schedule,100% of CMS 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,16.19,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.44,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,14.45,100,,,fee schedule,100% of CMS fee schedule,13.44,450,
ADH (ANTIDUIRETIC HORMONE),300008420,CDM,301,RC,84588,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,54.3,160,,,fee schedule,160% of CMS fee schedule,44.12,130,,,fee schedule,130% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,44.82,105,,,fee schedule,105% of GA fee schedule,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,33.94,100,,,fee schedule,100% of CMS 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,42.69,100,,,fee schedule,100% of GA fee schedule,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.56,93,,,fee schedule,93% of CMS fee schedule,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,33.94,100,,,fee schedule,100% of CMS fee schedule,33.94,100,,,fee schedule,100% of CMS fee schedule,31.56,450,
PROPAFENONE,300008421,CDM,301,RC,80299,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
HYDROXYPROLINE-URINE,300008423,CDM,301,RC,83505,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,24.3,100,,,fee schedule,100% of CMS fee schedule,38.88,160,,,fee schedule,160% of CMS fee schedule,31.59,130,,,fee schedule,130% of CMS fee schedule,30.56,100,,,fee schedule,100% of GA fee schedule,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,32.09,105,,,fee schedule,105% of GA fee schedule,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,24.3,100,,,fee schedule,100% of CMS fee schedule,30.56,100,,,fee schedule,100% of GA fee schedule,24.3,100,,,fee schedule,100% of CMS 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,30.56,100,,,fee schedule,100% of GA fee schedule,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.6,93,,,fee schedule,93% of CMS fee schedule,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,24.3,100,,,fee schedule,100% of CMS fee schedule,24.3,100,,,fee schedule,100% of CMS fee schedule,22.6,450,
INSULIN-LIKE GROWTH FACTOR I,300008424,CDM,301,RC,84305,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,34.02,160,,,fee schedule,160% of CMS fee schedule,27.64,130,,,fee schedule,130% of CMS fee schedule,26.73,100,,,fee schedule,100% of GA fee schedule,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,28.07,105,,,fee schedule,105% of GA fee schedule,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,26.73,100,,,fee schedule,100% of GA fee schedule,21.26,100,,,fee schedule,100% of CMS 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,26.73,100,,,fee schedule,100% of GA fee schedule,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.77,93,,,fee schedule,93% of CMS fee schedule,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,21.26,100,,,fee schedule,100% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,19.77,450,
PYRUVIC ACID,300008425,CDM,301,RC,84210,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,14.48,100,,,fee schedule,100% of CMS fee schedule,23.17,160,,,fee schedule,160% of CMS fee schedule,18.82,130,,,fee schedule,130% of CMS fee schedule,13.65,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,14.33,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,14.48,100,,,fee schedule,100% of CMS fee schedule,13.65,100,,,fee schedule,100% of GA fee schedule,14.48,100,,,fee schedule,100% of CMS 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,13.65,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.47,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,14.48,100,,,fee schedule,100% of CMS fee schedule,14.48,100,,,fee schedule,100% of CMS fee schedule,13.47,450,
PRO-INSULIN,300008427,CDM,301,RC,84206,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,26.69,100,,,fee schedule,100% of CMS fee schedule,42.7,160,,,fee schedule,160% of CMS fee schedule,34.7,130,,,fee schedule,130% of CMS fee schedule,22.4,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,23.52,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,26.69,100,,,fee schedule,100% of CMS fee schedule,22.4,100,,,fee schedule,100% of GA fee schedule,26.69,100,,,fee schedule,100% of CMS 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,22.4,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.82,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,26.69,100,,,fee schedule,100% of CMS fee schedule,26.69,100,,,fee schedule,100% of CMS fee schedule,22.4,450,
SULFONYLUREAN URINE OR BLOOD,300008428,CDM,301,RC,80377,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.49,450,
IGF BINDING PROTEIN 3,300008429,CDM,301,RC,83519,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,16.99,100,,,fee schedule,100% of GA fee schedule,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
DARVOCET LEVEL,300008431,CDM,301,RC,G0480,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,26.25,450,
"SODIUM,FECES",300008473,CDM,301,RC,84302,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,4.86,100,,,fee schedule,100% of CMS fee schedule,7.78,160,,,fee schedule,160% of CMS fee schedule,6.32,130,,,fee schedule,130% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,4.57,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,4.86,100,,,fee schedule,100% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,4.86,100,,,fee schedule,100% of CMS 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,4.35,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.52,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,4.86,100,,,fee schedule,100% of CMS fee schedule,4.86,100,,,fee schedule,100% of CMS fee schedule,4.35,450,
"CHLORIDE,FECES",300008474,CDM,301,RC,82438,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,5,100,,,fee schedule,100% of CMS fee schedule,8,160,,,fee schedule,160% of CMS fee schedule,6.5,130,,,fee schedule,130% of CMS fee schedule,6.15,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,6.46,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,5,100,,,fee schedule,100% of CMS fee schedule,6.15,100,,,fee schedule,100% of GA fee schedule,5,100,,,fee schedule,100% of CMS 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,6.15,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.65,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,5,100,,,fee schedule,100% of CMS fee schedule,5,100,,,fee schedule,100% of CMS fee schedule,4.65,450,
"POTASSIUM,FECES",300008475,CDM,301,RC,84133,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,7.57,160,,,fee schedule,160% of CMS fee schedule,6.15,130,,,fee schedule,130% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,5.68,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,4.73,100,,,fee schedule,100% of CMS 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,5.41,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.4,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,4.73,100,,,fee schedule,100% of CMS fee schedule,4.4,450,
BICARBONATE (HC03) URINE,300008486,CDM,301,RC,82374,HCPCS,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,7.81,160,,,fee schedule,160% of CMS fee schedule,6.34,130,,,fee schedule,130% of CMS fee schedule,6.15,100,,,fee schedule,100% of GA fee schedule,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,6.46,105,,,fee schedule,105% of GA fee schedule,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,6.15,100,,,fee schedule,100% of GA fee schedule,4.88,100,,,fee schedule,100% of CMS 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,6.15,100,,,fee schedule,100% of GA fee schedule,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.54,93,,,fee schedule,93% of CMS fee schedule,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,4.88,100,,,fee schedule,100% of CMS fee schedule,4.54,450,
CYSTINE URINE,300008488,CDM,301,RC,82131,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,36.77,160,,,fee schedule,160% of CMS fee schedule,29.87,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,22.98,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.37,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,450,
N-TELOPEPIDE,300008491,CDM,301,RC,82523,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,29.89,160,,,fee schedule,160% of CMS fee schedule,24.28,130,,,fee schedule,130% of CMS fee schedule,23.5,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,24.68,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,23.5,100,,,fee schedule,100% of GA fee schedule,18.68,100,,,fee schedule,100% of CMS 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,23.5,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.37,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,18.68,100,,,fee schedule,100% of CMS fee schedule,17.37,450,
BILE ACIDS,300008492,CDM,301,RC,82239,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,17.12,100,,,fee schedule,100% of CMS fee schedule,27.39,160,,,fee schedule,160% of CMS fee schedule,22.26,130,,,fee schedule,130% of CMS fee schedule,21.55,100,,,fee schedule,100% of GA fee schedule,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,22.63,105,,,fee schedule,105% of GA fee schedule,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,17.12,100,,,fee schedule,100% of CMS fee schedule,21.55,100,,,fee schedule,100% of GA fee schedule,17.12,100,,,fee schedule,100% of CMS fee schedule,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,21.55,100,,,fee schedule,100% of GA fee schedule,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.92,93,,,fee schedule,93% of CMS fee schedule,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,17.12,100,,,fee schedule,100% of CMS fee schedule,17.12,100,,,fee schedule,100% of CMS fee schedule,15.92,450,
"ZINC,PROTOPORPHYRIN",300008493,CDM,301,RC,84202,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,22.96,160,,,fee schedule,160% of CMS fee schedule,18.66,130,,,fee schedule,130% of CMS fee schedule,18.05,100,,,fee schedule,100% of GA fee schedule,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,18.95,105,,,fee schedule,105% of GA fee schedule,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,18.05,100,,,fee schedule,100% of GA fee schedule,14.35,100,,,fee schedule,100% of CMS 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,18.05,100,,,fee schedule,100% of GA fee schedule,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.35,93,,,fee schedule,93% of CMS fee schedule,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,14.35,100,,,fee schedule,100% of CMS fee schedule,13.35,450,
"TRYPSIN,SR",300008496,CDM,301,RC,83519,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
XYLOSE (ADULT-25g dose),300008508,CDM,301,RC,84620,HCPCS,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,12.91,100,,,fee schedule,100% of CMS fee schedule,20.66,160,,,fee schedule,160% of CMS fee schedule,16.78,130,,,fee schedule,130% of CMS fee schedule,14.9,100,,,fee schedule,100% of GA fee schedule,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,15.65,105,,,fee schedule,105% of GA fee schedule,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,12.91,100,,,fee schedule,100% of CMS fee schedule,14.9,100,,,fee schedule,100% of GA fee schedule,12.91,100,,,fee schedule,100% of CMS fee schedule,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,14.9,100,,,fee schedule,100% of GA fee schedule,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.01,93,,,fee schedule,93% of CMS fee schedule,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,12.91,100,,,fee schedule,100% of CMS fee schedule,12.91,100,,,fee schedule,100% of CMS fee schedule,12.01,450,
GM1 ANTIBODY IgG,300008515,CDM,301,RC,83516,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ASIALO GM1 ANTIBODY IgG,300008516,CDM,301,RC,83520,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,16.28,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
GM1 ANTIBODY IgM,300008517,CDM,301,RC,83516,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ASIALO GM1 ANTIBODY IgM,300008518,CDM,301,RC,83520,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,16.28,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
SGPG,300008519,CDM,301,RC,83520,HCPCS,outpatient,,,181,126.7,,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,139.77,77.22,,111.82,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,150.23,83,,120.18,percent of total billed charges,83% of total,171.95,95,,137.56,percent of total billed charges ,95% of total billed charges,144.8,80,,115.84,percent of total billed charges,78% of total billed charges,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
THYROID STIMULATION IMMUNOGLOB,300008524,CDM,301,RC,84445,HCPCS,outpatient,,,544,380.8,,429.76,79,,343.81,percent of total billed charges,79% of total billed charges,489.6,90,,391.68,percent of total billed charges,90% of total billed charges,50.86,100,,,fee schedule,100% of CMS fee schedule,81.38,160,,,fee schedule,160% of CMS fee schedule,66.12,130,,,fee schedule,130% of CMS fee schedule,10.65,100,,,fee schedule,100% of GA fee schedule,420.08,77.22,,336.06,percent of total billed charges,77.22% of total billed charges,11.18,105,,,fee schedule,105% of GA fee schedule,451.52,83,,361.22,percent of total billed charges,83% of total,516.8,95,,413.44,percent of total billed charges ,95% of total billed charges,435.2,80,,348.16,percent of total billed charges,78% of total billed charges,424.32,78,,339.456,percent of total billed charges,78% of total billed charges,50.86,100,,,fee schedule,100% of CMS fee schedule,10.65,100,,,fee schedule,100% of GA fee schedule,50.86,100,,,fee schedule,100% of CMS 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,10.65,100,,,fee schedule,100% of GA fee schedule,462.4,85,,369.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.3,93,,,fee schedule,93% of CMS fee schedule,429.76,79,,343.81,percent of total billed charges,79% of total billed charges,50.86,100,,,fee schedule,100% of CMS fee schedule,50.86,100,,,fee schedule,100% of CMS fee schedule,10.65,516.8,
ALCOHOL URINE,300008528,CDM,301,RC,80321,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.59,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,14.27,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.59,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,13.59,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.59,450,
IgG CSF,300008536,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
MYELIN BASIC PROTEIN,300008538,CDM,301,RC,83873,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,17.2,100,,,fee schedule,100% of CMS fee schedule,27.52,160,,,fee schedule,160% of CMS fee schedule,22.36,130,,,fee schedule,130% of CMS fee schedule,21.64,100,,,fee schedule,100% of GA fee schedule,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,22.72,105,,,fee schedule,105% of GA fee schedule,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,17.2,100,,,fee schedule,100% of CMS fee schedule,21.64,100,,,fee schedule,100% of GA fee schedule,17.2,100,,,fee schedule,100% of CMS 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,21.64,100,,,fee schedule,100% of GA fee schedule,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16,93,,,fee schedule,93% of CMS fee schedule,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,17.2,100,,,fee schedule,100% of CMS fee schedule,17.2,100,,,fee schedule,100% of CMS fee schedule,16,450,
KEPPRA LEVEL,300008540,CDM,301,RC,80177,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,15.19,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS 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,14.47,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
MYELOPEROXIDASE ABS,300008541,CDM,301,RC,83516,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
SERINE PROTEASE 3,300008542,CDM,301,RC,83516,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
FETAL FIBRONECTIN,300008544,CDM,301,RC,82731,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,103.06,160,,,fee schedule,160% of CMS fee schedule,83.73,130,,,fee schedule,130% of CMS fee schedule,80.99,100,,,fee schedule,100% of GA fee schedule,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,85.04,105,,,fee schedule,105% of GA fee schedule,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,80.99,100,,,fee schedule,100% of GA fee schedule,64.41,100,,,fee schedule,100% of CMS 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,80.99,100,,,fee schedule,100% of GA fee schedule,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,59.9,93,,,fee schedule,93% of CMS fee schedule,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,59.9,450,
STRYCHNINE SR,300008547,CDM,301,RC,G0480,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,32.43,450,
STRYCHNINE UA,300008548,CDM,301,RC,80323,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.75,100,,,fee schedule,100% of GA fee schedule,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,39.64,105,,,fee schedule,105% of GA fee schedule,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.75,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,37.75,100,,,fee schedule,100% of GA fee schedule,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.43,450,
PKU REPEAT (NON-BILLABLE),300008557,CDM,301,RC,84030,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.5,100,,,fee schedule,100% of CMS fee schedule,8.8,160,,,fee schedule,160% of CMS fee schedule,7.15,130,,,fee schedule,130% of CMS fee schedule,6.92,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,7.27,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.5,100,,,fee schedule,100% of CMS fee schedule,6.92,100,,,fee schedule,100% of GA fee schedule,5.5,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.92,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,5.12,93,,,fee schedule,93% of CMS fee schedule,,,,,other,not seperately reimbursable,5.5,100,,,fee schedule,100% of CMS fee schedule,5.5,100,,,fee schedule,100% of CMS fee schedule,5.12,450,
FECAL FAT QUANT,300008563,CDM,301,RC,82710,HCPCS,outpatient,,,192,134.4,,151.68,79,,121.34,percent of total billed charges,79% of total billed charges,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,26.88,160,,,fee schedule,160% of CMS fee schedule,21.84,130,,,fee schedule,130% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,148.26,77.22,,118.61,percent of total billed charges,77.22% of total billed charges,22.18,105,,,fee schedule,105% of GA fee schedule,159.36,83,,127.49,percent of total billed charges,83% of total,182.4,95,,145.92,percent of total billed charges ,95% of total billed charges,153.6,80,,122.88,percent of total billed charges,78% of total billed charges,149.76,78,,119.808,percent of total billed charges,78% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,16.8,100,,,fee schedule,100% of CMS 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,21.12,100,,,fee schedule,100% of GA fee schedule,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.62,93,,,fee schedule,93% of CMS fee schedule,151.68,79,,121.34,percent of total billed charges,79% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,15.62,450,
LH RELEASING HORMONE,300008564,CDM,301,RC,83727,HCPCS,outpatient,,,772,540.4,,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,694.8,90,,555.84,percent of total billed charges,90% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,27.5,160,,,fee schedule,160% of CMS fee schedule,22.35,130,,,fee schedule,130% of CMS fee schedule,21.62,100,,,fee schedule,100% of GA fee schedule,596.14,77.22,,476.91,percent of total billed charges,77.22% of total billed charges,22.7,105,,,fee schedule,105% of GA fee schedule,640.76,83,,512.61,percent of total billed charges,83% of total,733.4,95,,586.72,percent of total billed charges ,95% of total billed charges,617.6,80,,494.08,percent of total billed charges,78% of total billed charges,602.16,78,,481.728,percent of total billed charges,78% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,21.62,100,,,fee schedule,100% of GA fee schedule,17.19,100,,,fee schedule,100% of CMS 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,21.62,100,,,fee schedule,100% of GA fee schedule,656.2,85,,524.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.99,93,,,fee schedule,93% of CMS fee schedule,609.88,79,,487.9,percent of total billed charges,79% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,17.19,100,,,fee schedule,100% of CMS fee schedule,15.99,733.4,
OXCARBAZEPINE,300008567,CDM,301,RC,80183,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,15.19,105,,,fee schedule,105% of GA fee schedule,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS 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,14.47,100,,,fee schedule,100% of GA fee schedule,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
VITAMIN E,300008569,CDM,301,RC,84446,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,22.69,160,,,fee schedule,160% of CMS fee schedule,18.43,130,,,fee schedule,130% of CMS fee schedule,17.83,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,18.72,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,17.83,100,,,fee schedule,100% of GA fee schedule,14.18,100,,,fee schedule,100% of CMS 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,17.83,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.19,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,14.18,100,,,fee schedule,100% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,13.19,450,
"METANEPHRINE,PLASMA FREE",300008570,CDM,301,RC,83835,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,27.1,160,,,fee schedule,160% of CMS fee schedule,22.02,130,,,fee schedule,130% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,22.37,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,21.3,100,,,fee schedule,100% of GA fee schedule,16.94,100,,,fee schedule,100% of CMS 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,21.3,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.75,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,16.94,100,,,fee schedule,100% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,15.75,450,
BARBITURATES,300008573,CDM,301,RC,G0480,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,36.29,450,
INSULIN-LIKE GROWTH FACTOR II,300008574,CDM,301,RC,83519,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
PROGRAF,300008578,CDM,301,RC,80197,HCPCS,outpatient,,,287,200.9,,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,21.97,160,,,fee schedule,160% of CMS fee schedule,17.85,130,,,fee schedule,130% of CMS fee schedule,17.25,100,,,fee schedule,100% of GA fee schedule,221.62,77.22,,177.3,percent of total billed charges,77.22% of total billed charges,18.11,105,,,fee schedule,105% of GA fee schedule,238.21,83,,190.57,percent of total billed charges,83% of total,272.65,95,,218.12,percent of total billed charges ,95% of total billed charges,229.6,80,,183.68,percent of total billed charges,78% of total billed charges,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,17.25,100,,,fee schedule,100% of GA fee schedule,13.73,100,,,fee schedule,100% of CMS 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,17.25,100,,,fee schedule,100% of GA fee schedule,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.77,93,,,fee schedule,93% of CMS fee schedule,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,12.77,450,
CK MB,300008580,CDM,301,RC,82553,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,18.48,160,,,fee schedule,160% of CMS fee schedule,15.02,130,,,fee schedule,130% of CMS fee schedule,14.52,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,15.25,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,14.52,100,,,fee schedule,100% of GA fee schedule,11.55,100,,,fee schedule,100% of CMS 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,14.52,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.74,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,11.55,100,,,fee schedule,100% of CMS fee schedule,11.55,100,,,fee schedule,100% of CMS fee schedule,10.74,450,
"DRUG SCREEN,SERUM",300008581,CDM,301,RC,80307,HCPCS,outpatient,,,417,291.9,,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,322.01,77.22,,257.61,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,346.11,83,,276.89,percent of total billed charges,83% of total,396.15,95,,316.92,percent of total billed charges ,95% of total billed charges,333.6,80,,266.88,percent of total billed charges,78% of total billed charges,325.26,78,,260.208,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,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,61.16,100,,,fee schedule,100% of GA fee schedule,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
"DRUG SCREEN,20",300008582,CDM,301,RC,G0482,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,198.74,100,,,fee schedule,100% of CMS fee schedule,317.98,160,,,fee schedule,160% of CMS fee schedule,258.36,130,,,fee schedule,130% of CMS fee schedule,163.47,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,171.64,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,198.74,100,,,fee schedule,100% of CMS fee schedule,163.47,100,,,fee schedule,100% of GA fee schedule,198.74,100,,,fee schedule,100% of CMS 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,163.47,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,184.83,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,198.74,100,,,fee schedule,100% of CMS fee schedule,198.74,100,,,fee schedule,100% of CMS fee schedule,92.66,450,
RISPERIDONE LEVEL,300008583,CDM,301,RC,G0480,HCPCS,outpatient,,,268,187.6,,211.72,79,,169.38,percent of total billed charges,79% of total billed charges,241.2,90,,192.96,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,206.95,77.22,,165.56,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,222.44,83,,177.95,percent of total billed charges,83% of total,254.6,95,,203.68,percent of total billed charges ,95% of total billed charges,214.4,80,,171.52,percent of total billed charges,78% of total billed charges,209.04,78,,167.232,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,227.8,85,,182.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,211.72,79,,169.38,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
METHAMPHETAMINE,300008584,CDM,301,RC,82145,HCPCS,outpatient,,,328,229.6,,259.12,79,,207.3,percent of total billed charges,79% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,253.28,77.22,,202.62,percent of total billed charges,77.22% of total billed charges,216.81,66.1,,173.45,percent of total billed charges,66.1% of total billed charges,272.24,83,,217.79,percent of total billed charges,83% of total,311.6,95,,249.28,percent of total billed charges ,95% of total billed charges,262.4,80,,209.92,percent of total billed charges,78% of total billed charges,255.84,78,,204.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,259.12,79,,207.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.64,450,
METFORMIN,300008594,CDM,301,RC,G0480,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,88.03,450,
MOLYBDENUM,300008595,CDM,301,RC,83018,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,35.14,160,,,fee schedule,160% of CMS fee schedule,28.55,130,,,fee schedule,130% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,28.99,105,,,fee schedule,105% of GA fee schedule,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,21.96,100,,,fee schedule,100% of CMS 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,27.61,100,,,fee schedule,100% of GA fee schedule,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.42,93,,,fee schedule,93% of CMS fee schedule,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,20.42,450,
MANGANESE,300008596,CDM,301,RC,83785,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,26.65,100,,,fee schedule,100% of CMS fee schedule,42.64,160,,,fee schedule,160% of CMS fee schedule,34.65,130,,,fee schedule,130% of CMS fee schedule,30.92,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,32.47,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,26.65,100,,,fee schedule,100% of CMS fee schedule,30.92,100,,,fee schedule,100% of GA fee schedule,26.65,100,,,fee schedule,100% of CMS 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,30.92,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.78,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,26.65,100,,,fee schedule,100% of CMS fee schedule,26.65,100,,,fee schedule,100% of CMS fee schedule,24.78,450,
SOLUBLE LIVER ANTIGEN/ANTIBODY,300008599,CDM,301,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ESTRIOL URINE,300008601,CDM,301,RC,82677,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,38.69,160,,,fee schedule,160% of CMS fee schedule,31.43,130,,,fee schedule,130% of CMS fee schedule,30.41,100,,,fee schedule,100% of GA fee schedule,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,31.93,105,,,fee schedule,105% of GA fee schedule,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,30.41,100,,,fee schedule,100% of GA fee schedule,24.18,100,,,fee schedule,100% of CMS 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,30.41,100,,,fee schedule,100% of GA fee schedule,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.49,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,24.18,100,,,fee schedule,100% of CMS fee schedule,24.18,100,,,fee schedule,100% of CMS fee schedule,22.49,450,
B-TYPE NATRIURETIC PEPTIDE,300008602,CDM,301,RC,83880,HCPCS,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,62.82,160,,,fee schedule,160% of CMS fee schedule,51.04,130,,,fee schedule,130% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,145.95,77.22,,116.76,percent of total billed charges,77.22% of total billed charges,44.82,105,,,fee schedule,105% of GA fee schedule,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,39.26,100,,,fee schedule,100% of CMS 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,42.69,100,,,fee schedule,100% of GA fee schedule,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.51,93,,,fee schedule,93% of CMS fee schedule,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,39.26,100,,,fee schedule,100% of CMS fee schedule,36.51,450,
IMMUNOGLOBULIN D,300008605,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
APOLIPOPROTEIN B,300008611,CDM,301,RC,82172,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,33.74,160,,,fee schedule,160% of CMS fee schedule,27.42,130,,,fee schedule,130% of CMS fee schedule,19.49,100,,,fee schedule,100% of GA fee schedule,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,20.46,105,,,fee schedule,105% of GA fee schedule,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,19.49,100,,,fee schedule,100% of GA fee schedule,21.09,100,,,fee schedule,100% of CMS 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,19.49,100,,,fee schedule,100% of GA fee schedule,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.61,93,,,fee schedule,93% of CMS fee schedule,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,21.09,100,,,fee schedule,100% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,19.49,450,
TRICYCLIC ANTIDEPRESSANT,300008612,CDM,301,RC,80101,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
UREA NITROGEN CLEARANCE,300008616,CDM,301,RC,84545,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,11.52,160,,,fee schedule,160% of CMS fee schedule,9.36,130,,,fee schedule,130% of CMS fee schedule,8.31,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,8.73,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,8.31,100,,,fee schedule,100% of GA fee schedule,7.2,100,,,fee schedule,100% of CMS 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,8.31,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.7,93,,,fee schedule,93% of CMS fee schedule,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,7.2,100,,,fee schedule,100% of CMS fee schedule,6.7,450,
HOMOVANILLIC ACID UR,300008621,CDM,301,RC,83150,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,22.41,100,,,fee schedule,100% of CMS fee schedule,35.86,160,,,fee schedule,160% of CMS fee schedule,29.13,130,,,fee schedule,130% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,25.56,105,,,fee schedule,105% of GA fee schedule,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,22.41,100,,,fee schedule,100% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,22.41,100,,,fee schedule,100% of CMS 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,24.34,100,,,fee schedule,100% of GA fee schedule,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.84,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,22.41,100,,,fee schedule,100% of CMS fee schedule,22.41,100,,,fee schedule,100% of CMS fee schedule,20.84,450,
NEFAZODONE,300008622,CDM,301,RC,80338,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
MEPHNYTOIN,300008624,CDM,301,RC,80299,HCPCS,outpatient,,,304,212.8,,240.16,79,,192.13,percent of total billed charges,79% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,234.75,77.22,,187.8,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,252.32,83,,201.86,percent of total billed charges,83% of total,288.8,95,,231.04,percent of total billed charges ,95% of total billed charges,243.2,80,,194.56,percent of total billed charges,78% of total billed charges,237.12,78,,189.696,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,240.16,79,,192.13,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
FREE ERYTHROCYTE PROTOPORHYRIN,300008626,CDM,301,RC,84202,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,22.96,160,,,fee schedule,160% of CMS fee schedule,18.66,130,,,fee schedule,130% of CMS fee schedule,18.05,100,,,fee schedule,100% of GA fee schedule,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,18.95,105,,,fee schedule,105% of GA fee schedule,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,18.05,100,,,fee schedule,100% of GA fee schedule,14.35,100,,,fee schedule,100% of CMS 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,18.05,100,,,fee schedule,100% of GA fee schedule,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.35,93,,,fee schedule,93% of CMS fee schedule,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,14.35,100,,,fee schedule,100% of CMS fee schedule,14.35,100,,,fee schedule,100% of CMS fee schedule,13.35,450,
17-HYDROXYCORTICOSTEROIDS,300008627,CDM,301,RC,83491,HCPCS,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,28.64,160,,,fee schedule,160% of CMS fee schedule,23.27,130,,,fee schedule,130% of CMS fee schedule,22.02,100,,,fee schedule,100% of GA fee schedule,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,23.12,105,,,fee schedule,105% of GA fee schedule,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,22.02,100,,,fee schedule,100% of GA fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,22.02,100,,,fee schedule,100% of GA fee schedule,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.65,93,,,fee schedule,93% of CMS fee schedule,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,16.65,450,
TIAGABINE/GABITREL,300008642,CDM,301,RC,80199,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,27.11,100,,,fee schedule,100% of CMS fee schedule,43.38,160,,,fee schedule,160% of CMS fee schedule,35.24,130,,,fee schedule,130% of CMS fee schedule,6.55,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,6.88,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,27.11,100,,,fee schedule,100% of CMS fee schedule,6.55,100,,,fee schedule,100% of GA fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,6.55,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.21,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,27.11,100,,,fee schedule,100% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,6.55,450,
"OCCULT BLOOD, GASTRIC",300008645,CDM,301,RC,82271,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,8.51,160,,,fee schedule,160% of CMS fee schedule,6.92,130,,,fee schedule,130% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,4.24,105,,,fee schedule,105% of GA fee schedule,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,5.32,100,,,fee schedule,100% of CMS 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,4.04,100,,,fee schedule,100% of GA fee schedule,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.95,93,,,fee schedule,93% of CMS fee schedule,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,5.32,100,,,fee schedule,100% of CMS fee schedule,5.32,100,,,fee schedule,100% of CMS fee schedule,4.04,450,
PTH (RELATED PEPTIDE),300008675,CDM,301,RC,83519,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,16.99,100,,,fee schedule,100% of GA fee schedule,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
SIALIC ACID,300008684,CDM,301,RC,84275,HCPCS,outpatient,,,479,335.3,,378.41,79,,302.73,percent of total billed charges,79% of total billed charges,431.1,90,,344.88,percent of total billed charges,90% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,21.5,160,,,fee schedule,160% of CMS fee schedule,17.47,130,,,fee schedule,130% of CMS fee schedule,16.89,100,,,fee schedule,100% of GA fee schedule,369.88,77.22,,295.9,percent of total billed charges,77.22% of total billed charges,17.73,105,,,fee schedule,105% of GA fee schedule,397.57,83,,318.06,percent of total billed charges,83% of total,455.05,95,,364.04,percent of total billed charges ,95% of total billed charges,383.2,80,,306.56,percent of total billed charges,78% of total billed charges,373.62,78,,298.896,percent of total billed charges,78% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,16.89,100,,,fee schedule,100% of GA fee schedule,13.44,100,,,fee schedule,100% of CMS fee schedule,431.1,90,,344.88,percent of total billed charges,90% of total billed charges,383.2,80,,306.56,percent of total billed charges,80% of total billed charges,16.89,100,,,fee schedule,100% of GA fee schedule,407.15,85,,325.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.5,93,,,fee schedule,93% of CMS fee schedule,378.41,79,,302.73,percent of total billed charges,79% of total billed charges,13.44,100,,,fee schedule,100% of CMS fee schedule,13.44,100,,,fee schedule,100% of CMS fee schedule,12.5,455.05,
SULFATIDE/NOS,300008687,CDM,301,RC,83520,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
SULFATIDE/NOS,300008688,CDM,301,RC,83520,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
SULFATIDE/NOS,300008689,CDM,301,RC,83520,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
SULFATIDE/NOS,300008690,CDM,301,RC,83520,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
SULFATIDE CP,300008692,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
URINE CREATININE,300008699,CDM,301,RC,82570,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,8.29,160,,,fee schedule,160% of CMS fee schedule,6.73,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,5.18,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.82,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,4.82,450,
URINE PROTEIN,300008700,CDM,301,RC,84156,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,5.87,160,,,fee schedule,160% of CMS fee schedule,4.77,130,,,fee schedule,130% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,4.84,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,3.67,100,,,fee schedule,100% of CMS 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,4.61,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.41,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.41,450,
FERN TEST,300008702,CDM,301,RC,Q0114,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,9.74,100,,,fee schedule,100% of CMS fee schedule,15.58,160,,,fee schedule,160% of CMS fee schedule,12.66,130,,,fee schedule,130% of CMS fee schedule,9.99,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,10.49,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,9.74,100,,,fee schedule,100% of CMS fee schedule,9.99,100,,,fee schedule,100% of GA fee schedule,9.74,100,,,fee schedule,100% of CMS 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,9.99,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.06,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,9.74,100,,,fee schedule,100% of CMS fee schedule,9.74,100,,,fee schedule,100% of CMS fee schedule,9.06,450,
MAGNESIUM STOOL,300008705,CDM,301,RC,83735,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,10.72,160,,,fee schedule,160% of CMS fee schedule,8.71,130,,,fee schedule,130% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,8.84,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,6.7,100,,,fee schedule,100% of CMS 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,8.42,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.23,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.23,450,
CITRULLINE,300008706,CDM,301,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ZYPREXA,300008707,CDM,301,RC,80299,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
VITAMIN K,300008708,CDM,301,RC,84597,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,13.72,100,,,fee schedule,100% of CMS fee schedule,21.95,160,,,fee schedule,160% of CMS fee schedule,17.84,130,,,fee schedule,130% of CMS fee schedule,17.24,100,,,fee schedule,100% of GA fee schedule,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,18.1,105,,,fee schedule,105% of GA fee schedule,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,13.72,100,,,fee schedule,100% of CMS fee schedule,17.24,100,,,fee schedule,100% of GA fee schedule,13.72,100,,,fee schedule,100% of CMS 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,17.24,100,,,fee schedule,100% of GA fee schedule,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.76,93,,,fee schedule,93% of CMS fee schedule,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,13.72,100,,,fee schedule,100% of CMS fee schedule,13.72,100,,,fee schedule,100% of CMS fee schedule,12.76,450,
THYROID STIMU HORMONE 3RD GEN,300008710,CDM,301,RC,84443,HCPCS,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,26.88,160,,,fee schedule,160% of CMS fee schedule,21.84,130,,,fee schedule,130% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,22.18,105,,,fee schedule,105% of GA fee schedule,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,16.8,100,,,fee schedule,100% of CMS 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,21.12,100,,,fee schedule,100% of GA fee schedule,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.62,93,,,fee schedule,93% of CMS fee schedule,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,15.62,450,
GLUTIMIC ACID DECARBOXYL ANTI,300008711,CDM,301,RC,83519,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,16.99,100,,,fee schedule,100% of GA fee schedule,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
TSH 3RD GENERATION,300008729,CDM,301,RC,84443,HCPCS,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,26.88,160,,,fee schedule,160% of CMS fee schedule,21.84,130,,,fee schedule,130% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,22.18,105,,,fee schedule,105% of GA fee schedule,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,16.8,100,,,fee schedule,100% of CMS 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,21.12,100,,,fee schedule,100% of GA fee schedule,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.62,93,,,fee schedule,93% of CMS fee schedule,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,15.62,450,
ANTI-GQ1 ANTIBODY,300008734,CDM,301,RC,83520,HCPCS,outpatient,,,483,338.1,,381.57,79,,305.26,percent of total billed charges,79% of total billed charges,434.7,90,,347.76,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,372.97,77.22,,298.38,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,400.89,83,,320.71,percent of total billed charges,83% of total,458.85,95,,367.08,percent of total billed charges ,95% of total billed charges,386.4,80,,309.12,percent of total billed charges,78% of total billed charges,376.74,78,,301.392,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,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,16.28,100,,,fee schedule,100% of GA fee schedule,410.55,85,,328.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,381.57,79,,305.26,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,458.85,
VOLTAGE GATED CALCIUM,300008735,CDM,301,RC,86596,HCPCS,outpatient,,,645,451.5,,509.55,79,,407.64,percent of total billed charges,79% of total billed charges,580.5,90,,464.4,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,498.07,77.22,,398.46,percent of total billed charges,77.22% of total billed charges,15.46,105,,,fee schedule,105% of GA fee schedule,535.35,83,,428.28,percent of total billed charges,83% of total,612.75,95,,490.2,percent of total billed charges ,95% of total billed charges,516,80,,412.8,percent of total billed charges,78% of total billed charges,503.1,78,,402.48,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,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,14.72,100,,,fee schedule,100% of GA fee schedule,548.25,85,,438.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,509.55,79,,407.64,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,612.75,
FELBAMATE,300008739,CDM,301,RC,80299,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
CARNITINE,300008757,CDM,301,RC,82379,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,26.99,160,,,fee schedule,160% of CMS fee schedule,21.93,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,16.87,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.69,93,,,fee schedule,93% of CMS fee schedule,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,15.69,450,
TSH RECEPTOR ANTIBODY,300008759,CDM,301,RC,83519,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,16.99,100,,,fee schedule,100% of GA fee schedule,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
AMPHETAMINE/METH AMPHETAMINE,300008760,CDM,301,RC,82145,HCPCS,outpatient,,,328,229.6,,259.12,79,,207.3,percent of total billed charges,79% of total billed charges,295.2,90,,236.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,253.28,77.22,,202.62,percent of total billed charges,77.22% of total billed charges,216.81,66.1,,173.45,percent of total billed charges,66.1% of total billed charges,272.24,83,,217.79,percent of total billed charges,83% of total,311.6,95,,249.28,percent of total billed charges ,95% of total billed charges,262.4,80,,209.92,percent of total billed charges,78% of total billed charges,255.84,78,,204.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,206.64,63,,165.31,percent of total billed charges,63% of total billed charges,278.8,85,,223.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,259.12,79,,207.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,206.64,450,
ESTRADIOL,300008762,CDM,301,RC,82670,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,44.7,160,,,fee schedule,160% of CMS fee schedule,36.32,130,,,fee schedule,130% of CMS fee schedule,35.14,100,,,fee schedule,100% of GA fee schedule,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,36.9,105,,,fee schedule,105% of GA fee schedule,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,35.14,100,,,fee schedule,100% of GA fee schedule,27.94,100,,,fee schedule,100% of CMS 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,35.14,100,,,fee schedule,100% of GA fee schedule,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.98,93,,,fee schedule,93% of CMS fee schedule,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,25.98,450,
TSH,300008767,CDM,301,RC,84443,HCPCS,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,26.88,160,,,fee schedule,160% of CMS fee schedule,21.84,130,,,fee schedule,130% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,22.18,105,,,fee schedule,105% of GA fee schedule,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,16.8,100,,,fee schedule,100% of CMS 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,21.12,100,,,fee schedule,100% of GA fee schedule,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.62,93,,,fee schedule,93% of CMS fee schedule,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,15.62,450,
DNEA-S,300008768,CDM,301,RC,82627,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,35.57,160,,,fee schedule,160% of CMS fee schedule,28.9,130,,,fee schedule,130% of CMS fee schedule,27.96,100,,,fee schedule,100% of GA fee schedule,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,29.36,105,,,fee schedule,105% of GA fee schedule,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,27.96,100,,,fee schedule,100% of GA fee schedule,22.23,100,,,fee schedule,100% of CMS 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,27.96,100,,,fee schedule,100% of GA fee schedule,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.67,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,22.23,100,,,fee schedule,100% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,20.67,450,
ALPHA GALACTOSIDASE,300008785,CDM,301,RC,82657,HCPCS,outpatient,,,280,196,,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,35.47,160,,,fee schedule,160% of CMS fee schedule,28.82,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,216.22,77.22,,172.98,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,232.4,83,,185.92,percent of total billed charges,83% of total,266,95,,212.8,percent of total billed charges ,95% of total billed charges,224,80,,179.2,percent of total billed charges,78% of total billed charges,218.4,78,,174.72,percent of total billed charges,78% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,22.17,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,238,85,,190.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.62,93,,,fee schedule,93% of CMS fee schedule,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,22.17,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
ZONEGRAN,300008786,CDM,301,RC,80203,HCPCS,outpatient,,,142,99.4,,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,109.65,77.22,,87.72,percent of total billed charges,77.22% of total billed charges,15.19,105,,,fee schedule,105% of GA fee schedule,117.86,83,,94.29,percent of total billed charges,83% of total,134.9,95,,107.92,percent of total billed charges ,95% of total billed charges,113.6,80,,90.88,percent of total billed charges,78% of total billed charges,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,14.47,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS 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,14.47,100,,,fee schedule,100% of GA fee schedule,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
PROTEIN ELECTROPHORESIS UR,300008787,CDM,301,RC,84166,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,17.83,100,,,fee schedule,100% of CMS fee schedule,28.53,160,,,fee schedule,160% of CMS fee schedule,23.18,130,,,fee schedule,130% of CMS fee schedule,22.43,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,23.55,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,17.83,100,,,fee schedule,100% of CMS fee schedule,22.43,100,,,fee schedule,100% of GA fee schedule,17.83,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,22.43,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.58,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,17.83,100,,,fee schedule,100% of CMS fee schedule,17.83,100,,,fee schedule,100% of CMS fee schedule,16.58,450,
PROTEIN SERUM,300008789,CDM,301,RC,84155,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,5.87,160,,,fee schedule,160% of CMS fee schedule,4.77,130,,,fee schedule,130% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,4.84,105,,,fee schedule,105% of GA fee schedule,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,3.67,100,,,fee schedule,100% of CMS 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,4.61,100,,,fee schedule,100% of GA fee schedule,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.41,93,,,fee schedule,93% of CMS fee schedule,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.41,450,
HYPOGLYCEMIC AGENT SCREEN,300008791,CDM,301,RC,G0480,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
DIHYDROXYTESTOSTERONE,300008792,CDM,301,RC,82642,HCPCS,outpatient,,,279,195.3,,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,46.85,160,,,fee schedule,160% of CMS fee schedule,38.06,130,,,fee schedule,130% of CMS fee schedule,26.02,100,,,fee schedule,100% of GA fee schedule,215.44,77.22,,172.35,percent of total billed charges,77.22% of total billed charges,27.32,105,,,fee schedule,105% of GA fee schedule,231.57,83,,185.26,percent of total billed charges,83% of total,265.05,95,,212.04,percent of total billed charges ,95% of total billed charges,223.2,80,,178.56,percent of total billed charges,78% of total billed charges,217.62,78,,174.096,percent of total billed charges,78% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,26.02,100,,,fee schedule,100% of GA fee schedule,29.28,100,,,fee schedule,100% of CMS 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,26.02,100,,,fee schedule,100% of GA fee schedule,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.23,93,,,fee schedule,93% of CMS fee schedule,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,29.28,100,,,fee schedule,100% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,26.02,450,
UREA NITROGEN FLUID,300008793,CDM,301,RC,84520,HCPCS,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,6.32,160,,,fee schedule,160% of CMS fee schedule,5.14,130,,,fee schedule,130% of CMS fee schedule,4.96,100,,,fee schedule,100% of GA fee schedule,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,5.21,105,,,fee schedule,105% of GA fee schedule,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,4.96,100,,,fee schedule,100% of GA fee schedule,3.95,100,,,fee schedule,100% of CMS 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,4.96,100,,,fee schedule,100% of GA fee schedule,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.67,93,,,fee schedule,93% of CMS fee schedule,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,3.67,450,
PREGNENOLONE,300008794,CDM,301,RC,84140,HCPCS,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,20.67,100,,,fee schedule,100% of CMS fee schedule,33.07,160,,,fee schedule,160% of CMS fee schedule,26.87,130,,,fee schedule,130% of CMS fee schedule,26,100,,,fee schedule,100% of GA fee schedule,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,27.3,105,,,fee schedule,105% of GA fee schedule,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,20.67,100,,,fee schedule,100% of CMS fee schedule,26,100,,,fee schedule,100% of GA fee schedule,20.67,100,,,fee schedule,100% of CMS 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,26,100,,,fee schedule,100% of GA fee schedule,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.22,93,,,fee schedule,93% of CMS fee schedule,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,20.67,100,,,fee schedule,100% of CMS fee schedule,20.67,100,,,fee schedule,100% of CMS fee schedule,19.22,450,
AMPHETAMINES CONFIRMATION,300008819,CDM,301,RC,80324,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.55,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,20.53,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.55,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,19.55,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.55,450,
"CHOLINESTERASE, PLASMA",300008832,CDM,301,RC,82480,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,12.59,160,,,fee schedule,160% of CMS fee schedule,10.23,130,,,fee schedule,130% of CMS fee schedule,9.91,100,,,fee schedule,100% of GA fee schedule,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,10.41,105,,,fee schedule,105% of GA fee schedule,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,9.91,100,,,fee schedule,100% of GA fee schedule,7.87,100,,,fee schedule,100% of CMS 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,9.91,100,,,fee schedule,100% of GA fee schedule,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.32,93,,,fee schedule,93% of CMS fee schedule,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,7.87,100,,,fee schedule,100% of CMS fee schedule,7.87,100,,,fee schedule,100% of CMS fee schedule,7.32,450,
"CHOLINESTERASE,RBC",300008833,CDM,301,RC,82482,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,15.7,160,,,fee schedule,160% of CMS fee schedule,12.75,130,,,fee schedule,130% of CMS fee schedule,9.67,100,,,fee schedule,100% of GA fee schedule,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,10.15,105,,,fee schedule,105% of GA fee schedule,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,9.67,100,,,fee schedule,100% of GA fee schedule,9.81,100,,,fee schedule,100% of CMS 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,9.67,100,,,fee schedule,100% of GA fee schedule,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.12,93,,,fee schedule,93% of CMS fee schedule,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,9.81,100,,,fee schedule,100% of CMS fee schedule,9.81,100,,,fee schedule,100% of CMS fee schedule,9.12,450,
TESTOSTERONE,300008834,CDM,301,RC,84403,HCPCS,outpatient,,,263,184.1,,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,41.3,160,,,fee schedule,160% of CMS fee schedule,33.55,130,,,fee schedule,130% of CMS fee schedule,32.47,100,,,fee schedule,100% of GA fee schedule,203.09,77.22,,162.47,percent of total billed charges,77.22% of total billed charges,34.09,105,,,fee schedule,105% of GA fee schedule,218.29,83,,174.63,percent of total billed charges,83% of total,249.85,95,,199.88,percent of total billed charges ,95% of total billed charges,210.4,80,,168.32,percent of total billed charges,78% of total billed charges,205.14,78,,164.112,percent of total billed charges,78% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,32.47,100,,,fee schedule,100% of GA fee schedule,25.81,100,,,fee schedule,100% of CMS 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,32.47,100,,,fee schedule,100% of GA fee schedule,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24,93,,,fee schedule,93% of CMS fee schedule,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,24,450,
THIOPURINE METHYLTRANS ENZYME,300008844,CDM,301,RC,84433,HCPCS,outpatient,,,633,443.1,,500.07,79,,400.06,percent of total billed charges,79% of total billed charges,569.7,90,,455.76,percent of total billed charges,90% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,35.47,160,,,fee schedule,160% of CMS fee schedule,28.82,130,,,fee schedule,130% of CMS fee schedule,17.74,100,,,fee schedule,100% of GA fee schedule,488.8,77.22,,391.04,percent of total billed charges,77.22% of total billed charges,18.63,105,,,fee schedule,105% of GA fee schedule,525.39,83,,420.31,percent of total billed charges,83% of total,601.35,95,,481.08,percent of total billed charges ,95% of total billed charges,506.4,80,,405.12,percent of total billed charges,78% of total billed charges,493.74,78,,394.992,percent of total billed charges,78% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,17.74,100,,,fee schedule,100% of GA fee schedule,22.17,100,,,fee schedule,100% of CMS fee schedule,569.7,90,,455.76,percent of total billed charges,90% of total billed charges,506.4,80,,405.12,percent of total billed charges,80% of total billed charges,17.74,100,,,fee schedule,100% of GA fee schedule,538.05,85,,430.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.62,93,,,fee schedule,93% of CMS fee schedule,500.07,79,,400.06,percent of total billed charges,79% of total billed charges,22.17,100,,,fee schedule,100% of CMS fee schedule,22.17,100,,,fee schedule,100% of CMS fee schedule,17.74,601.35,
"CHROMATOGRAPHY, QUANT 1",300008845,CDM,301,RC,82542,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,38.54,160,,,fee schedule,160% of CMS fee schedule,31.32,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.09,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.4,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
"CHROMATOGRAPHY, QUANT 2",300008846,CDM,301,RC,82542,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,38.54,160,,,fee schedule,160% of CMS fee schedule,31.32,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.09,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.4,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
"PHENYTOIN,FREE",300008847,CDM,301,RC,80186,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,13.76,100,,,fee schedule,100% of CMS fee schedule,22.02,160,,,fee schedule,160% of CMS fee schedule,17.89,130,,,fee schedule,130% of CMS fee schedule,17.31,100,,,fee schedule,100% of GA fee schedule,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,18.18,105,,,fee schedule,105% of GA fee schedule,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,13.76,100,,,fee schedule,100% of CMS fee schedule,17.31,100,,,fee schedule,100% of GA fee schedule,13.76,100,,,fee schedule,100% of CMS 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,17.31,100,,,fee schedule,100% of GA fee schedule,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.8,93,,,fee schedule,93% of CMS fee schedule,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,13.76,100,,,fee schedule,100% of CMS fee schedule,13.76,100,,,fee schedule,100% of CMS fee schedule,12.8,450,
18 HYDROXYCORTICOSTERONE,300008848,CDM,301,RC,82528,HCPCS,outpatient,,,181,126.7,,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,22.52,100,,,fee schedule,100% of CMS fee schedule,36.03,160,,,fee schedule,160% of CMS fee schedule,29.28,130,,,fee schedule,130% of CMS fee schedule,28.31,100,,,fee schedule,100% of GA fee schedule,139.77,77.22,,111.82,percent of total billed charges,77.22% of total billed charges,29.73,105,,,fee schedule,105% of GA fee schedule,150.23,83,,120.18,percent of total billed charges,83% of total,171.95,95,,137.56,percent of total billed charges ,95% of total billed charges,144.8,80,,115.84,percent of total billed charges,78% of total billed charges,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,22.52,100,,,fee schedule,100% of CMS fee schedule,28.31,100,,,fee schedule,100% of GA fee schedule,22.52,100,,,fee schedule,100% of CMS 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,28.31,100,,,fee schedule,100% of GA fee schedule,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.94,93,,,fee schedule,93% of CMS fee schedule,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,22.52,100,,,fee schedule,100% of CMS fee schedule,22.52,100,,,fee schedule,100% of CMS fee schedule,20.94,450,
LDL CHOLESTEROL DIRECT,300008849,CDM,301,RC,83721,HCPCS,outpatient,,,13,9.1,,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,11.7,90,,9.36,percent of total billed charges,90% of total billed charges,10.5,100,,,fee schedule,100% of CMS fee schedule,16.8,160,,,fee schedule,160% of CMS fee schedule,13.65,130,,,fee schedule,130% of CMS fee schedule,12,100,,,fee schedule,100% of GA fee schedule,10.04,77.22,,8.03,percent of total billed charges,77.22% of total billed charges,12.6,105,,,fee schedule,105% of GA fee schedule,10.79,83,,8.63,percent of total billed charges,83% of total,12.35,95,,9.88,percent of total billed charges ,95% of total billed charges,10.4,80,,8.32,percent of total billed charges,78% of total billed charges,10.14,78,,8.112,percent of total billed charges,78% of total billed charges,10.5,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of GA fee schedule,10.5,100,,,fee schedule,100% of CMS 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,12,100,,,fee schedule,100% of GA fee schedule,11.05,85,,8.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.77,93,,,fee schedule,93% of CMS fee schedule,10.27,79,,8.22,percent of total billed charges,79% of total billed charges,10.5,100,,,fee schedule,100% of CMS fee schedule,10.5,100,,,fee schedule,100% of CMS fee schedule,9.77,450,
DEOXYPYRIDINOLINE CROSSLINKS,300008865,CDM,301,RC,82523,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,29.89,160,,,fee schedule,160% of CMS fee schedule,24.28,130,,,fee schedule,130% of CMS fee schedule,23.5,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,24.68,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,23.5,100,,,fee schedule,100% of GA fee schedule,18.68,100,,,fee schedule,100% of CMS 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,23.5,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.37,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,18.68,100,,,fee schedule,100% of CMS fee schedule,17.37,450,
CORTISOL FREE,300008867,CDM,301,RC,82530,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,26.74,160,,,fee schedule,160% of CMS fee schedule,21.72,130,,,fee schedule,130% of CMS fee schedule,21.02,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,22.07,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,21.02,100,,,fee schedule,100% of GA fee schedule,16.71,100,,,fee schedule,100% of CMS 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,21.02,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.54,93,,,fee schedule,93% of CMS fee schedule,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,16.71,100,,,fee schedule,100% of CMS fee schedule,16.71,100,,,fee schedule,100% of CMS fee schedule,15.54,450,
RAPAMUNE,300008869,CDM,301,RC,80299,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
NEURONAL NUCLEAR,300008870,CDM,301,RC,83516,HCPCS,outpatient,,,473,331.1,,373.67,79,,298.94,percent of total billed charges,79% of total billed charges,425.7,90,,340.56,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,365.25,77.22,,292.2,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,392.59,83,,314.07,percent of total billed charges,83% of total,449.35,95,,359.48,percent of total billed charges ,95% of total billed charges,378.4,80,,302.72,percent of total billed charges,78% of total billed charges,368.94,78,,295.152,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,425.7,90,,340.56,percent of total billed charges,90% of total billed charges,378.4,80,,302.72,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,402.05,85,,321.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,373.67,79,,298.94,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ALPHA GLYCOPROTEIN SUBUNIT,300008884,CDM,301,RC,83519,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
DRUG SCREEN 10,300008885,CDM,301,RC,80307,HCPCS,outpatient,,,417,291.9,,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,322.01,77.22,,257.61,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,346.11,83,,276.89,percent of total billed charges,83% of total,396.15,95,,316.92,percent of total billed charges ,95% of total billed charges,333.6,80,,266.88,percent of total billed charges,78% of total billed charges,325.26,78,,260.208,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,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,61.16,100,,,fee schedule,100% of GA fee schedule,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
OPIATES CONFIRMATION,300008888,CDM,301,RC,80101,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
CANNABINOIDS CONFIRMATION,300008889,CDM,301,RC,G0480,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
SULFONAMICLES,300008890,CDM,301,RC,80299,HCPCS,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
PANCREATIC ELASTASE FECAL,300008905,CDM,301,RC,82653,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,22.97,100,,,fee schedule,100% of CMS fee schedule,36.75,160,,,fee schedule,160% of CMS fee schedule,29.86,130,,,fee schedule,130% of CMS fee schedule,18.38,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,19.3,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,22.97,100,,,fee schedule,100% of CMS fee schedule,18.38,100,,,fee schedule,100% of GA fee schedule,22.97,100,,,fee schedule,100% of CMS 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,18.38,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.36,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,22.97,100,,,fee schedule,100% of CMS fee schedule,22.97,100,,,fee schedule,100% of CMS fee schedule,18.38,450,
"TRYPSIN, STOOL",300008906,CDM,301,RC,84488,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,11.68,160,,,fee schedule,160% of CMS fee schedule,9.49,130,,,fee schedule,130% of CMS fee schedule,9.18,100,,,fee schedule,100% of GA fee schedule,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,9.64,105,,,fee schedule,105% of GA fee schedule,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,9.18,100,,,fee schedule,100% of GA fee schedule,7.3,100,,,fee schedule,100% of CMS 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,9.18,100,,,fee schedule,100% of GA fee schedule,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.79,93,,,fee schedule,93% of CMS fee schedule,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,6.79,450,
NEURONAL CELL ANTIBODIES,300008907,CDM,301,RC,83520,HCPCS,outpatient,,,402,281.4,,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,310.42,77.22,,248.34,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,333.66,83,,266.93,percent of total billed charges,83% of total,381.9,95,,305.52,percent of total billed charges ,95% of total billed charges,321.6,80,,257.28,percent of total billed charges,78% of total billed charges,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
VITAMIN B2,300008921,CDM,301,RC,84252,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,20.24,100,,,fee schedule,100% of CMS fee schedule,32.38,160,,,fee schedule,160% of CMS fee schedule,26.31,130,,,fee schedule,130% of CMS fee schedule,25.45,100,,,fee schedule,100% of GA fee schedule,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,26.72,105,,,fee schedule,105% of GA fee schedule,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,20.24,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of GA fee schedule,20.24,100,,,fee schedule,100% of CMS 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,25.45,100,,,fee schedule,100% of GA fee schedule,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.82,93,,,fee schedule,93% of CMS fee schedule,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,20.24,100,,,fee schedule,100% of CMS fee schedule,20.24,100,,,fee schedule,100% of CMS fee schedule,18.82,450,
VITAMIN B3,300008922,CDM,301,RC,84591,HCPCS,outpatient,,,304,212.8,,240.16,79,,192.13,percent of total billed charges,79% of total billed charges,273.6,90,,218.88,percent of total billed charges,90% of total billed charges,17.06,100,,,fee schedule,100% of CMS fee schedule,27.3,160,,,fee schedule,160% of CMS fee schedule,22.18,130,,,fee schedule,130% of CMS fee schedule,14.58,100,,,fee schedule,100% of GA fee schedule,234.75,77.22,,187.8,percent of total billed charges,77.22% of total billed charges,15.31,105,,,fee schedule,105% of GA fee schedule,252.32,83,,201.86,percent of total billed charges,83% of total,288.8,95,,231.04,percent of total billed charges ,95% of total billed charges,243.2,80,,194.56,percent of total billed charges,78% of total billed charges,237.12,78,,189.696,percent of total billed charges,78% of total billed charges,17.06,100,,,fee schedule,100% of CMS fee schedule,14.58,100,,,fee schedule,100% of GA fee schedule,17.06,100,,,fee schedule,100% of CMS 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,14.58,100,,,fee schedule,100% of GA fee schedule,258.4,85,,206.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.87,93,,,fee schedule,93% of CMS fee schedule,240.16,79,,192.13,percent of total billed charges,79% of total billed charges,17.06,100,,,fee schedule,100% of CMS fee schedule,17.06,100,,,fee schedule,100% of CMS fee schedule,14.58,450,
SERUM IMMUNOASSAY,300008924,CDM,301,RC,80101,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
"SERUM, GC/FID",300008925,CDM,301,RC,80100,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
"SERUM, GC/ECD",300008926,CDM,301,RC,80100,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
URINE IMMUNOASSAY,300008927,CDM,301,RC,80100,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
URINE GC/MS,300008928,CDM,301,RC,80101,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
ISOPROPANOL,300008930,CDM,301,RC,84600,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,17.11,100,,,fee schedule,100% of CMS fee schedule,27.38,160,,,fee schedule,160% of CMS fee schedule,22.24,130,,,fee schedule,130% of CMS fee schedule,20.21,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,21.22,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,17.11,100,,,fee schedule,100% of CMS fee schedule,20.21,100,,,fee schedule,100% of GA fee schedule,17.11,100,,,fee schedule,100% of CMS 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,20.21,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.91,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,17.11,100,,,fee schedule,100% of CMS fee schedule,17.11,100,,,fee schedule,100% of CMS fee schedule,15.91,450,
"PHENOTHIAZINE SCREEN,URINE",300008931,CDM,301,RC,84022,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
METHANOL,300008932,CDM,301,RC,84600,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,17.11,100,,,fee schedule,100% of CMS fee schedule,27.38,160,,,fee schedule,160% of CMS fee schedule,22.24,130,,,fee schedule,130% of CMS fee schedule,20.21,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,21.22,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,17.11,100,,,fee schedule,100% of CMS fee schedule,20.21,100,,,fee schedule,100% of GA fee schedule,17.11,100,,,fee schedule,100% of CMS 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,20.21,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.91,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,17.11,100,,,fee schedule,100% of CMS fee schedule,17.11,100,,,fee schedule,100% of CMS fee schedule,15.91,450,
PAIN MGT DRUG SCREEN,300008933,CDM,301,RC,80307,HCPCS,outpatient,,,417,291.9,,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,322.01,77.22,,257.61,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,346.11,83,,276.89,percent of total billed charges,83% of total,396.15,95,,316.92,percent of total billed charges ,95% of total billed charges,333.6,80,,266.88,percent of total billed charges,78% of total billed charges,325.26,78,,260.208,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,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,61.16,100,,,fee schedule,100% of GA fee schedule,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
LEAD SCREEN,300008934,CDM,301,RC,83655,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,19.38,160,,,fee schedule,160% of CMS fee schedule,15.74,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,12.11,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.26,93,,,fee schedule,93% of CMS fee schedule,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,10,450,
BENZODIAZEPINES BLOOD  13 OR >,300008936,CDM,301,RC,G0480,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
HYDROXTBUTYRIC,300008937,CDM,301,RC,80101,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
FLUNITRAZEPAM,300008938,CDM,301,RC,83663,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,18.91,100,,,fee schedule,100% of CMS fee schedule,30.26,160,,,fee schedule,160% of CMS fee schedule,24.58,130,,,fee schedule,130% of CMS fee schedule,11.9,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,12.5,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,18.91,100,,,fee schedule,100% of CMS fee schedule,11.9,100,,,fee schedule,100% of GA fee schedule,18.91,100,,,fee schedule,100% of CMS 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,11.9,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.59,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,18.91,100,,,fee schedule,100% of CMS fee schedule,18.91,100,,,fee schedule,100% of CMS fee schedule,11.9,450,
AMNISURE,300008939,CDM,301,RC,84112,HCPCS,outpatient,,,287,200.9,,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,98.11,100,,,fee schedule,100% of CMS fee schedule,156.98,160,,,fee schedule,160% of CMS fee schedule,127.54,130,,,fee schedule,130% of CMS fee schedule,72.51,100,,,fee schedule,100% of GA fee schedule,221.62,77.22,,177.3,percent of total billed charges,77.22% of total billed charges,76.14,105,,,fee schedule,105% of GA fee schedule,238.21,83,,190.57,percent of total billed charges,83% of total,272.65,95,,218.12,percent of total billed charges ,95% of total billed charges,229.6,80,,183.68,percent of total billed charges,78% of total billed charges,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,98.11,100,,,fee schedule,100% of CMS fee schedule,72.51,100,,,fee schedule,100% of GA fee schedule,98.11,100,,,fee schedule,100% of CMS 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,72.51,100,,,fee schedule,100% of GA fee schedule,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,91.24,93,,,fee schedule,93% of CMS fee schedule,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,98.11,100,,,fee schedule,100% of CMS fee schedule,98.11,100,,,fee schedule,100% of CMS fee schedule,72.51,450,
DRUG SCREEN PANEL 7,300008952,CDM,301,RC,80307,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
DRUG SCREEN PANEL 7,300008953,CDM,301,RC,83520,HCPCS,outpatient,,,281,196.7,,221.99,79,,177.59,percent of total billed charges,79% of total billed charges,252.9,90,,202.32,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,216.99,77.22,,173.59,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,233.23,83,,186.58,percent of total billed charges,83% of total,266.95,95,,213.56,percent of total billed charges ,95% of total billed charges,224.8,80,,179.84,percent of total billed charges,78% of total billed charges,219.18,78,,175.344,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,238.85,85,,191.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,221.99,79,,177.59,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
HISTAMINE,300008958,CDM,301,RC,83088,HCPCS,outpatient,,,522,365.4,,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,29.53,100,,,fee schedule,100% of CMS fee schedule,47.25,160,,,fee schedule,160% of CMS fee schedule,38.39,130,,,fee schedule,130% of CMS fee schedule,37.13,100,,,fee schedule,100% of GA fee schedule,403.09,77.22,,322.47,percent of total billed charges,77.22% of total billed charges,38.99,105,,,fee schedule,105% of GA fee schedule,433.26,83,,346.61,percent of total billed charges,83% of total,495.9,95,,396.72,percent of total billed charges ,95% of total billed charges,417.6,80,,334.08,percent of total billed charges,78% of total billed charges,407.16,78,,325.728,percent of total billed charges,78% of total billed charges,29.53,100,,,fee schedule,100% of CMS fee schedule,37.13,100,,,fee schedule,100% of GA fee schedule,29.53,100,,,fee schedule,100% of CMS 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,37.13,100,,,fee schedule,100% of GA fee schedule,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.46,93,,,fee schedule,93% of CMS fee schedule,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,29.53,100,,,fee schedule,100% of CMS fee schedule,29.53,100,,,fee schedule,100% of CMS fee schedule,27.46,495.9,
THYROID STIMULATING HORMONE,300008961,CDM,301,RC,84443,HCPCS,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,26.88,160,,,fee schedule,160% of CMS fee schedule,21.84,130,,,fee schedule,130% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,22.18,105,,,fee schedule,105% of GA fee schedule,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,16.8,100,,,fee schedule,100% of CMS 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,21.12,100,,,fee schedule,100% of GA fee schedule,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.62,93,,,fee schedule,93% of CMS fee schedule,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,15.62,450,
XANAX,300008963,CDM,301,RC,G0480,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
IGE,300008975,CDM,301,RC,82785,HCPCS,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,26.34,160,,,fee schedule,160% of CMS fee schedule,21.4,130,,,fee schedule,130% of CMS fee schedule,20.71,100,,,fee schedule,100% of GA fee schedule,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,21.75,105,,,fee schedule,105% of GA fee schedule,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,20.71,100,,,fee schedule,100% of GA fee schedule,16.46,100,,,fee schedule,100% of CMS 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,20.71,100,,,fee schedule,100% of GA fee schedule,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.31,93,,,fee schedule,93% of CMS fee schedule,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,16.46,100,,,fee schedule,100% of CMS fee schedule,16.46,100,,,fee schedule,100% of CMS fee schedule,15.31,450,
CLOMIPRAMINE,300008980,CDM,301,RC,80335,HCPCS,outpatient,,,136,95.2,,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,105.02,77.22,,84.02,percent of total billed charges,77.22% of total billed charges,23.64,105,,,fee schedule,105% of GA fee schedule,112.88,83,,90.3,percent of total billed charges,83% of total,129.2,95,,103.36,percent of total billed charges ,95% of total billed charges,108.8,80,,87.04,percent of total billed charges,78% of total billed charges,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.51,100,,,fee schedule,100% of GA fee schedule,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.51,450,
UMETHAD,300008982,CDM,301,RC,G0480,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,34.75,450,
"ARSENIC, INORGANIC",300008983,CDM,301,RC,82175,HCPCS,outpatient,,,145,101.5,,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,30.35,160,,,fee schedule,160% of CMS fee schedule,24.66,130,,,fee schedule,130% of CMS fee schedule,23.86,100,,,fee schedule,100% of GA fee schedule,111.97,77.22,,89.58,percent of total billed charges,77.22% of total billed charges,25.05,105,,,fee schedule,105% of GA fee schedule,120.35,83,,96.28,percent of total billed charges,83% of total,137.75,95,,110.2,percent of total billed charges ,95% of total billed charges,116,80,,92.8,percent of total billed charges,78% of total billed charges,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,23.86,100,,,fee schedule,100% of GA fee schedule,18.97,100,,,fee schedule,100% of CMS 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,23.86,100,,,fee schedule,100% of GA fee schedule,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.64,93,,,fee schedule,93% of CMS fee schedule,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,18.97,100,,,fee schedule,100% of CMS fee schedule,18.97,100,,,fee schedule,100% of CMS fee schedule,17.64,450,
CLONIDINE,300008985,CDM,301,RC,80299,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
HEALTH CARE OPIATE SCREEN,300008989,CDM,301,RC,80100,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
INTERLEUKIN 6 BY CIA,300008990,CDM,301,RC,83529,HCPCS,outpatient,,,277,193.9,,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,13.82,100,,,fee schedule,100% of GA fee schedule,213.9,77.22,,171.12,percent of total billed charges,77.22% of total billed charges,14.51,105,,,fee schedule,105% of GA fee schedule,229.91,83,,183.93,percent of total billed charges,83% of total,263.15,95,,210.52,percent of total billed charges ,95% of total billed charges,221.6,80,,177.28,percent of total billed charges,78% of total billed charges,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,13.82,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,13.82,100,,,fee schedule,100% of GA fee schedule,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,13.82,450,
25 HYDROXY VITAMIN D2/D3,300009001,CDM,301,RC,82306,HCPCS,outpatient,,,221,154.7,,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,47.36,160,,,fee schedule,160% of CMS fee schedule,38.48,130,,,fee schedule,130% of CMS fee schedule,37.22,100,,,fee schedule,100% of GA fee schedule,170.66,77.22,,136.53,percent of total billed charges,77.22% of total billed charges,39.08,105,,,fee schedule,105% of GA fee schedule,183.43,83,,146.74,percent of total billed charges,83% of total,209.95,95,,167.96,percent of total billed charges ,95% of total billed charges,176.8,80,,141.44,percent of total billed charges,78% of total billed charges,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,37.22,100,,,fee schedule,100% of GA fee schedule,29.6,100,,,fee schedule,100% of CMS 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,37.22,100,,,fee schedule,100% of GA fee schedule,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.53,93,,,fee schedule,93% of CMS fee schedule,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,29.6,100,,,fee schedule,100% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,27.53,450,
"METHYLHISTAMINE, 24 HR UR",300009034,CDM,301,RC,83789,HCPCS,outpatient,,,338,236.6,,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,38.58,160,,,fee schedule,160% of CMS fee schedule,31.34,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,261,77.22,,208.8,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,280.54,83,,224.43,percent of total billed charges,83% of total,321.1,95,,256.88,percent of total billed charges ,95% of total billed charges,270.4,80,,216.32,percent of total billed charges,78% of total billed charges,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.42,93,,,fee schedule,93% of CMS fee schedule,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
DEXAMETHASONE,300009036,CDM,301,RC,80299,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
PHENYLALANINE LEVEL,300009038,CDM,301,RC,82131,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,36.77,160,,,fee schedule,160% of CMS fee schedule,29.87,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,22.98,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.37,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,450,
TYROSINE LEVEL,300009039,CDM,301,RC,84510,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,10.63,100,,,fee schedule,100% of CMS fee schedule,17.01,160,,,fee schedule,160% of CMS fee schedule,13.82,130,,,fee schedule,130% of CMS fee schedule,13.08,100,,,fee schedule,100% of GA fee schedule,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,13.73,105,,,fee schedule,105% of GA fee schedule,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,10.63,100,,,fee schedule,100% of CMS fee schedule,13.08,100,,,fee schedule,100% of GA fee schedule,10.63,100,,,fee schedule,100% of CMS 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,13.08,100,,,fee schedule,100% of GA fee schedule,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.89,93,,,fee schedule,93% of CMS fee schedule,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,10.63,100,,,fee schedule,100% of CMS fee schedule,10.63,100,,,fee schedule,100% of CMS fee schedule,9.89,450,
INHIBIN B,300009043,CDM,301,RC,83520,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
GLYCOMARK,300009044,CDM,301,RC,84378,HCPCS,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,14.49,100,,,fee schedule,100% of GA fee schedule,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,15.21,105,,,fee schedule,105% of GA fee schedule,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,14.49,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,14.49,100,,,fee schedule,100% of GA fee schedule,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
SEROQUEL,300009056,CDM,301,RC,80299,HCPCS,outpatient,,,262,183.4,,206.98,79,,165.58,percent of total billed charges,79% of total billed charges,235.8,90,,188.64,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,202.32,77.22,,161.86,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,217.46,83,,173.97,percent of total billed charges,83% of total,248.9,95,,199.12,percent of total billed charges ,95% of total billed charges,209.6,80,,167.68,percent of total billed charges,78% of total billed charges,204.36,78,,163.488,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,222.7,85,,178.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,206.98,79,,165.58,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
CARBON MONOXIDE,300009057,CDM,301,RC,82375,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,19.71,160,,,fee schedule,160% of CMS fee schedule,16.02,130,,,fee schedule,130% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,3.8,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,12.32,100,,,fee schedule,100% of CMS 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,3.62,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.46,93,,,fee schedule,93% of CMS fee schedule,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,12.32,100,,,fee schedule,100% of CMS fee schedule,12.32,100,,,fee schedule,100% of CMS fee schedule,3.62,450,
"HER-Z/NEU,SERUM",300009065,CDM,301,RC,83950,HCPCS,outpatient,,,390,273,,308.1,79,,246.48,percent of total billed charges,79% of total billed charges,351,90,,280.8,percent of total billed charges,90% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,103.06,160,,,fee schedule,160% of CMS fee schedule,83.73,130,,,fee schedule,130% of CMS fee schedule,80.99,100,,,fee schedule,100% of GA fee schedule,301.16,77.22,,240.93,percent of total billed charges,77.22% of total billed charges,85.04,105,,,fee schedule,105% of GA fee schedule,323.7,83,,258.96,percent of total billed charges,83% of total,370.5,95,,296.4,percent of total billed charges ,95% of total billed charges,312,80,,249.6,percent of total billed charges,78% of total billed charges,304.2,78,,243.36,percent of total billed charges,78% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,80.99,100,,,fee schedule,100% of GA fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,351,90,,280.8,percent of total billed charges,90% of total billed charges,312,80,,249.6,percent of total billed charges,80% of total billed charges,80.99,100,,,fee schedule,100% of GA fee schedule,331.5,85,,265.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,59.9,93,,,fee schedule,93% of CMS fee schedule,308.1,79,,246.48,percent of total billed charges,79% of total billed charges,64.41,100,,,fee schedule,100% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,59.9,450,
EPIDERMAL GROWTH FACTOR,300009066,CDM,301,RC,84238,HCPCS,outpatient,,,323,226.1,,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,36.57,100,,,fee schedule,100% of CMS fee schedule,58.51,160,,,fee schedule,160% of CMS fee schedule,47.54,130,,,fee schedule,130% of CMS fee schedule,45.98,100,,,fee schedule,100% of GA fee schedule,249.42,77.22,,199.54,percent of total billed charges,77.22% of total billed charges,48.28,105,,,fee schedule,105% of GA fee schedule,268.09,83,,214.47,percent of total billed charges,83% of total,306.85,95,,245.48,percent of total billed charges ,95% of total billed charges,258.4,80,,206.72,percent of total billed charges,78% of total billed charges,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,36.57,100,,,fee schedule,100% of CMS fee schedule,45.98,100,,,fee schedule,100% of GA fee schedule,36.57,100,,,fee schedule,100% of CMS fee schedule,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,45.98,100,,,fee schedule,100% of GA fee schedule,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,34.01,93,,,fee schedule,93% of CMS fee schedule,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,36.57,100,,,fee schedule,100% of CMS fee schedule,36.57,100,,,fee schedule,100% of CMS fee schedule,34.01,450,
VASCULAR ENDOTHELIAL GROWTH F,300009067,CDM,301,RC,83520,HCPCS,outpatient,,,334,233.8,,263.86,79,,211.09,percent of total billed charges,79% of total billed charges,300.6,90,,240.48,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,257.91,77.22,,206.33,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,277.22,83,,221.78,percent of total billed charges,83% of total,317.3,95,,253.84,percent of total billed charges ,95% of total billed charges,267.2,80,,213.76,percent of total billed charges,78% of total billed charges,260.52,78,,208.416,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,283.9,85,,227.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,263.86,79,,211.09,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
IGA,300009068,CDM,301,RC,82784,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,14.88,160,,,fee schedule,160% of CMS fee schedule,12.09,130,,,fee schedule,130% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,12.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,11.69,100,,,fee schedule,100% of GA fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,11.69,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.65,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,8.65,450,
IGA SUBCLASS I,300009069,CDM,301,RC,82787,HCPCS,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,12.83,160,,,fee schedule,160% of CMS fee schedule,10.43,130,,,fee schedule,130% of CMS fee schedule,10.08,100,,,fee schedule,100% of GA fee schedule,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,10.58,105,,,fee schedule,105% of GA fee schedule,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,10.08,100,,,fee schedule,100% of GA fee schedule,8.02,100,,,fee schedule,100% of CMS 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,10.08,100,,,fee schedule,100% of GA fee schedule,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.46,93,,,fee schedule,93% of CMS fee schedule,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,8.02,100,,,fee schedule,100% of CMS fee schedule,7.46,450,
IGA SUBCLASS II,300009070,CDM,301,RC,82787,HCPCS,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,12.83,160,,,fee schedule,160% of CMS fee schedule,10.43,130,,,fee schedule,130% of CMS fee schedule,10.08,100,,,fee schedule,100% of GA fee schedule,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,10.58,105,,,fee schedule,105% of GA fee schedule,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,10.08,100,,,fee schedule,100% of GA fee schedule,8.02,100,,,fee schedule,100% of CMS 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,10.08,100,,,fee schedule,100% of GA fee schedule,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.46,93,,,fee schedule,93% of CMS fee schedule,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,8.02,100,,,fee schedule,100% of CMS fee schedule,8.02,100,,,fee schedule,100% of CMS fee schedule,7.46,450,
RENIN,300009078,CDM,301,RC,84244,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,35.18,160,,,fee schedule,160% of CMS fee schedule,28.59,130,,,fee schedule,130% of CMS fee schedule,27.66,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,29.04,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,27.66,100,,,fee schedule,100% of GA fee schedule,21.99,100,,,fee schedule,100% of CMS 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,27.66,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.45,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,21.99,100,,,fee schedule,100% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,20.45,450,
PEPSINOGEN,300009081,CDM,301,RC,83519,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
ANTI IGE,300009098,CDM,301,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
GALACTOSE-1-PHOSPHATE URIDYLTR,300009099,CDM,301,RC,82775,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,21.07,100,,,fee schedule,100% of CMS fee schedule,33.71,160,,,fee schedule,160% of CMS fee schedule,27.39,130,,,fee schedule,130% of CMS fee schedule,26.49,100,,,fee schedule,100% of GA fee schedule,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,27.81,105,,,fee schedule,105% of GA fee schedule,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,21.07,100,,,fee schedule,100% of CMS fee schedule,26.49,100,,,fee schedule,100% of GA fee schedule,21.07,100,,,fee schedule,100% of CMS fee schedule,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,26.49,100,,,fee schedule,100% of GA fee schedule,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.6,93,,,fee schedule,93% of CMS fee schedule,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,21.07,100,,,fee schedule,100% of CMS fee schedule,21.07,100,,,fee schedule,100% of CMS fee schedule,19.6,450,
LIGHT CHAIN KAPPA,300009100,CDM,301,RC,83521,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,13.82,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,14.51,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,13.82,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,13.82,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,13.82,450,
LIGHT CHAIN LAMDBA,300009101,CDM,301,RC,83521,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,13.82,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,14.51,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,13.82,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,13.82,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,13.82,450,
CALPROTECTIN FECAL,300009102,CDM,301,RC,83993,HCPCS,outpatient,,,182,127.4,,143.78,79,,115.02,percent of total billed charges,79% of total billed charges,163.8,90,,131.04,percent of total billed charges,90% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,31.41,160,,,fee schedule,160% of CMS fee schedule,25.52,130,,,fee schedule,130% of CMS fee schedule,24.68,100,,,fee schedule,100% of GA fee schedule,140.54,77.22,,112.43,percent of total billed charges,77.22% of total billed charges,25.91,105,,,fee schedule,105% of GA fee schedule,151.06,83,,120.85,percent of total billed charges,83% of total,172.9,95,,138.32,percent of total billed charges ,95% of total billed charges,145.6,80,,116.48,percent of total billed charges,78% of total billed charges,141.96,78,,113.568,percent of total billed charges,78% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,24.68,100,,,fee schedule,100% of GA fee schedule,19.63,100,,,fee schedule,100% of CMS 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,24.68,100,,,fee schedule,100% of GA fee schedule,154.7,85,,123.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.26,93,,,fee schedule,93% of CMS fee schedule,143.78,79,,115.02,percent of total billed charges,79% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,18.26,450,
OCCULT BLOOD (OTHER THAN SCREN,300009103,CDM,301,RC,82272,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,6.77,160,,,fee schedule,160% of CMS fee schedule,5.5,130,,,fee schedule,130% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,4.24,105,,,fee schedule,105% of GA fee schedule,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,4.23,100,,,fee schedule,100% of CMS 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,4.04,100,,,fee schedule,100% of GA fee schedule,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.93,93,,,fee schedule,93% of CMS fee schedule,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,3.93,450,
MYCOPHENOLIC ACID,300009104,CDM,301,RC,80180,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,28.88,160,,,fee schedule,160% of CMS fee schedule,23.47,130,,,fee schedule,130% of CMS fee schedule,6.5,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,6.83,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,6.5,100,,,fee schedule,100% of GA fee schedule,18.05,100,,,fee schedule,100% of CMS 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,6.5,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.79,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,18.05,100,,,fee schedule,100% of CMS fee schedule,18.05,100,,,fee schedule,100% of CMS fee schedule,6.5,450,
"FATTY ACID, FREE",300009114,CDM,301,RC,82725,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,18.77,100,,,fee schedule,100% of CMS fee schedule,30.03,160,,,fee schedule,160% of CMS fee schedule,24.4,130,,,fee schedule,130% of CMS fee schedule,16.74,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,17.58,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,18.77,100,,,fee schedule,100% of CMS fee schedule,16.74,100,,,fee schedule,100% of GA fee schedule,18.77,100,,,fee schedule,100% of CMS 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,16.74,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.46,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,18.77,100,,,fee schedule,100% of CMS fee schedule,18.77,100,,,fee schedule,100% of CMS fee schedule,16.74,450,
TISSUE PREPARATION,300009115,CDM,301,RC,80103,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
MAGANESIUM,300009116,CDM,301,RC,83735,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,10.72,160,,,fee schedule,160% of CMS fee schedule,8.71,130,,,fee schedule,130% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,8.84,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,6.7,100,,,fee schedule,100% of CMS 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,8.42,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.23,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.23,450,
THIN LAYER ANALYTE,300009117,CDM,301,RC,84999,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
PHOSPHORUS INORGANIC,300009118,CDM,301,RC,84100,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,7.58,160,,,fee schedule,160% of CMS fee schedule,6.16,130,,,fee schedule,130% of CMS fee schedule,5.97,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,6.27,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,5.97,100,,,fee schedule,100% of GA fee schedule,4.74,100,,,fee schedule,100% of CMS 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,5.97,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.41,93,,,fee schedule,93% of CMS fee schedule,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,4.74,100,,,fee schedule,100% of CMS fee schedule,4.41,450,
ACETYLCHOLINE REC BINDING AB,300009130,CDM,301,RC,83519,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
ACETYLCHOLINE REC BLOCKING AB,300009132,CDM,301,RC,83519,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
ACETYLCHOLINE RC MODULATING AB,300009133,CDM,301,RC,86043,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.64,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,450,
MACRO PROLACTIN,300009135,CDM,301,RC,84146,HCPCS,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,31.01,160,,,fee schedule,160% of CMS fee schedule,25.19,130,,,fee schedule,130% of CMS fee schedule,24.37,100,,,fee schedule,100% of GA fee schedule,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,25.59,105,,,fee schedule,105% of GA fee schedule,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,24.37,100,,,fee schedule,100% of GA fee schedule,19.38,100,,,fee schedule,100% of CMS 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,24.37,100,,,fee schedule,100% of GA fee schedule,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.02,93,,,fee schedule,93% of CMS fee schedule,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,18.02,450,
PROLACTIN ICMA,300009136,CDM,301,RC,84146,HCPCS,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,31.01,160,,,fee schedule,160% of CMS fee schedule,25.19,130,,,fee schedule,130% of CMS fee schedule,24.37,100,,,fee schedule,100% of GA fee schedule,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,25.59,105,,,fee schedule,105% of GA fee schedule,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,24.37,100,,,fee schedule,100% of GA fee schedule,19.38,100,,,fee schedule,100% of CMS 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,24.37,100,,,fee schedule,100% of GA fee schedule,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.02,93,,,fee schedule,93% of CMS fee schedule,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,19.38,100,,,fee schedule,100% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,18.02,450,
OCCULT BLOOD FECAL IMMUNOASSAY,300009138,CDM,301,RC,82274,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,15.92,100,,,fee schedule,100% of CMS fee schedule,25.47,160,,,fee schedule,160% of CMS fee schedule,20.7,130,,,fee schedule,130% of CMS fee schedule,21.69,100,,,fee schedule,100% of GA fee schedule,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,22.77,105,,,fee schedule,105% of GA fee schedule,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,15.92,100,,,fee schedule,100% of CMS fee schedule,21.69,100,,,fee schedule,100% of GA fee schedule,15.92,100,,,fee schedule,100% of CMS 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,21.69,100,,,fee schedule,100% of GA fee schedule,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.81,93,,,fee schedule,93% of CMS fee schedule,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,15.92,100,,,fee schedule,100% of CMS fee schedule,15.92,100,,,fee schedule,100% of CMS fee schedule,14.81,450,
LIPROTEIN BLOOD,300009142,CDM,301,RC,83704,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,54.7,160,,,fee schedule,160% of CMS fee schedule,44.45,130,,,fee schedule,130% of CMS fee schedule,39.67,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,41.65,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,39.67,100,,,fee schedule,100% of GA fee schedule,34.19,100,,,fee schedule,100% of CMS 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,39.67,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.8,93,,,fee schedule,93% of CMS fee schedule,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,34.19,100,,,fee schedule,100% of CMS fee schedule,31.8,450,
TRIGLYCERIDES,300009143,CDM,301,RC,84478,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,9.18,160,,,fee schedule,160% of CMS fee schedule,7.46,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.74,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.34,93,,,fee schedule,93% of CMS fee schedule,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,5.74,100,,,fee schedule,100% of CMS fee schedule,5.34,450,
BENZTROPINE SERUM,300009149,CDM,301,RC,80299,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
BENZODIAZEPENE CONF URINE 1-12,300009160,CDM,301,RC,G0480,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
URINE IODINE,300009177,CDM,301,RC,83789,HCPCS,outpatient,,,338,236.6,,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,38.58,160,,,fee schedule,160% of CMS fee schedule,31.34,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,261,77.22,,208.8,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,280.54,83,,224.43,percent of total billed charges,83% of total,321.1,95,,256.88,percent of total billed charges ,95% of total billed charges,270.4,80,,216.32,percent of total billed charges,78% of total billed charges,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.42,93,,,fee schedule,93% of CMS fee schedule,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
FSHP - FSH PEDIATRICS,300009182,CDM,301,RC,83001,HCPCS,outpatient,,,211,147.7,,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,29.73,160,,,fee schedule,160% of CMS fee schedule,24.15,130,,,fee schedule,130% of CMS fee schedule,23.37,100,,,fee schedule,100% of GA fee schedule,162.93,77.22,,130.34,percent of total billed charges,77.22% of total billed charges,24.54,105,,,fee schedule,105% of GA fee schedule,175.13,83,,140.1,percent of total billed charges,83% of total,200.45,95,,160.36,percent of total billed charges ,95% of total billed charges,168.8,80,,135.04,percent of total billed charges,78% of total billed charges,164.58,78,,131.664,percent of total billed charges,78% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,23.37,100,,,fee schedule,100% of GA fee schedule,18.58,100,,,fee schedule,100% of CMS 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,23.37,100,,,fee schedule,100% of GA fee schedule,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.28,93,,,fee schedule,93% of CMS fee schedule,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,18.58,100,,,fee schedule,100% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,17.28,450,
LHPED - LH PEDIATRICS,300009183,CDM,301,RC,83002,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,29.63,160,,,fee schedule,160% of CMS fee schedule,24.08,130,,,fee schedule,130% of CMS fee schedule,23.29,100,,,fee schedule,100% of GA fee schedule,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,24.45,105,,,fee schedule,105% of GA fee schedule,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,23.29,100,,,fee schedule,100% of GA fee schedule,18.52,100,,,fee schedule,100% of CMS 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,23.29,100,,,fee schedule,100% of GA fee schedule,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.22,93,,,fee schedule,93% of CMS fee schedule,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,17.22,450,
METHYLMALONIC ACID URINE,300009184,CDM,301,RC,82570,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,8.29,160,,,fee schedule,160% of CMS fee schedule,6.73,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,5.18,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.82,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,4.82,450,
COLBALT BLOOD,300009185,CDM,301,RC,83018,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,35.14,160,,,fee schedule,160% of CMS fee schedule,28.55,130,,,fee schedule,130% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,28.99,105,,,fee schedule,105% of GA fee schedule,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,21.96,100,,,fee schedule,100% of CMS 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,27.61,100,,,fee schedule,100% of GA fee schedule,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.42,93,,,fee schedule,93% of CMS fee schedule,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,20.42,450,
INSULIN FREE,300009187,CDM,301,RC,83527,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,20.72,160,,,fee schedule,160% of CMS fee schedule,16.84,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,12.95,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.04,93,,,fee schedule,93% of CMS fee schedule,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,12.04,450,
CORTISOL SALIVARY,300009188,CDM,301,RC,82533,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,26.08,160,,,fee schedule,160% of CMS fee schedule,21.19,130,,,fee schedule,130% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,21.53,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,16.3,100,,,fee schedule,100% of CMS 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,20.5,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.16,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,15.16,450,
ALPHA 2 MACROGLOBULINS QN,300009191,CDM,301,RC,83883,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,21.76,160,,,fee schedule,160% of CMS fee schedule,17.68,130,,,fee schedule,130% of CMS fee schedule,17.1,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,17.96,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,17.1,100,,,fee schedule,100% of GA fee schedule,13.6,100,,,fee schedule,100% of CMS 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,17.1,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.65,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,13.6,100,,,fee schedule,100% of CMS fee schedule,12.65,450,
CORTISOL SALIVARY W MODIFIER,300009198,CDM,301,RC,82533,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,26.08,160,,,fee schedule,160% of CMS fee schedule,21.19,130,,,fee schedule,130% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,21.53,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,16.3,100,,,fee schedule,100% of CMS 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,20.5,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.16,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,15.16,450,
AMMONIA STONE RISK,300009218,CDM,301,RC,82140,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,23.31,160,,,fee schedule,160% of CMS fee schedule,18.94,130,,,fee schedule,130% of CMS fee schedule,12.44,100,,,fee schedule,100% of GA fee schedule,168.34,77.22,,134.67,percent of total billed charges,77.22% of total billed charges,13.06,105,,,fee schedule,105% of GA fee schedule,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,12.44,100,,,fee schedule,100% of GA fee schedule,14.57,100,,,fee schedule,100% of CMS 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,12.44,100,,,fee schedule,100% of GA fee schedule,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.55,93,,,fee schedule,93% of CMS fee schedule,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,14.57,100,,,fee schedule,100% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,12.44,450,
URINE CALCIUM STONE RISK,300009219,CDM,301,RC,82340,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,9.65,160,,,fee schedule,160% of CMS fee schedule,7.84,130,,,fee schedule,130% of CMS fee schedule,7.59,100,,,fee schedule,100% of GA fee schedule,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,7.97,105,,,fee schedule,105% of GA fee schedule,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,7.59,100,,,fee schedule,100% of GA fee schedule,6.03,100,,,fee schedule,100% of CMS 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,7.59,100,,,fee schedule,100% of GA fee schedule,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.61,93,,,fee schedule,93% of CMS fee schedule,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,6.03,100,,,fee schedule,100% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,5.61,450,
CITRIC ACID STONE RISK,300009220,CDM,301,RC,82507,HCPCS,outpatient,,,369,258.3,,291.51,79,,233.21,percent of total billed charges,79% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,44.48,160,,,fee schedule,160% of CMS fee schedule,36.14,130,,,fee schedule,130% of CMS fee schedule,34.97,100,,,fee schedule,100% of GA fee schedule,284.94,77.22,,227.95,percent of total billed charges,77.22% of total billed charges,36.72,105,,,fee schedule,105% of GA fee schedule,306.27,83,,245.02,percent of total billed charges,83% of total,350.55,95,,280.44,percent of total billed charges ,95% of total billed charges,295.2,80,,236.16,percent of total billed charges,78% of total billed charges,287.82,78,,230.256,percent of total billed charges,78% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,34.97,100,,,fee schedule,100% of GA fee schedule,27.8,100,,,fee schedule,100% of CMS 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,34.97,100,,,fee schedule,100% of GA fee schedule,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.85,93,,,fee schedule,93% of CMS fee schedule,291.51,79,,233.21,percent of total billed charges,79% of total billed charges,27.8,100,,,fee schedule,100% of CMS fee schedule,27.8,100,,,fee schedule,100% of CMS fee schedule,25.85,450,
CREATNINE STONE RISK,300009221,CDM,301,RC,82570,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,8.29,160,,,fee schedule,160% of CMS fee schedule,6.73,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,5.18,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.82,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,4.82,450,
MAGNESIUM STONE RISK,300009222,CDM,301,RC,83735,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,10.72,160,,,fee schedule,160% of CMS fee schedule,8.71,130,,,fee schedule,130% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,8.84,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,8.42,100,,,fee schedule,100% of GA fee schedule,6.7,100,,,fee schedule,100% of CMS 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,8.42,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.23,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.23,450,
OXALATE STONE RISK,300009223,CDM,301,RC,83945,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,23.12,160,,,fee schedule,160% of CMS fee schedule,18.79,130,,,fee schedule,130% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,17,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,16.19,100,,,fee schedule,100% of GA fee schedule,14.45,100,,,fee schedule,100% of CMS 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,16.19,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.44,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,14.45,100,,,fee schedule,100% of CMS fee schedule,14.45,100,,,fee schedule,100% of CMS fee schedule,13.44,450,
PH URINE STONE RISK,300009224,CDM,301,RC,83986,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,5.73,160,,,fee schedule,160% of CMS fee schedule,4.65,130,,,fee schedule,130% of CMS fee schedule,4.5,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,4.73,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,4.5,100,,,fee schedule,100% of GA fee schedule,3.58,100,,,fee schedule,100% of CMS 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,4.5,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.33,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,3.58,100,,,fee schedule,100% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,3.33,450,
PHOSPHORUS STONE RISK,300009225,CDM,301,RC,84105,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,9.25,160,,,fee schedule,160% of CMS fee schedule,7.51,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,5.78,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.38,93,,,fee schedule,93% of CMS fee schedule,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,5.38,450,
POTASSIUM STONE RISK,300009226,CDM,301,RC,84133,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,7.57,160,,,fee schedule,160% of CMS fee schedule,6.15,130,,,fee schedule,130% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,5.68,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,4.73,100,,,fee schedule,100% of CMS 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,5.41,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.4,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,4.73,100,,,fee schedule,100% of CMS fee schedule,4.73,100,,,fee schedule,100% of CMS fee schedule,4.4,450,
SODIUM STONE RISK,300009227,CDM,301,RC,84300,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,5.06,100,,,fee schedule,100% of CMS fee schedule,8.1,160,,,fee schedule,160% of CMS fee schedule,6.58,130,,,fee schedule,130% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,4.57,105,,,fee schedule,105% of GA fee schedule,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,5.06,100,,,fee schedule,100% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,5.06,100,,,fee schedule,100% of CMS 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,4.35,100,,,fee schedule,100% of GA fee schedule,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.71,93,,,fee schedule,93% of CMS fee schedule,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,5.06,100,,,fee schedule,100% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,4.35,450,
SULFATE STONE RISK,300009228,CDM,301,RC,84392,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,5.49,100,,,fee schedule,100% of CMS fee schedule,8.78,160,,,fee schedule,160% of CMS fee schedule,7.14,130,,,fee schedule,130% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,6.28,105,,,fee schedule,105% of GA fee schedule,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,5.49,100,,,fee schedule,100% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,5.49,100,,,fee schedule,100% of CMS 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,5.98,100,,,fee schedule,100% of GA fee schedule,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.11,93,,,fee schedule,93% of CMS fee schedule,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,5.49,100,,,fee schedule,100% of CMS fee schedule,5.49,100,,,fee schedule,100% of CMS fee schedule,5.11,450,
URIC ACID STONE RISK,300009229,CDM,301,RC,84560,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,8.13,160,,,fee schedule,160% of CMS fee schedule,6.6,130,,,fee schedule,130% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,6.28,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,5.98,100,,,fee schedule,100% of GA fee schedule,5.08,100,,,fee schedule,100% of CMS 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,5.98,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.72,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,5.08,100,,,fee schedule,100% of CMS fee schedule,5.08,100,,,fee schedule,100% of CMS fee schedule,4.72,450,
17 HYDROXYPREGNENOLONE,300009233,CDM,301,RC,84143,HCPCS,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,22.81,100,,,fee schedule,100% of CMS fee schedule,36.5,160,,,fee schedule,160% of CMS fee schedule,29.65,130,,,fee schedule,130% of CMS fee schedule,28.7,100,,,fee schedule,100% of GA fee schedule,59.46,77.22,,47.57,percent of total billed charges,77.22% of total billed charges,30.14,105,,,fee schedule,105% of GA fee schedule,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,22.81,100,,,fee schedule,100% of CMS fee schedule,28.7,100,,,fee schedule,100% of GA fee schedule,22.81,100,,,fee schedule,100% of CMS 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,28.7,100,,,fee schedule,100% of GA fee schedule,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.21,93,,,fee schedule,93% of CMS fee schedule,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,22.81,100,,,fee schedule,100% of CMS fee schedule,22.81,100,,,fee schedule,100% of CMS fee schedule,21.21,450,
SOLUBLE TRANSFERRIN RECEPTOR,300009234,CDM,301,RC,84238,HCPCS,outpatient,,,323,226.1,,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,36.57,100,,,fee schedule,100% of CMS fee schedule,58.51,160,,,fee schedule,160% of CMS fee schedule,47.54,130,,,fee schedule,130% of CMS fee schedule,45.98,100,,,fee schedule,100% of GA fee schedule,249.42,77.22,,199.54,percent of total billed charges,77.22% of total billed charges,48.28,105,,,fee schedule,105% of GA fee schedule,268.09,83,,214.47,percent of total billed charges,83% of total,306.85,95,,245.48,percent of total billed charges ,95% of total billed charges,258.4,80,,206.72,percent of total billed charges,78% of total billed charges,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,36.57,100,,,fee schedule,100% of CMS fee schedule,45.98,100,,,fee schedule,100% of GA fee schedule,36.57,100,,,fee schedule,100% of CMS fee schedule,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,45.98,100,,,fee schedule,100% of GA fee schedule,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,34.01,93,,,fee schedule,93% of CMS fee schedule,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,36.57,100,,,fee schedule,100% of CMS fee schedule,36.57,100,,,fee schedule,100% of CMS fee schedule,34.01,450,
ENZYMATIC DIGESTION,300009236,CDM,301,RC,83892,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
METHADONE,300009249,CDM,301,RC,G0480,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,34.75,450,
FENTANYL,300009250,CDM,301,RC,G0480,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,89.58,450,
CYSTATIN,300009258,CDM,301,RC,82610,HCPCS,outpatient,,,145,101.5,,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,29.63,160,,,fee schedule,160% of CMS fee schedule,24.08,130,,,fee schedule,130% of CMS fee schedule,17.1,100,,,fee schedule,100% of GA fee schedule,111.97,77.22,,89.58,percent of total billed charges,77.22% of total billed charges,17.96,105,,,fee schedule,105% of GA fee schedule,120.35,83,,96.28,percent of total billed charges,83% of total,137.75,95,,110.2,percent of total billed charges ,95% of total billed charges,116,80,,92.8,percent of total billed charges,78% of total billed charges,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,17.1,100,,,fee schedule,100% of GA fee schedule,18.52,100,,,fee schedule,100% of CMS 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,17.1,100,,,fee schedule,100% of GA fee schedule,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.22,93,,,fee schedule,93% of CMS fee schedule,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,18.52,100,,,fee schedule,100% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,17.1,450,
ESTRADID FREE,300009259,CDM,301,RC,82670,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,44.7,160,,,fee schedule,160% of CMS fee schedule,36.32,130,,,fee schedule,130% of CMS fee schedule,35.14,100,,,fee schedule,100% of GA fee schedule,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,36.9,105,,,fee schedule,105% of GA fee schedule,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,35.14,100,,,fee schedule,100% of GA fee schedule,27.94,100,,,fee schedule,100% of CMS 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,35.14,100,,,fee schedule,100% of GA fee schedule,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.98,93,,,fee schedule,93% of CMS fee schedule,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,27.94,100,,,fee schedule,100% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,25.98,450,
LONG CHAIN FATTY ACIDS,300009260,CDM,301,RC,82726,HCPCS,outpatient,,,388,271.6,,306.52,79,,245.22,percent of total billed charges,79% of total billed charges,349.2,90,,279.36,percent of total billed charges,90% of total billed charges,19.75,100,,,fee schedule,100% of CMS fee schedule,31.6,160,,,fee schedule,160% of CMS fee schedule,25.68,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,299.61,77.22,,239.69,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,322.04,83,,257.63,percent of total billed charges,83% of total,368.6,95,,294.88,percent of total billed charges ,95% of total billed charges,310.4,80,,248.32,percent of total billed charges,78% of total billed charges,302.64,78,,242.112,percent of total billed charges,78% of total billed charges,19.75,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,19.75,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,329.8,85,,263.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.37,93,,,fee schedule,93% of CMS fee schedule,306.52,79,,245.22,percent of total billed charges,79% of total billed charges,19.75,100,,,fee schedule,100% of CMS fee schedule,19.75,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
GLYCOSYLATED HCG,300009263,CDM,301,RC,82397,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,22.59,160,,,fee schedule,160% of CMS fee schedule,18.36,130,,,fee schedule,130% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,18.66,105,,,fee schedule,105% of GA fee schedule,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,14.12,100,,,fee schedule,100% of CMS 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,17.77,100,,,fee schedule,100% of GA fee schedule,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.13,93,,,fee schedule,93% of CMS fee schedule,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,14.12,100,,,fee schedule,100% of CMS fee schedule,13.13,450,
PROSTAGLANDIN D2,300009264,CDM,301,RC,84150,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,41.77,100,,,fee schedule,100% of CMS fee schedule,66.83,160,,,fee schedule,160% of CMS fee schedule,54.3,130,,,fee schedule,130% of CMS fee schedule,31.39,100,,,fee schedule,100% of GA fee schedule,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,32.96,105,,,fee schedule,105% of GA fee schedule,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,41.77,100,,,fee schedule,100% of CMS fee schedule,31.39,100,,,fee schedule,100% of GA fee schedule,41.77,100,,,fee schedule,100% of CMS 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,31.39,100,,,fee schedule,100% of GA fee schedule,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,38.85,93,,,fee schedule,93% of CMS fee schedule,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,41.77,100,,,fee schedule,100% of CMS fee schedule,41.77,100,,,fee schedule,100% of CMS fee schedule,31.39,613.7,
HEMOGLOBIN ELECTRO REFLEX,300009271,CDM,301,RC,83021,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,18.06,100,,,fee schedule,100% of CMS fee schedule,28.9,160,,,fee schedule,160% of CMS fee schedule,23.48,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,18.06,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,18.06,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.8,93,,,fee schedule,93% of CMS fee schedule,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,18.06,100,,,fee schedule,100% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
C-TELOPEPIDE,300009272,CDM,301,RC,82523,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,29.89,160,,,fee schedule,160% of CMS fee schedule,24.28,130,,,fee schedule,130% of CMS fee schedule,23.5,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,24.68,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,23.5,100,,,fee schedule,100% of GA fee schedule,18.68,100,,,fee schedule,100% of CMS 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,23.5,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.37,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,18.68,100,,,fee schedule,100% of CMS fee schedule,18.68,100,,,fee schedule,100% of CMS fee schedule,17.37,450,
TPMT ASSAY,300009280,CDM,301,RC,83789,HCPCS,outpatient,,,338,236.6,,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,38.58,160,,,fee schedule,160% of CMS fee schedule,31.34,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,261,77.22,,208.8,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,280.54,83,,224.43,percent of total billed charges,83% of total,321.1,95,,256.88,percent of total billed charges ,95% of total billed charges,270.4,80,,216.32,percent of total billed charges,78% of total billed charges,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.42,93,,,fee schedule,93% of CMS fee schedule,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
PROCALLAGEN TYPE I INTACT,300009281,CDM,301,RC,83519,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,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,16.99,100,,,fee schedule,100% of GA fee schedule,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
METHYLOHENIDATE URINE,300009282,CDM,301,RC,83789,HCPCS,outpatient,,,338,236.6,,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,304.2,90,,243.36,percent of total billed charges,90% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,38.58,160,,,fee schedule,160% of CMS fee schedule,31.34,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,261,77.22,,208.8,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,280.54,83,,224.43,percent of total billed charges,83% of total,321.1,95,,256.88,percent of total billed charges ,95% of total billed charges,270.4,80,,216.32,percent of total billed charges,78% of total billed charges,263.64,78,,210.912,percent of total billed charges,78% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,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,7.55,100,,,fee schedule,100% of GA fee schedule,287.3,85,,229.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.42,93,,,fee schedule,93% of CMS fee schedule,267.02,79,,213.62,percent of total billed charges,79% of total billed charges,24.11,100,,,fee schedule,100% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
TITANIUM,300009285,CDM,301,RC,83018,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,35.14,160,,,fee schedule,160% of CMS fee schedule,28.55,130,,,fee schedule,130% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,28.99,105,,,fee schedule,105% of GA fee schedule,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,27.61,100,,,fee schedule,100% of GA fee schedule,21.96,100,,,fee schedule,100% of CMS 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,27.61,100,,,fee schedule,100% of GA fee schedule,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.42,93,,,fee schedule,93% of CMS fee schedule,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,21.96,100,,,fee schedule,100% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,20.42,450,
LEPTIN,300009288,CDM,301,RC,82397,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,22.59,160,,,fee schedule,160% of CMS fee schedule,18.36,130,,,fee schedule,130% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,18.66,105,,,fee schedule,105% of GA fee schedule,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,14.12,100,,,fee schedule,100% of CMS 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,17.77,100,,,fee schedule,100% of GA fee schedule,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.13,93,,,fee schedule,93% of CMS fee schedule,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,14.12,100,,,fee schedule,100% of CMS fee schedule,13.13,450,
OSMOLALITY STONE RISK,300009289,CDM,301,RC,83935,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,10.91,160,,,fee schedule,160% of CMS fee schedule,8.87,130,,,fee schedule,130% of CMS fee schedule,8.57,100,,,fee schedule,100% of GA fee schedule,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,9,105,,,fee schedule,105% of GA fee schedule,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,8.57,100,,,fee schedule,100% of GA fee schedule,6.82,100,,,fee schedule,100% of CMS 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,8.57,100,,,fee schedule,100% of GA fee schedule,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.34,93,,,fee schedule,93% of CMS fee schedule,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,6.82,100,,,fee schedule,100% of CMS fee schedule,6.82,100,,,fee schedule,100% of CMS fee schedule,6.34,450,
CHLORIDE STONE RISK,300009290,CDM,301,RC,82436,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,9.2,160,,,fee schedule,160% of CMS fee schedule,7.48,130,,,fee schedule,130% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,6.64,105,,,fee schedule,105% of GA fee schedule,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,5.75,100,,,fee schedule,100% of CMS 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,6.32,100,,,fee schedule,100% of GA fee schedule,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.35,93,,,fee schedule,93% of CMS fee schedule,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,5.75,100,,,fee schedule,100% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,5.35,450,
CYSTINE STONE RISK,300009291,CDM,301,RC,82131,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,36.77,160,,,fee schedule,160% of CMS fee schedule,29.87,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,22.98,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.37,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,450,
MIRTAZAPINE,300009801,CDM,301,RC,80335,HCPCS,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,23.64,105,,,fee schedule,105% of GA fee schedule,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.51,100,,,fee schedule,100% of GA fee schedule,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.51,450,
SMITH LAMIL OPITZ SCREEN,300040906,CDM,301,RC,82542,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,38.54,160,,,fee schedule,160% of CMS fee schedule,31.32,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.09,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.4,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
IMMUNOASSAY FOR ANALYTE,300040925,CDM,301,RC,83519,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
IMMUNOASSAY FOR ANALYTE,300040926,CDM,301,RC,83520,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,16.28,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
PROTEIN WESTERN BLOT,300040927,CDM,301,RC,84181,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,27.25,160,,,fee schedule,160% of CMS fee schedule,22.14,130,,,fee schedule,130% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,22.49,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,21.42,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.84,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,15.84,450,
PROTEIN WESTER BLOT EACH,300040928,CDM,301,RC,84182,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,46.74,160,,,fee schedule,160% of CMS fee schedule,37.97,130,,,fee schedule,130% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,23.77,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,22.64,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.17,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,450,
ANTI-MULLERIAN HORMONE,300040930,CDM,301,RC,82166,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,38.62,100,,,fee schedule,100% of CMS fee schedule,61.79,160,,,fee schedule,160% of CMS fee schedule,50.21,130,,,fee schedule,130% of CMS fee schedule,30.9,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,32.45,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,38.62,100,,,fee schedule,100% of CMS fee schedule,30.9,100,,,fee schedule,100% of GA fee schedule,38.62,100,,,fee schedule,100% of CMS 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,30.9,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.92,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,38.62,100,,,fee schedule,100% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,30.9,450,
LACOSAMIDE,300040931,CDM,301,RC,80235,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,27.11,100,,,fee schedule,100% of CMS fee schedule,43.38,160,,,fee schedule,160% of CMS fee schedule,35.24,130,,,fee schedule,130% of CMS fee schedule,21.69,100,,,fee schedule,100% of GA fee schedule,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,22.77,105,,,fee schedule,105% of GA fee schedule,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,27.11,100,,,fee schedule,100% of CMS fee schedule,21.69,100,,,fee schedule,100% of GA fee schedule,27.11,100,,,fee schedule,100% of CMS 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,21.69,100,,,fee schedule,100% of GA fee schedule,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.21,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,27.11,100,,,fee schedule,100% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,21.69,450,
MEDICAL DRUG SCREEN,300040948,CDM,301,RC,80307,HCPCS,outpatient,,,361,252.7,,285.19,79,,228.15,percent of total billed charges,79% of total billed charges,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,278.76,77.22,,223.01,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,299.63,83,,239.7,percent of total billed charges,83% of total,342.95,95,,274.36,percent of total billed charges ,95% of total billed charges,288.8,80,,231.04,percent of total billed charges,78% of total billed charges,281.58,78,,225.264,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,285.19,79,,228.15,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
MEDICAL DRUG SCREEN CP,300040949,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CORTISOL,300040953,CDM,301,RC,82533,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,26.08,160,,,fee schedule,160% of CMS fee schedule,21.19,130,,,fee schedule,130% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,21.53,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,16.3,100,,,fee schedule,100% of CMS 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,20.5,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.16,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,15.16,450,
CHROMIUM,300040954,CDM,301,RC,82495,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,20.28,100,,,fee schedule,100% of CMS fee schedule,32.45,160,,,fee schedule,160% of CMS fee schedule,26.36,130,,,fee schedule,130% of CMS fee schedule,25.51,100,,,fee schedule,100% of GA fee schedule,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,26.79,105,,,fee schedule,105% of GA fee schedule,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,20.28,100,,,fee schedule,100% of CMS fee schedule,25.51,100,,,fee schedule,100% of GA fee schedule,20.28,100,,,fee schedule,100% of CMS 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,25.51,100,,,fee schedule,100% of GA fee schedule,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.86,93,,,fee schedule,93% of CMS fee schedule,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,20.28,100,,,fee schedule,100% of CMS fee schedule,20.28,100,,,fee schedule,100% of CMS fee schedule,18.86,450,
"BILIRUBIN,TOT, TRANSCUTANEOUS",300040956,CDM,301,RC,88720,HCPCS,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,8.03,160,,,fee schedule,160% of CMS fee schedule,6.53,130,,,fee schedule,130% of CMS fee schedule,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,34.37,66.1,,27.5,percent of total billed charges,66.1% of total billed charges,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,5.02,100,,,fee schedule,100% of CMS 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,32.76,63,,26.21,percent of total billed charges,63% of total billed charges,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.67,93,,,fee schedule,93% of CMS fee schedule,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,4.67,450,
CORTISOL 60 MIN,300040957,CDM,301,RC,82533,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,26.08,160,,,fee schedule,160% of CMS fee schedule,21.19,130,,,fee schedule,130% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,21.53,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,20.5,100,,,fee schedule,100% of GA fee schedule,16.3,100,,,fee schedule,100% of CMS 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,20.5,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.16,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,16.3,100,,,fee schedule,100% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,15.16,450,
OBSTETRIC PANEL INCL HIV,300080081,CDM,301,RC,80081,HCPCS,outpatient,,,560,392,,442.4,79,,353.92,percent of total billed charges,79% of total billed charges,504,90,,403.2,percent of total billed charges,90% of total billed charges,74.86,100,,,fee schedule,100% of CMS fee schedule,119.78,160,,,fee schedule,160% of CMS fee schedule,97.32,130,,,fee schedule,130% of CMS fee schedule,81.58,100,,,fee schedule,100% of GA fee schedule,432.43,77.22,,345.94,percent of total billed charges,77.22% of total billed charges,85.66,105,,,fee schedule,105% of GA fee schedule,464.8,83,,371.84,percent of total billed charges,83% of total,532,95,,425.6,percent of total billed charges ,95% of total billed charges,448,80,,358.4,percent of total billed charges,78% of total billed charges,436.8,78,,349.44,percent of total billed charges,78% of total billed charges,74.86,100,,,fee schedule,100% of CMS fee schedule,81.58,100,,,fee schedule,100% of GA fee schedule,74.86,100,,,fee schedule,100% of CMS fee schedule,504,90,,403.2,percent of total billed charges,90% of total billed charges,448,80,,358.4,percent of total billed charges,80% of total billed charges,81.58,100,,,fee schedule,100% of GA fee schedule,476,85,,380.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,69.62,93,,,fee schedule,93% of CMS fee schedule,442.4,79,,353.92,percent of total billed charges,79% of total billed charges,74.86,100,,,fee schedule,100% of CMS fee schedule,74.86,100,,,fee schedule,100% of CMS fee schedule,69.62,532,
CLOZAPINE SERUM,300080159,CDM,301,RC,80159,HCPCS,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,20.15,100,,,fee schedule,100% of CMS fee schedule,32.24,160,,,fee schedule,160% of CMS fee schedule,26.2,130,,,fee schedule,130% of CMS fee schedule,20.18,100,,,fee schedule,100% of GA fee schedule,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,21.19,105,,,fee schedule,105% of GA fee schedule,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,20.15,100,,,fee schedule,100% of CMS fee schedule,20.18,100,,,fee schedule,100% of GA fee schedule,20.15,100,,,fee schedule,100% of CMS 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,20.18,100,,,fee schedule,100% of GA fee schedule,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.74,93,,,fee schedule,93% of CMS fee schedule,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,20.15,100,,,fee schedule,100% of CMS fee schedule,20.15,100,,,fee schedule,100% of CMS fee schedule,18.74,450,
EVEROLIMUS,300080169,CDM,301,RC,80169,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,21.97,160,,,fee schedule,160% of CMS fee schedule,17.85,130,,,fee schedule,130% of CMS fee schedule,14.98,100,,,fee schedule,100% of GA fee schedule,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,15.73,105,,,fee schedule,105% of GA fee schedule,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,14.98,100,,,fee schedule,100% of GA fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,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,14.98,100,,,fee schedule,100% of GA fee schedule,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.77,93,,,fee schedule,93% of CMS fee schedule,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,13.73,100,,,fee schedule,100% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,12.77,450,
SYNTHETIC STIMULANTS QUANT,300080301,CDM,301,RC,G0480,HCPCS,outpatient,,,361,252.7,,285.19,79,,228.15,percent of total billed charges,79% of total billed charges,324.9,90,,259.92,percent of total billed charges,90% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,183.09,160,,,fee schedule,160% of CMS fee schedule,148.76,130,,,fee schedule,130% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,278.76,77.22,,223.01,percent of total billed charges,77.22% of total billed charges,98.83,105,,,fee schedule,105% of GA fee schedule,299.63,83,,239.7,percent of total billed charges,83% of total,342.95,95,,274.36,percent of total billed charges ,95% of total billed charges,288.8,80,,231.04,percent of total billed charges,78% of total billed charges,281.58,78,,225.264,percent of total billed charges,78% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,100,,,fee schedule,100% of GA fee schedule,114.43,100,,,fee schedule,100% of CMS 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,94.12,100,,,fee schedule,100% of GA fee schedule,306.85,85,,245.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,106.42,93,,,fee schedule,93% of CMS fee schedule,285.19,79,,228.15,percent of total billed charges,79% of total billed charges,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,94.12,450,
ER OCCULT BLOOD DIAGNOSTIC,300081026,CDM,301,RC,82272,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,6.77,160,,,fee schedule,160% of CMS fee schedule,5.5,130,,,fee schedule,130% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,4.24,105,,,fee schedule,105% of GA fee schedule,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,4.04,100,,,fee schedule,100% of GA fee schedule,4.23,100,,,fee schedule,100% of CMS 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,4.04,100,,,fee schedule,100% of GA fee schedule,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.93,93,,,fee schedule,93% of CMS fee schedule,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,4.23,100,,,fee schedule,100% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,3.93,450,
CORTISOL STIMULATION 30 MIN CP,300081029,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CORTISOL STIMULATION 60 MIN CP,300081030,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MUSCLE SPE KINASE ANTIBODIES,300083519,CDM,301,RC,86366,HCPCS,outpatient,,,1125,787.5,,888.75,79,,711,percent of total billed charges,79% of total billed charges,1012.5,90,,810,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,868.73,77.22,,694.98,percent of total billed charges,77.22% of total billed charges,15.46,105,,,fee schedule,105% of GA fee schedule,933.75,83,,747,percent of total billed charges,83% of total,1068.75,95,,855,percent of total billed charges ,95% of total billed charges,900,80,,720,percent of total billed charges,78% of total billed charges,877.5,78,,702,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,14.72,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,1012.5,90,,810,percent of total billed charges,90% of total billed charges,900,80,,720,percent of total billed charges,80% of total billed charges,14.72,100,,,fee schedule,100% of GA fee schedule,956.25,85,,765,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,888.75,79,,711,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,14.72,1068.75,
FECAL LACTOFERRIN QUANT,300083630,CDM,301,RC,83631,HCPCS,outpatient,,,332,232.4,,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,31.41,160,,,fee schedule,160% of CMS fee schedule,25.52,130,,,fee schedule,130% of CMS fee schedule,24.68,100,,,fee schedule,100% of GA fee schedule,256.37,77.22,,205.1,percent of total billed charges,77.22% of total billed charges,25.91,105,,,fee schedule,105% of GA fee schedule,275.56,83,,220.45,percent of total billed charges,83% of total,315.4,95,,252.32,percent of total billed charges ,95% of total billed charges,265.6,80,,212.48,percent of total billed charges,78% of total billed charges,258.96,78,,207.168,percent of total billed charges,78% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,24.68,100,,,fee schedule,100% of GA fee schedule,19.63,100,,,fee schedule,100% of CMS 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,24.68,100,,,fee schedule,100% of GA fee schedule,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.26,93,,,fee schedule,93% of CMS fee schedule,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,19.63,100,,,fee schedule,100% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,18.26,450,
LIPOPROTEIN (A),300083695,CDM,301,RC,83695,HCPCS,outpatient,,,72,50.4,,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,64.8,90,,51.84,percent of total billed charges,90% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,22.91,160,,,fee schedule,160% of CMS fee schedule,18.62,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,55.6,77.22,,44.48,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,59.76,83,,47.81,percent of total billed charges,83% of total,68.4,95,,54.72,percent of total billed charges ,95% of total billed charges,57.6,80,,46.08,percent of total billed charges,78% of total billed charges,56.16,78,,44.928,percent of total billed charges,78% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,14.32,100,,,fee schedule,100% of CMS fee schedule,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,16.28,100,,,fee schedule,100% of GA fee schedule,61.2,85,,48.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.32,93,,,fee schedule,93% of CMS fee schedule,56.88,79,,45.5,percent of total billed charges,79% of total billed charges,14.32,100,,,fee schedule,100% of CMS fee schedule,14.32,100,,,fee schedule,100% of CMS fee schedule,13.32,450,
CARDIO IQ LIPO FRACTION,300083704,CDM,301,RC,83701,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,33.86,100,,,fee schedule,100% of CMS fee schedule,54.18,160,,,fee schedule,160% of CMS fee schedule,44.02,130,,,fee schedule,130% of CMS fee schedule,31.21,100,,,fee schedule,100% of GA fee schedule,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,32.77,105,,,fee schedule,105% of GA fee schedule,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,33.86,100,,,fee schedule,100% of CMS fee schedule,31.21,100,,,fee schedule,100% of GA fee schedule,33.86,100,,,fee schedule,100% of CMS 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,31.21,100,,,fee schedule,100% of GA fee schedule,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.49,93,,,fee schedule,93% of CMS fee schedule,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,33.86,100,,,fee schedule,100% of CMS fee schedule,33.86,100,,,fee schedule,100% of CMS fee schedule,31.21,450,
RETINOL BINDING PROTEIN,300083883,CDM,301,RC,83883,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,21.76,160,,,fee schedule,160% of CMS fee schedule,17.68,130,,,fee schedule,130% of CMS fee schedule,17.1,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,17.96,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,17.1,100,,,fee schedule,100% of GA fee schedule,13.6,100,,,fee schedule,100% of CMS 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,17.1,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.65,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,13.6,100,,,fee schedule,100% of CMS fee schedule,13.6,100,,,fee schedule,100% of CMS fee schedule,12.65,450,
BONE SPECIFIC ALK PHOS,300084080,CDM,301,RC,84080,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,23.65,160,,,fee schedule,160% of CMS fee schedule,19.21,130,,,fee schedule,130% of CMS fee schedule,18.59,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,19.52,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,18.59,100,,,fee schedule,100% of GA fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,18.59,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.75,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,14.78,100,,,fee schedule,100% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,13.75,450,
MYOSITIS PANEL,300084182,CDM,301,RC,84182,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,46.74,160,,,fee schedule,160% of CMS fee schedule,37.97,130,,,fee schedule,130% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,23.77,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,22.64,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.17,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,450,
CHOLESTEROL BODY FLUID,300084311,CDM,301,RC,84311,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,12.96,160,,,fee schedule,160% of CMS fee schedule,10.53,130,,,fee schedule,130% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,9.23,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,8.1,100,,,fee schedule,100% of CMS 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,8.79,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.53,93,,,fee schedule,93% of CMS fee schedule,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,8.1,100,,,fee schedule,100% of CMS fee schedule,8.1,100,,,fee schedule,100% of CMS fee schedule,7.53,450,
MUCOR RACEMOSUS IGE,300286003,CDM,301,RC,86003,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SETOMELANOMMA ROSTRAT IGE,300386003,CDM,301,RC,86003,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
FUSARIUM PROLIFERATION IGE,300486003,CDM,301,RC,86003,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SALIVARY CORTISOL X2 MS END CP,300502120,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
EPICOCCUM PURPUR IGE,300586003,CDM,301,RC,86003,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
STEMPHYLIUM HERBARUM,300686003,CDM,301,RC,86003,HCPCS,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
GLUTEN F79 ALLERGEN,300786003,CDM,301,RC,86003,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
RHC GLUCOSE CHECK,300800330,CDM,301,RC,82962,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,5.25,160,,,fee schedule,160% of CMS fee schedule,4.26,130,,,fee schedule,130% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,3.09,105,,,fee schedule,105% of GA fee schedule,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,3.28,100,,,fee schedule,100% of CMS 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,2.94,100,,,fee schedule,100% of GA fee schedule,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.05,93,,,fee schedule,93% of CMS fee schedule,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,450,
ALT (SGPT) P5P,300900100,CDM,301,RC,84460,HCPCS,outpatient,,,42,29.4,,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,37.8,90,,30.24,percent of total billed charges,90% of total billed charges,5.3,100,,,fee schedule,100% of CMS fee schedule,8.48,160,,,fee schedule,160% of CMS fee schedule,6.89,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,32.43,77.22,,25.94,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,34.86,83,,27.89,percent of total billed charges,83% of total,39.9,95,,31.92,percent of total billed charges ,95% of total billed charges,33.6,80,,26.88,percent of total billed charges,78% of total billed charges,32.76,78,,26.208,percent of total billed charges,78% of total billed charges,5.3,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.3,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,35.7,85,,28.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.93,93,,,fee schedule,93% of CMS fee schedule,33.18,79,,26.54,percent of total billed charges,79% of total billed charges,5.3,100,,,fee schedule,100% of CMS fee schedule,5.3,100,,,fee schedule,100% of CMS fee schedule,4.93,450,
AST (SGOT) P5P,300900102,CDM,301,RC,84450,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,8.29,160,,,fee schedule,160% of CMS fee schedule,6.73,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.18,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.82,93,,,fee schedule,93% of CMS fee schedule,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,4.82,450,
"BILIRUBIN,DIRECT",300900103,CDM,301,RC,82248,HCPCS,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,8.03,160,,,fee schedule,160% of CMS fee schedule,6.53,130,,,fee schedule,130% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,6.64,105,,,fee schedule,105% of GA fee schedule,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,5.02,100,,,fee schedule,100% of CMS 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,6.32,100,,,fee schedule,100% of GA fee schedule,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.67,93,,,fee schedule,93% of CMS fee schedule,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,4.67,450,
"BILIRUBIN,TOTAL",300900104,CDM,301,RC,82247,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,8.03,160,,,fee schedule,160% of CMS fee schedule,6.53,130,,,fee schedule,130% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,6.64,105,,,fee schedule,105% of GA fee schedule,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,6.32,100,,,fee schedule,100% of GA fee schedule,5.02,100,,,fee schedule,100% of CMS 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,6.32,100,,,fee schedule,100% of GA fee schedule,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.67,93,,,fee schedule,93% of CMS fee schedule,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,5.02,100,,,fee schedule,100% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,4.67,450,
CALCIUM,300900105,CDM,301,RC,82310,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,5.16,100,,,fee schedule,100% of CMS fee schedule,8.26,160,,,fee schedule,160% of CMS fee schedule,6.71,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,5.16,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.16,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.8,93,,,fee schedule,93% of CMS fee schedule,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,5.16,100,,,fee schedule,100% of CMS fee schedule,5.16,100,,,fee schedule,100% of CMS fee schedule,4.8,450,
CARBON DIOXIDE (C02),300900106,CDM,301,RC,82374,HCPCS,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,7.81,160,,,fee schedule,160% of CMS fee schedule,6.34,130,,,fee schedule,130% of CMS fee schedule,6.15,100,,,fee schedule,100% of GA fee schedule,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,6.46,105,,,fee schedule,105% of GA fee schedule,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,6.15,100,,,fee schedule,100% of GA fee schedule,4.88,100,,,fee schedule,100% of CMS 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,6.15,100,,,fee schedule,100% of GA fee schedule,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.54,93,,,fee schedule,93% of CMS fee schedule,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,4.88,100,,,fee schedule,100% of CMS fee schedule,4.88,100,,,fee schedule,100% of CMS fee schedule,4.54,450,
CHLORIDE,300900107,CDM,301,RC,82435,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,4.6,100,,,fee schedule,100% of CMS fee schedule,7.36,160,,,fee schedule,160% of CMS fee schedule,5.98,130,,,fee schedule,130% of CMS fee schedule,5.78,100,,,fee schedule,100% of GA fee schedule,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,6.07,105,,,fee schedule,105% of GA fee schedule,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,4.6,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of GA fee schedule,4.6,100,,,fee schedule,100% of CMS 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,5.78,100,,,fee schedule,100% of GA fee schedule,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.28,93,,,fee schedule,93% of CMS fee schedule,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,4.6,100,,,fee schedule,100% of CMS fee schedule,4.6,100,,,fee schedule,100% of CMS fee schedule,4.28,450,
CHOLESTEROL TOTAL,300900108,CDM,301,RC,82465,HCPCS,outpatient,,,22,15.4,,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,19.8,90,,15.84,percent of total billed charges,90% of total billed charges,4.35,100,,,fee schedule,100% of CMS fee schedule,6.96,160,,,fee schedule,160% of CMS fee schedule,5.66,130,,,fee schedule,130% of CMS fee schedule,5.47,100,,,fee schedule,100% of GA fee schedule,16.99,77.22,,13.59,percent of total billed charges,77.22% of total billed charges,5.74,105,,,fee schedule,105% of GA fee schedule,18.26,83,,14.61,percent of total billed charges,83% of total,20.9,95,,16.72,percent of total billed charges ,95% of total billed charges,17.6,80,,14.08,percent of total billed charges,78% of total billed charges,17.16,78,,13.728,percent of total billed charges,78% of total billed charges,4.35,100,,,fee schedule,100% of CMS fee schedule,5.47,100,,,fee schedule,100% of GA fee schedule,4.35,100,,,fee schedule,100% of CMS 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,5.47,100,,,fee schedule,100% of GA fee schedule,18.7,85,,14.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.05,93,,,fee schedule,93% of CMS fee schedule,17.38,79,,13.9,percent of total billed charges,79% of total billed charges,4.35,100,,,fee schedule,100% of CMS fee schedule,4.35,100,,,fee schedule,100% of CMS fee schedule,4.05,450,
CK,300900109,CDM,301,RC,82550,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,10.42,160,,,fee schedule,160% of CMS fee schedule,8.46,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,6.51,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.05,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,6.51,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of CMS fee schedule,6.05,450,
CREATININE,300900110,CDM,301,RC,82565,HCPCS,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,8.19,160,,,fee schedule,160% of CMS fee schedule,6.66,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.12,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.76,93,,,fee schedule,93% of CMS fee schedule,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,5.12,100,,,fee schedule,100% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,4.76,450,
GGT,300900111,CDM,301,RC,82977,HCPCS,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,11.52,160,,,fee schedule,160% of CMS fee schedule,9.36,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,7.2,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.7,93,,,fee schedule,93% of CMS fee schedule,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,7.2,100,,,fee schedule,100% of CMS fee schedule,7.2,100,,,fee schedule,100% of CMS fee schedule,6.35,450,
GLUCOSE,300900112,CDM,301,RC,82947,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,6.29,160,,,fee schedule,160% of CMS fee schedule,5.11,130,,,fee schedule,130% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,5.18,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,4.93,100,,,fee schedule,100% of GA fee schedule,3.93,100,,,fee schedule,100% of CMS 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,4.93,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.65,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.65,450,
LDH (LACTATE DEHYDROGENASE),300900113,CDM,301,RC,83615,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,9.66,160,,,fee schedule,160% of CMS fee schedule,7.85,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,6.04,100,,,fee schedule,100% of CMS fee schedule,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,6.35,100,,,fee schedule,100% of GA fee schedule,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.62,93,,,fee schedule,93% of CMS fee schedule,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,6.04,100,,,fee schedule,100% of CMS fee schedule,6.04,100,,,fee schedule,100% of CMS fee schedule,5.62,450,
ALKALINE PHOSPHATASE,300900114,CDM,301,RC,84075,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,8.29,160,,,fee schedule,160% of CMS fee schedule,6.73,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.18,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.82,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,4.82,450,
PHOSPHORUS,300900115,CDM,301,RC,84100,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,7.58,160,,,fee schedule,160% of CMS fee schedule,6.16,130,,,fee schedule,130% of CMS fee schedule,5.97,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,6.27,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,5.97,100,,,fee schedule,100% of GA fee schedule,4.74,100,,,fee schedule,100% of CMS 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,5.97,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.41,93,,,fee schedule,93% of CMS fee schedule,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,4.74,100,,,fee schedule,100% of CMS fee schedule,4.74,100,,,fee schedule,100% of CMS fee schedule,4.41,450,
POTASIUM,300900116,CDM,301,RC,84132,HCPCS,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,4.76,100,,,fee schedule,100% of CMS fee schedule,7.62,160,,,fee schedule,160% of CMS fee schedule,6.19,130,,,fee schedule,130% of CMS fee schedule,5.78,100,,,fee schedule,100% of GA fee schedule,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,6.07,105,,,fee schedule,105% of GA fee schedule,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,4.76,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of GA fee schedule,4.76,100,,,fee schedule,100% of CMS 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,5.78,100,,,fee schedule,100% of GA fee schedule,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.43,93,,,fee schedule,93% of CMS fee schedule,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,4.76,100,,,fee schedule,100% of CMS fee schedule,4.76,100,,,fee schedule,100% of CMS fee schedule,4.43,450,
"PROTEIN,TOTAL",300900117,CDM,301,RC,84156,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,5.87,160,,,fee schedule,160% of CMS fee schedule,4.77,130,,,fee schedule,130% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,4.84,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,4.61,100,,,fee schedule,100% of GA fee schedule,3.67,100,,,fee schedule,100% of CMS 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,4.61,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.41,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.41,450,
SODIUM,300900118,CDM,301,RC,84295,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,4.81,100,,,fee schedule,100% of CMS fee schedule,7.7,160,,,fee schedule,160% of CMS fee schedule,6.25,130,,,fee schedule,130% of CMS fee schedule,6.05,100,,,fee schedule,100% of GA fee schedule,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,6.35,105,,,fee schedule,105% of GA fee schedule,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,4.81,100,,,fee schedule,100% of CMS fee schedule,6.05,100,,,fee schedule,100% of GA fee schedule,4.81,100,,,fee schedule,100% of CMS 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,6.05,100,,,fee schedule,100% of GA fee schedule,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.47,93,,,fee schedule,93% of CMS fee schedule,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,4.81,100,,,fee schedule,100% of CMS fee schedule,4.81,100,,,fee schedule,100% of CMS fee schedule,4.47,450,
UREA NITROGEN,300900119,CDM,301,RC,84520,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,6.32,160,,,fee schedule,160% of CMS fee schedule,5.14,130,,,fee schedule,130% of CMS fee schedule,4.96,100,,,fee schedule,100% of GA fee schedule,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,5.21,105,,,fee schedule,105% of GA fee schedule,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,4.96,100,,,fee schedule,100% of GA fee schedule,3.95,100,,,fee schedule,100% of CMS 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,4.96,100,,,fee schedule,100% of GA fee schedule,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.67,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,3.95,100,,,fee schedule,100% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,3.67,450,
URIC ACID,300900120,CDM,301,RC,84550,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,4.52,100,,,fee schedule,100% of CMS fee schedule,7.23,160,,,fee schedule,160% of CMS fee schedule,5.88,130,,,fee schedule,130% of CMS fee schedule,5.68,100,,,fee schedule,100% of GA fee schedule,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,5.96,105,,,fee schedule,105% of GA fee schedule,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,4.52,100,,,fee schedule,100% of CMS fee schedule,5.68,100,,,fee schedule,100% of GA fee schedule,4.52,100,,,fee schedule,100% of CMS 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,5.68,100,,,fee schedule,100% of GA fee schedule,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.2,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,4.52,100,,,fee schedule,100% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,4.2,450,
TRIGLYCERIDES,300900121,CDM,301,RC,84478,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,9.18,160,,,fee schedule,160% of CMS fee schedule,7.46,130,,,fee schedule,130% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,6.67,105,,,fee schedule,105% of GA fee schedule,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,6.35,100,,,fee schedule,100% of GA fee schedule,5.74,100,,,fee schedule,100% of CMS 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,6.35,100,,,fee schedule,100% of GA fee schedule,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.34,93,,,fee schedule,93% of CMS fee schedule,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,5.74,100,,,fee schedule,100% of CMS fee schedule,5.74,100,,,fee schedule,100% of CMS fee schedule,5.34,450,
ELECTROLYTES PANEL,300900122,CDM,301,RC,80051,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,7.01,100,,,fee schedule,100% of CMS fee schedule,11.22,160,,,fee schedule,160% of CMS fee schedule,9.11,130,,,fee schedule,130% of CMS fee schedule,8.82,100,,,fee schedule,100% of GA fee schedule,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,9.26,105,,,fee schedule,105% of GA fee schedule,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,7.01,100,,,fee schedule,100% of CMS fee schedule,8.82,100,,,fee schedule,100% of GA fee schedule,7.01,100,,,fee schedule,100% of CMS 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,8.82,100,,,fee schedule,100% of GA fee schedule,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.52,93,,,fee schedule,93% of CMS fee schedule,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,7.01,100,,,fee schedule,100% of CMS fee schedule,7.01,100,,,fee schedule,100% of CMS fee schedule,6.52,450,
BASIC METABOLIC PANEL,300900124,CDM,301,RC,80048,HCPCS,outpatient,,,174,121.8,,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,8.46,100,,,fee schedule,100% of CMS fee schedule,13.54,160,,,fee schedule,160% of CMS fee schedule,11,130,,,fee schedule,130% of CMS fee schedule,10.65,100,,,fee schedule,100% of GA fee schedule,134.36,77.22,,107.49,percent of total billed charges,77.22% of total billed charges,11.18,105,,,fee schedule,105% of GA fee schedule,144.42,83,,115.54,percent of total billed charges,83% of total,165.3,95,,132.24,percent of total billed charges ,95% of total billed charges,139.2,80,,111.36,percent of total billed charges,78% of total billed charges,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,8.46,100,,,fee schedule,100% of CMS fee schedule,10.65,100,,,fee schedule,100% of GA fee schedule,8.46,100,,,fee schedule,100% of CMS 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,10.65,100,,,fee schedule,100% of GA fee schedule,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.87,93,,,fee schedule,93% of CMS fee schedule,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,8.46,100,,,fee schedule,100% of CMS fee schedule,8.46,100,,,fee schedule,100% of CMS fee schedule,7.87,450,
COMPREHENSIVE METABOLIC PANEL,300900129,CDM,301,RC,80053,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,10.56,100,,,fee schedule,100% of CMS fee schedule,16.9,160,,,fee schedule,160% of CMS fee schedule,13.73,130,,,fee schedule,130% of CMS fee schedule,13.29,100,,,fee schedule,100% of GA fee schedule,159.85,77.22,,127.88,percent of total billed charges,77.22% of total billed charges,13.95,105,,,fee schedule,105% of GA fee schedule,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,10.56,100,,,fee schedule,100% of CMS fee schedule,13.29,100,,,fee schedule,100% of GA fee schedule,10.56,100,,,fee schedule,100% of CMS fee schedule,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,13.29,100,,,fee schedule,100% of GA fee schedule,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.82,93,,,fee schedule,93% of CMS fee schedule,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,10.56,100,,,fee schedule,100% of CMS fee schedule,10.56,100,,,fee schedule,100% of CMS fee schedule,9.82,450,
HEPATIC PROFILE PANEL,300900130,CDM,301,RC,80076,HCPCS,outpatient,,,224,156.8,,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,13.07,160,,,fee schedule,160% of CMS fee schedule,10.62,130,,,fee schedule,130% of CMS fee schedule,10.28,100,,,fee schedule,100% of GA fee schedule,172.97,77.22,,138.38,percent of total billed charges,77.22% of total billed charges,10.79,105,,,fee schedule,105% of GA fee schedule,185.92,83,,148.74,percent of total billed charges,83% of total,212.8,95,,170.24,percent of total billed charges ,95% of total billed charges,179.2,80,,143.36,percent of total billed charges,78% of total billed charges,174.72,78,,139.776,percent of total billed charges,78% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,10.28,100,,,fee schedule,100% of GA fee schedule,8.17,100,,,fee schedule,100% of CMS 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,10.28,100,,,fee schedule,100% of GA fee schedule,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.6,93,,,fee schedule,93% of CMS fee schedule,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,8.17,100,,,fee schedule,100% of CMS fee schedule,7.6,450,
ANTI-GLIADIN ANTIBODY CHG CP,300900147,CDM,301,RC,83520,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,17.09,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.28,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,,,,,other,not seperately reimbursable,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
"TESTOSTERONE,BIOAVAILABLE",300900154,CDM,301,RC,84410,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,51.28,100,,,fee schedule,100% of CMS fee schedule,82.05,160,,,fee schedule,160% of CMS fee schedule,66.66,130,,,fee schedule,130% of CMS fee schedule,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,51.28,100,,,fee schedule,100% of CMS fee schedule,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,51.28,100,,,fee schedule,100% of CMS 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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.69,93,,,fee schedule,93% of CMS fee schedule,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,51.28,100,,,fee schedule,100% of CMS fee schedule,51.28,100,,,fee schedule,100% of CMS fee schedule,47.69,450,
CATECHOLAMINES AND VMA CP,301000023,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BURPRE NORBUPRENORPHINE UR CP,301000150,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NASH FIBROSURE CP,301000151,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PROTEIN ELECTROPHORESIS RAN CP,301000156,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
TOXASSURE,301000170,CDM,301,RC,G0483,HCPCS,outpatient,,,580,406,,458.2,79,,366.56,percent of total billed charges,79% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,246.92,100,,,fee schedule,100% of CMS fee schedule,395.07,160,,,fee schedule,160% of CMS fee schedule,321,130,,,fee schedule,130% of CMS fee schedule,203.1,100,,,fee schedule,100% of GA fee schedule,447.88,77.22,,358.3,percent of total billed charges,77.22% of total billed charges,213.26,105,,,fee schedule,105% of GA fee schedule,481.4,83,,385.12,percent of total billed charges,83% of total,551,95,,440.8,percent of total billed charges ,95% of total billed charges,464,80,,371.2,percent of total billed charges,78% of total billed charges,452.4,78,,361.92,percent of total billed charges,78% of total billed charges,246.92,100,,,fee schedule,100% of CMS fee schedule,203.1,100,,,fee schedule,100% of GA fee schedule,246.92,100,,,fee schedule,100% of CMS 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,203.1,100,,,fee schedule,100% of GA fee schedule,493,85,,394.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,229.64,93,,,fee schedule,93% of CMS fee schedule,458.2,79,,366.56,percent of total billed charges,79% of total billed charges,246.92,100,,,fee schedule,100% of CMS fee schedule,246.92,100,,,fee schedule,100% of CMS fee schedule,203.1,551,
CARDIO IQ COMPONENT,301000171,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RESPIRATORY PANEL W SARS COV2,301000202,CDM,301,RC,0202U,HCPCS,outpatient,,,1500,1050,,1185,79,,948,percent of total billed charges,79% of total billed charges,1350,90,,1080,percent of total billed charges,90% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,666.85,160,,,fee schedule,160% of CMS fee schedule,541.81,130,,,fee schedule,130% of CMS fee schedule,333.42,100,,,fee schedule,100% of GA fee schedule,1158.3,77.22,,926.64,percent of total billed charges,77.22% of total billed charges,350.09,105,,,fee schedule,105% of GA fee schedule,1245,83,,996,percent of total billed charges,83% of total,1425,95,,1140,percent of total billed charges ,95% of total billed charges,1200,80,,960,percent of total billed charges,78% of total billed charges,1170,78,,936,percent of total billed charges,78% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,333.42,100,,,fee schedule,100% of GA fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,1350,90,,1080,percent of total billed charges,90% of total billed charges,1200,80,,960,percent of total billed charges,80% of total billed charges,333.42,100,,,fee schedule,100% of GA fee schedule,1275,85,,1020,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,387.61,93,,,fee schedule,93% of CMS fee schedule,1185,79,,948,percent of total billed charges,79% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,333.42,1425,
ANTIDEPRESSANTS NOT OTW SPECIF,301000338,CDM,301,RC,80338,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
BUPRENORPHINE,301000348,CDM,301,RC,80348,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
COCAINE CONFIRMATION,301000480,CDM,301,RC,80353,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.06,100,,,fee schedule,100% of GA fee schedule,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,12.66,105,,,fee schedule,105% of GA fee schedule,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.06,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,12.06,100,,,fee schedule,100% of GA fee schedule,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.06,450,
DRUG TEST DEFIN 22+ CLASSES,301000483,CDM,301,RC,G0483,HCPCS,outpatient,,,580,406,,458.2,79,,366.56,percent of total billed charges,79% of total billed charges,522,90,,417.6,percent of total billed charges,90% of total billed charges,246.92,100,,,fee schedule,100% of CMS fee schedule,395.07,160,,,fee schedule,160% of CMS fee schedule,321,130,,,fee schedule,130% of CMS fee schedule,203.1,100,,,fee schedule,100% of GA fee schedule,447.88,77.22,,358.3,percent of total billed charges,77.22% of total billed charges,213.26,105,,,fee schedule,105% of GA fee schedule,481.4,83,,385.12,percent of total billed charges,83% of total,551,95,,440.8,percent of total billed charges ,95% of total billed charges,464,80,,371.2,percent of total billed charges,78% of total billed charges,452.4,78,,361.92,percent of total billed charges,78% of total billed charges,246.92,100,,,fee schedule,100% of CMS fee schedule,203.1,100,,,fee schedule,100% of GA fee schedule,246.92,100,,,fee schedule,100% of CMS 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,203.1,100,,,fee schedule,100% of GA fee schedule,493,85,,394.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,229.64,93,,,fee schedule,93% of CMS fee schedule,458.2,79,,366.56,percent of total billed charges,79% of total billed charges,246.92,100,,,fee schedule,100% of CMS fee schedule,246.92,100,,,fee schedule,100% of CMS fee schedule,203.1,551,
NICOTINE SWAB,301000484,CDM,301,RC,,,outpatient,,,7,4.9,,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,6.3,90,,5.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.41,77.22,,4.33,percent of total billed charges,77.22% of total billed charges,4.63,66.1,,3.7,percent of total billed charges,66.1% of total billed charges,5.81,83,,4.65,percent of total billed charges,83% of total,6.65,95,,5.32,percent of total billed charges ,95% of total billed charges,5.6,80,,4.48,percent of total billed charges,78% of total billed charges,5.46,78,,4.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,4.41,63,,3.53,percent of total billed charges,63% of total billed charges,5.95,85,,4.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.53,79,,4.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,4.41,450,
ANTI-MYELIN GLYCOPROTEIN IGM,301003520,CDM,301,RC,83520,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
NEURONAL NUCLEAR AB (YO),301004182,CDM,301,RC,84182,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,46.74,160,,,fee schedule,160% of CMS fee schedule,37.97,130,,,fee schedule,130% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,23.77,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,22.64,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.17,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,450,
NEURONAL NUCLEAR AB (TR/DNER),301004183,CDM,301,RC,84182,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,46.74,160,,,fee schedule,160% of CMS fee schedule,37.97,130,,,fee schedule,130% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,23.77,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,22.64,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.17,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,450,
NEURONAL NUCLEAR AB (RI),301004184,CDM,301,RC,84182,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,46.74,160,,,fee schedule,160% of CMS fee schedule,37.97,130,,,fee schedule,130% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,23.77,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,22.64,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.17,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,450,
NEURONAL NUCLEAR AB (HU),301004185,CDM,301,RC,84182,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,46.74,160,,,fee schedule,160% of CMS fee schedule,37.97,130,,,fee schedule,130% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,23.77,105,,,fee schedule,105% of GA fee schedule,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,100,,,fee schedule,100% of GA fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,22.64,100,,,fee schedule,100% of GA fee schedule,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.17,93,,,fee schedule,93% of CMS fee schedule,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,29.21,100,,,fee schedule,100% of CMS fee schedule,29.21,100,,,fee schedule,100% of CMS fee schedule,22.64,450,
GQ1B ANTIBODY IGM,301008351,CDM,301,RC,83516,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
GD1B ANTIBODY IGG,301008352,CDM,301,RC,83516,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
GD1B ANTIBODY IGM,301008353,CDM,301,RC,83516,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
GANGLIOSIDE IGG IGM,301008354,CDM,301,RC,83516,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
INFLIXIMAB & ANTI-INFLIXIMAB,301008656,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ADALIMUMAB LEVEL,301080145,CDM,301,RC,80145,HCPCS,outpatient,,,264,184.8,,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,61.71,160,,,fee schedule,160% of CMS fee schedule,50.14,130,,,fee schedule,130% of CMS fee schedule,30.86,100,,,fee schedule,100% of GA fee schedule,203.86,77.22,,163.09,percent of total billed charges,77.22% of total billed charges,32.4,105,,,fee schedule,105% of GA fee schedule,219.12,83,,175.3,percent of total billed charges,83% of total,250.8,95,,200.64,percent of total billed charges ,95% of total billed charges,211.2,80,,168.96,percent of total billed charges,78% of total billed charges,205.92,78,,164.736,percent of total billed charges,78% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,30.86,100,,,fee schedule,100% of GA fee schedule,38.57,100,,,fee schedule,100% of CMS 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,30.86,100,,,fee schedule,100% of GA fee schedule,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.87,93,,,fee schedule,93% of CMS fee schedule,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,38.57,100,,,fee schedule,100% of CMS fee schedule,30.86,450,
ANTI-INFLIXIMAB ANTIBODY,301080230,CDM,301,RC,80230,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,61.71,160,,,fee schedule,160% of CMS fee schedule,50.14,130,,,fee schedule,130% of CMS fee schedule,30.86,100,,,fee schedule,100% of GA fee schedule,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,32.4,105,,,fee schedule,105% of GA fee schedule,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,30.86,100,,,fee schedule,100% of GA fee schedule,38.57,100,,,fee schedule,100% of CMS 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,30.86,100,,,fee schedule,100% of GA fee schedule,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.87,93,,,fee schedule,93% of CMS fee schedule,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,38.57,100,,,fee schedule,100% of CMS fee schedule,38.57,100,,,fee schedule,100% of CMS fee schedule,30.86,450,
THIOPURINE METABOLITE,301080299,CDM,301,RC,80299,HCPCS,outpatient,,,325,227.5,,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,292.5,90,,234,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,250.97,77.22,,200.78,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,269.75,83,,215.8,percent of total billed charges,83% of total,308.75,95,,247,percent of total billed charges ,95% of total billed charges,260,80,,208,percent of total billed charges,78% of total billed charges,253.5,78,,202.8,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,276.25,85,,221,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,256.75,79,,205.4,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
ESLICARBAZEPINE ACETATE,301080300,CDM,301,RC,80299,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
CENOBAMATE,301080301,CDM,301,RC,80299,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
CLOBAZAM LEVEL,301080302,CDM,301,RC,80299,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,29.82,160,,,fee schedule,160% of CMS fee schedule,24.23,130,,,fee schedule,130% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.9,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,100,,,fee schedule,100% of GA fee schedule,18.64,100,,,fee schedule,100% of CMS 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,15.14,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.34,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,15.14,450,
METHAQUALONE SCREEN,301080306,CDM,301,RC,80307,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,54.05,450,
DRUG TEST PRESUMPTIVE,301080307,CDM,301,RC,80307,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,15.44,450,
AMPHETAMINES SCREEN,301080308,CDM,301,RC,80307,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,34.75,450,
PHOSHATIDYLETHANOL,301080321,CDM,301,RC,80321,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.59,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,14.27,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.59,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,13.59,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.59,450,
AMPHETAMINES 5 OR MORE,301080326,CDM,301,RC,80326,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.55,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,20.53,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.55,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,19.55,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
ANALGESICS NON-OPIOID 6 OR >,301080331,CDM,301,RC,80331,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.45,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,26.72,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.45,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,25.45,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
ANTIDEPRESSANT SEROTONERGIC 6>,301080334,CDM,301,RC,80334,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
ANTIDEPRESSANTS TRICYCLIC 6>,301080337,CDM,301,RC,80337,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,23.64,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.51,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
BUPROPION HYDROXYBUPROPION SR,301080338,CDM,301,RC,80338,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
FYCOMPA-PERAMPANEL,301080339,CDM,301,RC,80339,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.41,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,18.28,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.41,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,17.41,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.41,450,
ANTIEPILEPTICS NOT OTW SPEC 7,301080341,CDM,301,RC,80341,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.41,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,18.28,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.41,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,17.41,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
ANTIPSYCHOTICS NOT OTW SPEC 7>,301080344,CDM,301,RC,80344,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.58,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,20.56,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.58,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,19.58,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
BENZODIAZEPINES 13 OR MORE,301080347,CDM,301,RC,80347,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.26,100,,,fee schedule,100% of GA fee schedule,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,24.42,105,,,fee schedule,105% of GA fee schedule,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.26,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,23.26,100,,,fee schedule,100% of GA fee schedule,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.26,450,
DEFINITIVE DRUG TESTING,301080348,CDM,301,RC,80348,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
COCAINE,301080353,CDM,301,RC,80353,HCPCS,outpatient,,,87,60.9,,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,78.3,90,,62.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.06,100,,,fee schedule,100% of GA fee schedule,67.18,77.22,,53.74,percent of total billed charges,77.22% of total billed charges,12.66,105,,,fee schedule,105% of GA fee schedule,72.21,83,,57.77,percent of total billed charges,83% of total,82.65,95,,66.12,percent of total billed charges ,95% of total billed charges,69.6,80,,55.68,percent of total billed charges,78% of total billed charges,67.86,78,,54.288,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.06,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,12.06,100,,,fee schedule,100% of GA fee schedule,73.95,85,,59.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,68.73,79,,54.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.06,450,
FENTANYL,301080354,CDM,301,RC,80354,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,76.68,66.1,,61.34,percent of total billed charges,66.1% of total billed charges,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,73.08,63,,58.46,percent of total billed charges,63% of total billed charges,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73.08,450,
GABAPENTIN NON-BLOOD,301080355,CDM,301,RC,80355,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
KETAMINE AND NORKETAMINE,301080357,CDM,301,RC,80357,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
METHADONE,301080358,CDM,301,RC,80358,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.53,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,21.56,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.53,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,20.53,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.53,450,
METHYLENEDIOXYAMPHETAMINES,301080359,CDM,301,RC,80359,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
METHYLPHENIDATE,301080360,CDM,301,RC,80360,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
OPIATES 1 OR MORE,301080361,CDM,301,RC,80361,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.97,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,27.27,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.97,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,25.97,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
OPIOID MONITORING,301080362,CDM,301,RC,80362,HCPCS,outpatient,,,201,140.7,,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,180.9,90,,144.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.47,100,,,fee schedule,100% of GA fee schedule,155.21,77.22,,124.17,percent of total billed charges,77.22% of total billed charges,25.69,105,,,fee schedule,105% of GA fee schedule,166.83,83,,133.46,percent of total billed charges,83% of total,190.95,95,,152.76,percent of total billed charges ,95% of total billed charges,160.8,80,,128.64,percent of total billed charges,78% of total billed charges,156.78,78,,125.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,24.47,100,,,fee schedule,100% of GA fee schedule,170.85,85,,136.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,158.79,79,,127.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.47,450,
OPIOIDS AND OPIATE ANALOGS 5>,301080364,CDM,301,RC,80364,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.47,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,25.69,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,24.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,24.47,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
OXYCODONE,301080365,CDM,301,RC,80365,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
PREGABALIN,301080366,CDM,301,RC,80366,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
PROPOXYPHENE,301080367,CDM,301,RC,80367,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SEDATIVE HYPNOTICS,301080368,CDM,301,RC,80368,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
SKELETAL MUSCLE RELAXANTS 3>,301080370,CDM,301,RC,80370,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.17,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,23.28,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.17,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.17,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.44,450,
STIMULANTS SYNTHETIC,301080371,CDM,301,RC,80371,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
TAPENTADOL,301080372,CDM,301,RC,80372,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
TRAMADOL,301080373,CDM,301,RC,80373,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12.6,450,
DRUG SUBSTANC DEF QUAL/QUAT 7>,301080377,CDM,301,RC,80377,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.49,450,
APO E GENOTYPING,301081401,CDM,301,RC,81401,HCPCS,outpatient,,,488,341.6,,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,137,100,,,fee schedule,100% of CMS fee schedule,219.2,160,,,fee schedule,160% of CMS fee schedule,178.1,130,,,fee schedule,130% of CMS fee schedule,112,100,,,fee schedule,100% of GA fee schedule,376.83,77.22,,301.46,percent of total billed charges,77.22% of total billed charges,117.6,105,,,fee schedule,105% of GA fee schedule,405.04,83,,324.03,percent of total billed charges,83% of total,463.6,95,,370.88,percent of total billed charges ,95% of total billed charges,390.4,80,,312.32,percent of total billed charges,78% of total billed charges,380.64,78,,304.512,percent of total billed charges,78% of total billed charges,137,100,,,fee schedule,100% of CMS fee schedule,112,100,,,fee schedule,100% of GA fee schedule,137,100,,,fee schedule,100% of CMS fee schedule,439.2,90,,351.36,percent of total billed charges,90% of total billed charges,390.4,80,,312.32,percent of total billed charges,80% of total billed charges,112,100,,,fee schedule,100% of GA fee schedule,414.8,85,,331.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,127.41,93,,,fee schedule,93% of CMS fee schedule,385.52,79,,308.42,percent of total billed charges,79% of total billed charges,137,100,,,fee schedule,100% of CMS fee schedule,137,100,,,fee schedule,100% of CMS fee schedule,112,463.6,
METHIONINE,301082131,CDM,301,RC,82131,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,36.77,160,,,fee schedule,160% of CMS fee schedule,29.87,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,22.98,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.37,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,21.21,450,
ADALIMUMAB ANTIBODY,301082397,CDM,301,RC,82397,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,22.59,160,,,fee schedule,160% of CMS fee schedule,18.36,130,,,fee schedule,130% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,18.66,105,,,fee schedule,105% of GA fee schedule,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,14.12,100,,,fee schedule,100% of CMS 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,17.77,100,,,fee schedule,100% of GA fee schedule,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.13,93,,,fee schedule,93% of CMS fee schedule,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,14.12,100,,,fee schedule,100% of CMS fee schedule,13.13,450,
ACYLGLYCINES URINE,301082542,CDM,301,RC,82542,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,38.54,160,,,fee schedule,160% of CMS fee schedule,31.32,130,,,fee schedule,130% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,7.93,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,100,,,fee schedule,100% of GA fee schedule,24.09,100,,,fee schedule,100% of CMS 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,7.55,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.4,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,7.55,450,
GM1ABP GM1 ANTIBODY PANEL CP,301083516,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NMR LIPO PROFILE,301083704,CDM,301,RC,83704,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,54.7,160,,,fee schedule,160% of CMS fee schedule,44.45,130,,,fee schedule,130% of CMS fee schedule,39.67,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,41.65,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,39.67,100,,,fee schedule,100% of GA fee schedule,34.19,100,,,fee schedule,100% of CMS 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,39.67,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.8,93,,,fee schedule,93% of CMS fee schedule,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,34.19,100,,,fee schedule,100% of CMS fee schedule,34.19,100,,,fee schedule,100% of CMS fee schedule,31.8,450,
NT-proBNP,301083880,CDM,301,RC,83880,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,62.82,160,,,fee schedule,160% of CMS fee schedule,51.04,130,,,fee schedule,130% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,44.82,105,,,fee schedule,105% of GA fee schedule,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,42.69,100,,,fee schedule,100% of GA fee schedule,39.26,100,,,fee schedule,100% of CMS 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,42.69,100,,,fee schedule,100% of GA fee schedule,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.51,93,,,fee schedule,93% of CMS fee schedule,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,39.26,100,,,fee schedule,100% of CMS fee schedule,39.26,100,,,fee schedule,100% of CMS fee schedule,36.51,450,
PHENCYCLIDINE,301083992,CDM,301,RC,83992,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.49,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,19.41,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,18.49,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,18.49,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18.49,450,
PROCALCITONIN,301084145,CDM,301,RC,84145,HCPCS,outpatient,,,112,78.4,,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,27.22,100,,,fee schedule,100% of CMS fee schedule,43.55,160,,,fee schedule,160% of CMS fee schedule,35.39,130,,,fee schedule,130% of CMS fee schedule,24.06,100,,,fee schedule,100% of GA fee schedule,86.49,77.22,,69.19,percent of total billed charges,77.22% of total billed charges,25.26,105,,,fee schedule,105% of GA fee schedule,92.96,83,,74.37,percent of total billed charges,83% of total,106.4,95,,85.12,percent of total billed charges ,95% of total billed charges,89.6,80,,71.68,percent of total billed charges,78% of total billed charges,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,27.22,100,,,fee schedule,100% of CMS fee schedule,24.06,100,,,fee schedule,100% of GA fee schedule,27.22,100,,,fee schedule,100% of CMS fee schedule,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,24.06,100,,,fee schedule,100% of GA fee schedule,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.31,93,,,fee schedule,93% of CMS fee schedule,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,27.22,100,,,fee schedule,100% of CMS fee schedule,27.22,100,,,fee schedule,100% of CMS fee schedule,24.06,450,
NEURONAL NUCLEAR ANTIBODIES CP,301084182,CDM,301,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHYMOTRYPSIN STOOL,301084490,CDM,301,RC,84490,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,9.93,100,,,fee schedule,100% of CMS fee schedule,15.89,160,,,fee schedule,160% of CMS fee schedule,12.91,130,,,fee schedule,130% of CMS fee schedule,9.57,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,10.05,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,9.93,100,,,fee schedule,100% of CMS fee schedule,9.57,100,,,fee schedule,100% of GA fee schedule,9.93,100,,,fee schedule,100% of CMS 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,9.57,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.23,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,9.93,100,,,fee schedule,100% of CMS fee schedule,9.93,100,,,fee schedule,100% of CMS fee schedule,9.23,450,
GALACTOSE ALPHA 1 3,301086008,CDM,301,RC,86008,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,18.6,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,17.71,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ZINC TRANSPORT 8 ANTIBODIES,301086341,CDM,301,RC,86341,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,37.71,160,,,fee schedule,160% of CMS fee schedule,30.64,130,,,fee schedule,130% of CMS fee schedule,24.89,100,,,fee schedule,100% of GA fee schedule,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,26.13,105,,,fee schedule,105% of GA fee schedule,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,24.89,100,,,fee schedule,100% of GA fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,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,24.89,100,,,fee schedule,100% of GA fee schedule,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.92,93,,,fee schedule,93% of CMS fee schedule,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,21.92,450,
BUPRENORPHINE SCREEN,301180307,CDM,301,RC,80307,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,99.42,160,,,fee schedule,160% of CMS fee schedule,80.78,130,,,fee schedule,130% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,64.22,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,61.16,100,,,fee schedule,100% of GA fee schedule,62.14,100,,,fee schedule,100% of CMS 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,61.16,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.79,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,57.79,450,
DOG FENNEL AG,301586003,CDM,301,RC,,,outpatient,,,11,7.7,,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,9.9,90,,7.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,8.49,77.22,,6.79,percent of total billed charges,77.22% of total billed charges,7.27,66.1,,5.82,percent of total billed charges,66.1% of total billed charges,9.13,83,,7.3,percent of total billed charges,83% of total,10.45,95,,8.36,percent of total billed charges ,95% of total billed charges,8.8,80,,7.04,percent of total billed charges,78% of total billed charges,8.58,78,,6.864,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,6.93,63,,5.54,percent of total billed charges,63% of total billed charges,9.35,85,,7.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,8.69,79,,6.95,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.93,450,
INFLIXIMAB DRUG LEVEL,301882397,CDM,301,RC,82397,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,22.59,160,,,fee schedule,160% of CMS fee schedule,18.36,130,,,fee schedule,130% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,18.66,105,,,fee schedule,105% of GA fee schedule,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,17.77,100,,,fee schedule,100% of GA fee schedule,14.12,100,,,fee schedule,100% of CMS 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,17.77,100,,,fee schedule,100% of GA fee schedule,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.13,93,,,fee schedule,93% of CMS fee schedule,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,14.12,100,,,fee schedule,100% of CMS fee schedule,14.12,100,,,fee schedule,100% of CMS fee schedule,13.13,450,
VBG ANALYSIS,306082803,CDM,301,RC,82803,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,41.71,160,,,fee schedule,160% of CMS fee schedule,33.89,130,,,fee schedule,130% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,25.56,105,,,fee schedule,105% of GA fee schedule,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,26.07,100,,,fee schedule,100% of CMS 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,24.34,100,,,fee schedule,100% of GA fee schedule,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.25,93,,,fee schedule,93% of CMS fee schedule,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,24.25,450,
GLUCOSE BLOOD TEST,324082962,CDM,301,RC,82962,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,5.25,160,,,fee schedule,160% of CMS fee schedule,4.26,130,,,fee schedule,130% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,3.09,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,3.28,100,,,fee schedule ,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,2.94,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.05,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,450,
ER PREGNANCY TEST (SERUM)QUANT,450084702,CDM,301,RC,84702,HCPCS,outpatient,,,355,248.5,,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,274.13,77.22,,219.3,percent of total billed charges,77.22% of total billed charges,8.47,105,,,fee schedule,105% of GA fee schedule,294.65,83,,235.72,percent of total billed charges,83% of total,337.25,95,,269.8,percent of total billed charges ,95% of total billed charges,284,80,,227.2,percent of total billed charges,78% of total billed charges,276.9,78,,221.52,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule ,100% of CMS fee schedule,319.5,90,,255.6,percent of total billed charges,90% of total billed charges,284,80,,227.2,percent of total billed charges,80% of total billed charges,8.07,100,,,fee schedule,100% of GA fee schedule,301.75,85,,241.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,280.45,79,,224.36,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,8.07,450,
ER PREGANCY TEST (SERUM) QUAL,450084703,CDM,301,RC,84703,HCPCS,outpatient,,,234,163.8,,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,210.6,90,,168.48,percent of total billed charges,90% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,12.03,160,,,fee schedule,160% of CMS fee schedule,9.78,130,,,fee schedule,130% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,180.69,77.22,,144.55,percent of total billed charges,77.22% of total billed charges,8.47,105,,,fee schedule,105% of GA fee schedule,194.22,83,,155.38,percent of total billed charges,83% of total,222.3,95,,177.84,percent of total billed charges ,95% of total billed charges,187.2,80,,149.76,percent of total billed charges,78% of total billed charges,182.52,78,,146.016,percent of total billed charges,78% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of GA fee schedule,7.52,100,,,fee schedule ,100% of CMS fee schedule,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,8.07,100,,,fee schedule,100% of GA fee schedule,198.9,85,,159.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.99,93,,,fee schedule,93% of CMS fee schedule,184.86,79,,147.89,percent of total billed charges,79% of total billed charges,7.52,100,,,fee schedule,100% of CMS fee schedule,7.52,100,,,fee schedule,100% of CMS fee schedule,6.99,450,
OBS FERN TEST BY NURSE,7620Q0114,CDM,301,RC,Q0114,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,9.74,100,,,fee schedule,100% of CMS fee schedule,15.58,160,,,fee schedule,160% of CMS fee schedule,12.66,130,,,fee schedule,130% of CMS fee schedule,9.99,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,10.49,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,9.74,100,,,fee schedule,100% of CMS fee schedule,9.99,100,,,fee schedule,100% of GA fee schedule,9.74,100,,,fee schedule ,100% of CMS 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,9.99,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.06,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,9.74,100,,,fee schedule,100% of CMS fee schedule,9.74,100,,,fee schedule,100% of CMS fee schedule,9.06,450,
GLUCOSE BLOOD TESTING,82962,CDM,301,RC,82962,HCPCS,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,5.25,160,,,fee schedule,160% of CMS fee schedule,4.26,130,,,fee schedule,130% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,3.09,105,,,fee schedule,105% of GA fee schedule,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,100,,,fee schedule,100% of GA fee schedule,3.28,100,,,fee schedule ,100% of CMS 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,2.94,100,,,fee schedule,100% of GA fee schedule,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.05,93,,,fee schedule,93% of CMS fee schedule,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.94,450,
RAPID PLASMA REAGIN,300000002,CDM,302,RC,86592,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,4.65,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,4.88,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.65,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,4.65,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.97,450,
"RA FACTOR SCREEN,QUALITATIVE",300000033,CDM,302,RC,86430,HCPCS,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,6.14,100,,,fee schedule,100% of CMS fee schedule,9.82,160,,,fee schedule,160% of CMS fee schedule,7.98,130,,,fee schedule,130% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,43.24,77.22,,34.59,percent of total billed charges,77.22% of total billed charges,7.5,105,,,fee schedule,105% of GA fee schedule,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,6.14,100,,,fee schedule,100% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,6.14,100,,,fee schedule,100% of CMS 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,7.14,100,,,fee schedule,100% of GA fee schedule,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.71,93,,,fee schedule,93% of CMS fee schedule,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,6.14,100,,,fee schedule,100% of CMS fee schedule,6.14,100,,,fee schedule,100% of CMS fee schedule,5.71,450,
"IMMUNOELECTROPHORESIS,FLUIDS",300000051,CDM,302,RC,86320,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,29.92,100,,,fee schedule,100% of CMS fee schedule,47.87,160,,,fee schedule,160% of CMS fee schedule,38.9,130,,,fee schedule,130% of CMS fee schedule,28.19,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,29.6,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,29.92,100,,,fee schedule,100% of CMS fee schedule,28.19,100,,,fee schedule,100% of GA fee schedule,29.92,100,,,fee schedule,100% of CMS 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,28.19,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.83,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,29.92,100,,,fee schedule,100% of CMS fee schedule,29.92,100,,,fee schedule,100% of CMS fee schedule,27.83,450,
STREPTOZYME,300000099,CDM,302,RC,86063,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,9.23,160,,,fee schedule,160% of CMS fee schedule,7.5,130,,,fee schedule,130% of CMS fee schedule,7.26,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,7.62,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,7.26,100,,,fee schedule,100% of GA fee schedule,5.77,100,,,fee schedule,100% of CMS 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,7.26,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.37,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,5.77,100,,,fee schedule,100% of CMS fee schedule,5.37,450,
COLD AGGLUTININ TITER,300000100,CDM,302,RC,86157,HCPCS,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,8.06,100,,,fee schedule,100% of CMS fee schedule,12.9,160,,,fee schedule,160% of CMS fee schedule,10.48,130,,,fee schedule,130% of CMS fee schedule,10.14,100,,,fee schedule,100% of GA fee schedule,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,10.65,105,,,fee schedule,105% of GA fee schedule,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,8.06,100,,,fee schedule,100% of CMS fee schedule,10.14,100,,,fee schedule,100% of GA fee schedule,8.06,100,,,fee schedule,100% of CMS 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,10.14,100,,,fee schedule,100% of GA fee schedule,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.5,93,,,fee schedule,93% of CMS fee schedule,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,8.06,100,,,fee schedule,100% of CMS fee schedule,8.06,100,,,fee schedule,100% of CMS fee schedule,7.5,450,
RUBELLA,300000113,CDM,302,RC,86762,HCPCS,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
ANA,300000115,CDM,302,RC,86038,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,19.34,160,,,fee schedule,160% of CMS fee schedule,15.72,130,,,fee schedule,130% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.96,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,12.09,100,,,fee schedule,100% of CMS 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,15.2,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.24,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,11.24,450,
T-H/T-S LYMPH P,300000130,CDM,302,RC,86353,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,78.45,160,,,fee schedule,160% of CMS fee schedule,63.74,130,,,fee schedule,130% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,64.72,105,,,fee schedule,105% of GA fee schedule,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,61.64,100,,,fee schedule,100% of GA fee schedule,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.6,93,,,fee schedule,93% of CMS fee schedule,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,45.6,450,
ANA DIRECT,300000141,CDM,302,RC,86038,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,19.34,160,,,fee schedule,160% of CMS fee schedule,15.72,130,,,fee schedule,130% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.96,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,12.09,100,,,fee schedule,100% of CMS 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,15.2,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.24,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,11.24,450,
RHEUMATOID FACTOR,300000149,CDM,302,RC,86431,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,9.07,160,,,fee schedule,160% of CMS fee schedule,7.37,130,,,fee schedule,130% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,7.5,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,5.67,100,,,fee schedule,100% of CMS 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,7.14,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.27,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,5.27,450,
HIV TESTING HIV-1,300000167,CDM,302,RC,86701,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,8.89,100,,,fee schedule,100% of CMS fee schedule,14.22,160,,,fee schedule,160% of CMS fee schedule,11.56,130,,,fee schedule,130% of CMS fee schedule,9.7,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,10.19,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,8.89,100,,,fee schedule,100% of CMS fee schedule,9.7,100,,,fee schedule,100% of GA fee schedule,8.89,100,,,fee schedule,100% of CMS 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,9.7,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.27,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,8.89,100,,,fee schedule,100% of CMS fee schedule,8.89,100,,,fee schedule,100% of CMS fee schedule,8.27,450,
CA 125,300000201,CDM,302,RC,86304,HCPCS,outpatient,,,227,158.9,,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,175.29,77.22,,140.23,percent of total billed charges,77.22% of total billed charges,27.47,105,,,fee schedule,105% of GA fee schedule,188.41,83,,150.73,percent of total billed charges,83% of total,215.65,95,,172.52,percent of total billed charges ,95% of total billed charges,181.6,80,,145.28,percent of total billed charges,78% of total billed charges,177.06,78,,141.648,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,20.81,100,,,fee schedule,100% of CMS 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,26.16,100,,,fee schedule,100% of GA fee schedule,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,450,
C4 COMPLENENT ANTIGEN,300000207,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
"C-REACTIVE PROTEIN,QUANT",300000219,CDM,302,RC,86140,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,8.29,160,,,fee schedule,160% of CMS fee schedule,6.73,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,5.18,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.82,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,4.82,450,
HEPATITIS B SURFACE ANTIBODY,300000232,CDM,302,RC,86706,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,17.18,160,,,fee schedule,160% of CMS fee schedule,13.96,130,,,fee schedule,130% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,14.19,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,10.74,100,,,fee schedule,100% of CMS 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,13.51,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.99,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,9.99,450,
ROTAZYME,300000308,CDM,302,RC,86759,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,18.23,100,,,fee schedule,100% of CMS fee schedule,29.17,160,,,fee schedule,160% of CMS fee schedule,23.7,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,18.23,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,18.23,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.95,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,18.23,100,,,fee schedule,100% of CMS fee schedule,18.23,100,,,fee schedule,100% of CMS fee schedule,16.59,450,
ANTI-DNA (DS),300000333,CDM,302,RC,86225,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,21.98,160,,,fee schedule,160% of CMS fee schedule,17.86,130,,,fee schedule,130% of CMS fee schedule,17.28,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,18.14,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,17.28,100,,,fee schedule,100% of GA fee schedule,13.74,100,,,fee schedule,100% of CMS 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,17.28,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.78,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,13.74,100,,,fee schedule,100% of CMS fee schedule,12.78,450,
ANTI-DNA (SS),300000334,CDM,302,RC,86226,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,19.38,160,,,fee schedule,160% of CMS fee schedule,15.74,130,,,fee schedule,130% of CMS fee schedule,15.23,100,,,fee schedule,100% of GA fee schedule,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,15.99,105,,,fee schedule,105% of GA fee schedule,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,15.23,100,,,fee schedule,100% of GA fee schedule,12.11,100,,,fee schedule,100% of CMS 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,15.23,100,,,fee schedule,100% of GA fee schedule,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.26,93,,,fee schedule,93% of CMS fee schedule,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,11.26,450,
ANTI-MITOCHONDRAIL,300000336,CDM,302,RC,86381,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,20.36,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,21.38,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,20.36,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,20.36,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,20.36,450,
CH-50,300000338,CDM,302,RC,86162,HCPCS,outpatient,,,236,165.2,,186.44,79,,149.15,percent of total billed charges,79% of total billed charges,212.4,90,,169.92,percent of total billed charges,90% of total billed charges,20.32,100,,,fee schedule,100% of CMS fee schedule,32.51,160,,,fee schedule,160% of CMS fee schedule,26.42,130,,,fee schedule,130% of CMS fee schedule,25.55,100,,,fee schedule,100% of GA fee schedule,182.24,77.22,,145.79,percent of total billed charges,77.22% of total billed charges,26.83,105,,,fee schedule,105% of GA fee schedule,195.88,83,,156.7,percent of total billed charges,83% of total,224.2,95,,179.36,percent of total billed charges ,95% of total billed charges,188.8,80,,151.04,percent of total billed charges,78% of total billed charges,184.08,78,,147.264,percent of total billed charges,78% of total billed charges,20.32,100,,,fee schedule,100% of CMS fee schedule,25.55,100,,,fee schedule,100% of GA fee schedule,20.32,100,,,fee schedule,100% of CMS fee schedule,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,25.55,100,,,fee schedule,100% of GA fee schedule,200.6,85,,160.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.9,93,,,fee schedule,93% of CMS fee schedule,186.44,79,,149.15,percent of total billed charges,79% of total billed charges,20.32,100,,,fee schedule,100% of CMS fee schedule,20.32,100,,,fee schedule,100% of CMS fee schedule,18.9,450,
HLA-B27,300000349,CDM,302,RC,86812,HCPCS,outpatient,,,263,184.1,,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,41.3,160,,,fee schedule,160% of CMS fee schedule,33.55,130,,,fee schedule,130% of CMS fee schedule,32.45,100,,,fee schedule,100% of GA fee schedule,203.09,77.22,,162.47,percent of total billed charges,77.22% of total billed charges,34.07,105,,,fee schedule,105% of GA fee schedule,218.29,83,,174.63,percent of total billed charges,83% of total,249.85,95,,199.88,percent of total billed charges ,95% of total billed charges,210.4,80,,168.32,percent of total billed charges,78% of total billed charges,205.14,78,,164.112,percent of total billed charges,78% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,32.45,100,,,fee schedule,100% of GA fee schedule,25.81,100,,,fee schedule,100% of CMS 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,32.45,100,,,fee schedule,100% of GA fee schedule,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24,93,,,fee schedule,93% of CMS fee schedule,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,24,450,
LYME DISEASE ANTIBODIES,300000397,CDM,302,RC,86618,HCPCS,outpatient,,,384,268.8,,303.36,79,,242.69,percent of total billed charges,79% of total billed charges,345.6,90,,276.48,percent of total billed charges,90% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,27.25,160,,,fee schedule,160% of CMS fee schedule,22.14,130,,,fee schedule,130% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,296.52,77.22,,237.22,percent of total billed charges,77.22% of total billed charges,22.49,105,,,fee schedule,105% of GA fee schedule,318.72,83,,254.98,percent of total billed charges,83% of total,364.8,95,,291.84,percent of total billed charges ,95% of total billed charges,307.2,80,,245.76,percent of total billed charges,78% of total billed charges,299.52,78,,239.616,percent of total billed charges,78% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,345.6,90,,276.48,percent of total billed charges,90% of total billed charges,307.2,80,,245.76,percent of total billed charges,80% of total billed charges,21.42,100,,,fee schedule,100% of GA fee schedule,326.4,85,,261.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.84,93,,,fee schedule,93% of CMS fee schedule,303.36,79,,242.69,percent of total billed charges,79% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,15.84,450,
HEPATITIS A IgM ANTIBODY,300000414,CDM,302,RC,86709,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,18.02,160,,,fee schedule,160% of CMS fee schedule,14.64,130,,,fee schedule,130% of CMS fee schedule,14.16,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,14.87,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,14.16,100,,,fee schedule,100% of GA fee schedule,11.26,100,,,fee schedule,100% of CMS 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,14.16,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.47,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,11.26,100,,,fee schedule,100% of CMS fee schedule,11.26,100,,,fee schedule,100% of CMS fee schedule,10.47,450,
HEPATITIS B CORE IgM ANTIBODY,300000416,CDM,302,RC,86705,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,11.77,100,,,fee schedule,100% of CMS fee schedule,18.83,160,,,fee schedule,160% of CMS fee schedule,15.3,130,,,fee schedule,130% of CMS fee schedule,14.8,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,15.54,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,11.77,100,,,fee schedule,100% of CMS fee schedule,14.8,100,,,fee schedule,100% of GA fee schedule,11.77,100,,,fee schedule,100% of CMS 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,14.8,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.95,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,11.77,100,,,fee schedule,100% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,10.95,450,
IMMUNOELECTROPHORESIS URINE,300000454,CDM,302,RC,86335,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,29.35,100,,,fee schedule,100% of CMS fee schedule,46.96,160,,,fee schedule,160% of CMS fee schedule,38.16,130,,,fee schedule,130% of CMS fee schedule,36.9,100,,,fee schedule,100% of GA fee schedule,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,38.75,105,,,fee schedule,105% of GA fee schedule,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,29.35,100,,,fee schedule,100% of CMS fee schedule,36.9,100,,,fee schedule,100% of GA fee schedule,29.35,100,,,fee schedule,100% of CMS 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,36.9,100,,,fee schedule,100% of GA fee schedule,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.3,93,,,fee schedule,93% of CMS fee schedule,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,29.35,100,,,fee schedule,100% of CMS fee schedule,29.35,100,,,fee schedule,100% of CMS fee schedule,27.3,450,
"ANTI-SS-A,SS-B",300000496,CDM,302,RC,86325,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,23.13,100,,,fee schedule,100% of CMS fee schedule,37.01,160,,,fee schedule,160% of CMS fee schedule,30.07,130,,,fee schedule,130% of CMS fee schedule,28.12,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,29.53,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,23.13,100,,,fee schedule,100% of CMS fee schedule,28.12,100,,,fee schedule,100% of GA fee schedule,23.13,100,,,fee schedule,100% of CMS 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,28.12,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.51,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,23.13,100,,,fee schedule,100% of CMS fee schedule,23.13,100,,,fee schedule,100% of CMS fee schedule,21.51,450,
BACTA ANTIGEN,300000520,CDM,302,RC,,,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,142.78,66.1,,114.22,percent of total billed charges,66.1% of total billed charges,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,136.08,63,,108.86,percent of total billed charges,63% of total billed charges,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,136.08,450,
FTA,300000523,CDM,302,RC,86592,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,4.65,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,4.88,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.65,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,4.65,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.97,450,
RSV ANTIGEN,300000534,CDM,302,RC,87807,HCPCS,outpatient,,,49,34.3,,38.71,79,,30.97,percent of total billed charges,79% of total billed charges,44.1,90,,35.28,percent of total billed charges,90% of total billed charges,13.1,100,,,fee schedule,100% of CMS fee schedule,20.96,160,,,fee schedule,160% of CMS fee schedule,17.03,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,37.84,77.22,,30.27,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,40.67,83,,32.54,percent of total billed charges,83% of total,46.55,95,,37.24,percent of total billed charges ,95% of total billed charges,39.2,80,,31.36,percent of total billed charges,78% of total billed charges,38.22,78,,30.576,percent of total billed charges,78% of total billed charges,13.1,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.1,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,41.65,85,,33.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.18,93,,,fee schedule,93% of CMS fee schedule,38.71,79,,30.97,percent of total billed charges,79% of total billed charges,13.1,100,,,fee schedule,100% of CMS fee schedule,13.1,100,,,fee schedule,100% of CMS fee schedule,12.18,450,
MHA-TP,300000535,CDM,302,RC,86780,HCPCS,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,21.18,160,,,fee schedule,160% of CMS fee schedule,17.21,130,,,fee schedule,130% of CMS fee schedule,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,63,63,,50.4,percent of total billed charges,63% of total billed charges,13.24,100,,,fee schedule,100% of CMS 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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.31,93,,,fee schedule,93% of CMS fee schedule,79,79,,63.2,percent of total billed charges,79% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,12.31,450,
INFLUENZA A OR B ANTIBODY,300000550,CDM,302,RC,86710,HCPCS,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,21.68,160,,,fee schedule,160% of CMS fee schedule,17.62,130,,,fee schedule,130% of CMS fee schedule,17.05,100,,,fee schedule,100% of GA fee schedule,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,17.9,105,,,fee schedule,105% of GA fee schedule,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,17.05,100,,,fee schedule,100% of GA fee schedule,13.55,100,,,fee schedule,100% of CMS 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,17.05,100,,,fee schedule,100% of GA fee schedule,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.6,93,,,fee schedule,93% of CMS fee schedule,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,13.55,100,,,fee schedule,100% of CMS fee schedule,13.55,100,,,fee schedule,100% of CMS fee schedule,12.6,450,
H-PYLORI IgG,300000560,CDM,302,RC,86677,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,26.96,160,,,fee schedule,160% of CMS fee schedule,21.91,130,,,fee schedule,130% of CMS fee schedule,18.25,100,,,fee schedule,100% of GA fee schedule,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,19.16,105,,,fee schedule,105% of GA fee schedule,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,18.25,100,,,fee schedule,100% of GA fee schedule,16.85,100,,,fee schedule,100% of CMS 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,18.25,100,,,fee schedule,100% of GA fee schedule,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.67,93,,,fee schedule,93% of CMS fee schedule,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,15.67,450,
CA19-9,300000569,CDM,302,RC,86301,HCPCS,outpatient,,,168,117.6,,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,151.2,90,,120.96,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,129.73,77.22,,103.78,percent of total billed charges,77.22% of total billed charges,27.47,105,,,fee schedule,105% of GA fee schedule,139.44,83,,111.55,percent of total billed charges,83% of total,159.6,95,,127.68,percent of total billed charges ,95% of total billed charges,134.4,80,,107.52,percent of total billed charges,78% of total billed charges,131.04,78,,104.832,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,20.81,100,,,fee schedule,100% of CMS 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,26.16,100,,,fee schedule,100% of GA fee schedule,142.8,85,,114.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,132.72,79,,106.18,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,450,
TGFB TRANS GROWTH FACT BETA 1,300000835,CDM,302,RC,83520,HCPCS,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
FTA-ABS,300003070,CDM,302,RC,86780,HCPCS,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,21.18,160,,,fee schedule,160% of CMS fee schedule,17.21,130,,,fee schedule,130% of CMS fee schedule,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,63,63,,50.4,percent of total billed charges,63% of total billed charges,13.24,100,,,fee schedule,100% of CMS 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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.31,93,,,fee schedule,93% of CMS fee schedule,79,79,,63.2,percent of total billed charges,79% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,12.31,450,
PHOSPHOLIPASE A2 RECEPTOR,300003516,CDM,302,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
MELANOCYTE STIMUL HORMONE MSH,300003519,CDM,302,RC,83519,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,29.44,160,,,fee schedule,160% of CMS fee schedule,23.92,130,,,fee schedule,130% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,17.84,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,100,,,fee schedule,100% of GA fee schedule,18.4,100,,,fee schedule,100% of CMS 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,16.99,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.11,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,16.99,450,
MATRIX METALLOPROTEINASE 9,300003520,CDM,302,RC,83520,HCPCS,outpatient,,,225,157.5,,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,173.75,77.22,,139,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,186.75,83,,149.4,percent of total billed charges,83% of total,213.75,95,,171,percent of total billed charges ,95% of total billed charges,180,80,,144,percent of total billed charges,78% of total billed charges,175.5,78,,140.4,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,191.25,85,,153,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
SMOOTH MUSCLE ANTIBODY,300008001,CDM,302,RC,86015,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,9.68,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.22,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,9.22,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.22,450,
ANTI-CENTROMERE,300008003,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
SCL-70,300008004,CDM,302,RC,86235,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANTI-J01 ANTIBODY,300008005,CDM,302,RC,86235,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANTI-HISTONE ANTIBODY,300008017,CDM,302,RC,86235,HCPCS,outpatient,,,264,184.8,,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,203.86,77.22,,163.09,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,219.12,83,,175.3,percent of total billed charges,83% of total,250.8,95,,200.64,percent of total billed charges ,95% of total billed charges,211.2,80,,168.96,percent of total billed charges,78% of total billed charges,205.92,78,,164.736,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
"VDRL,QUANT",300008020,CDM,302,RC,86593,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,7.04,160,,,fee schedule,160% of CMS fee schedule,5.72,130,,,fee schedule,130% of CMS fee schedule,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,80.64,66.1,,64.51,percent of total billed charges,66.1% of total billed charges,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,4.4,100,,,fee schedule,100% of CMS 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,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.09,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,4.09,450,
"VDRL,QUALITATIVE",300008021,CDM,302,RC,86592,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,4.65,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,4.88,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.65,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,4.65,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.97,450,
"RA FACTOR TEST,QUANTITATIVE",300008027,CDM,302,RC,86431,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,9.07,160,,,fee schedule,160% of CMS fee schedule,7.37,130,,,fee schedule,130% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,7.5,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,5.67,100,,,fee schedule,100% of CMS 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,7.14,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.27,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,5.27,450,
NITROBLUE TETRAZOLIUM,300008033,CDM,302,RC,86384,HCPCS,outpatient,,,483,338.1,,381.57,79,,305.26,percent of total billed charges,79% of total billed charges,434.7,90,,347.76,percent of total billed charges,90% of total billed charges,13.61,100,,,fee schedule,100% of CMS fee schedule,21.78,160,,,fee schedule,160% of CMS fee schedule,17.69,130,,,fee schedule,130% of CMS fee schedule,14.32,100,,,fee schedule,100% of GA fee schedule,372.97,77.22,,298.38,percent of total billed charges,77.22% of total billed charges,15.04,105,,,fee schedule,105% of GA fee schedule,400.89,83,,320.71,percent of total billed charges,83% of total,458.85,95,,367.08,percent of total billed charges ,95% of total billed charges,386.4,80,,309.12,percent of total billed charges,78% of total billed charges,376.74,78,,301.392,percent of total billed charges,78% of total billed charges,13.61,100,,,fee schedule,100% of CMS fee schedule,14.32,100,,,fee schedule,100% of GA fee schedule,13.61,100,,,fee schedule,100% of CMS fee schedule,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,14.32,100,,,fee schedule,100% of GA fee schedule,410.55,85,,328.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.66,93,,,fee schedule,93% of CMS fee schedule,381.57,79,,305.26,percent of total billed charges,79% of total billed charges,13.61,100,,,fee schedule,100% of CMS fee schedule,13.61,100,,,fee schedule,100% of CMS fee schedule,12.66,458.85,
CANDIDA ANTIGEN,300008035,CDM,302,RC,86628,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,19.22,160,,,fee schedule,160% of CMS fee schedule,15.61,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12.01,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.17,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,11.17,450,
CA 27-29,300008036,CDM,302,RC,86300,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,27.47,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,20.81,100,,,fee schedule,100% of CMS 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,26.16,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,450,
HISTOPLASMA ANTIBODY,300008037,CDM,302,RC,86698,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,22.06,160,,,fee schedule,160% of CMS fee schedule,17.93,130,,,fee schedule,130% of CMS fee schedule,15.71,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,16.5,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,15.71,100,,,fee schedule,100% of GA fee schedule,13.79,100,,,fee schedule,100% of CMS fee schedule,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,15.71,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.82,93,,,fee schedule,93% of CMS fee schedule,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,13.79,100,,,fee schedule,100% of CMS fee schedule,13.79,100,,,fee schedule,100% of CMS fee schedule,12.82,450,
CAIS-3,300008043,CDM,302,RC,86316,HCPCS,outpatient,,,282,197.4,,222.78,79,,178.22,percent of total billed charges,79% of total billed charges,253.8,90,,203.04,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,217.76,77.22,,174.21,percent of total billed charges,77.22% of total billed charges,27.47,105,,,fee schedule,105% of GA fee schedule,234.06,83,,187.25,percent of total billed charges,83% of total,267.9,95,,214.32,percent of total billed charges ,95% of total billed charges,225.6,80,,180.48,percent of total billed charges,78% of total billed charges,219.96,78,,175.968,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,20.81,100,,,fee schedule,100% of CMS 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,26.16,100,,,fee schedule,100% of GA fee schedule,239.7,85,,191.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,222.78,79,,178.22,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,450,
IMMUNOFIX ELECT,300008044,CDM,302,RC,86334,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,22.34,100,,,fee schedule,100% of CMS fee schedule,35.74,160,,,fee schedule,160% of CMS fee schedule,29.04,130,,,fee schedule,130% of CMS fee schedule,28.09,100,,,fee schedule,100% of GA fee schedule,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,29.49,105,,,fee schedule,105% of GA fee schedule,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,22.34,100,,,fee schedule,100% of CMS fee schedule,28.09,100,,,fee schedule,100% of GA fee schedule,22.34,100,,,fee schedule,100% of CMS 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,28.09,100,,,fee schedule,100% of GA fee schedule,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.78,93,,,fee schedule,93% of CMS fee schedule,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,22.34,100,,,fee schedule,100% of CMS fee schedule,22.34,100,,,fee schedule,100% of CMS fee schedule,20.78,450,
INTRINSIC FACTOR,300008054,CDM,302,RC,86340,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,24.13,160,,,fee schedule,160% of CMS fee schedule,19.6,130,,,fee schedule,130% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,19.9,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,18.95,100,,,fee schedule,100% of GA fee schedule,15.08,100,,,fee schedule,100% of CMS 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,18.95,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.02,93,,,fee schedule,93% of CMS fee schedule,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,15.08,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,14.02,450,
"MEASLE,IGM (RUBEOLA)",300008055,CDM,302,RC,86765,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
VARICELLA IGM,300008066,CDM,302,RC,86787,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
HEPATITIS C RIBA,300008070,CDM,302,RC,86317,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,23.98,160,,,fee schedule,160% of CMS fee schedule,19.49,130,,,fee schedule,130% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,15.84,105,,,fee schedule,105% of GA fee schedule,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,14.99,100,,,fee schedule,100% of CMS 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,15.09,100,,,fee schedule,100% of GA fee schedule,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.94,93,,,fee schedule,93% of CMS fee schedule,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,14.99,100,,,fee schedule,100% of CMS fee schedule,13.94,450,
"ALLERGEN GALACTOSE-ALPHA 1,2",300008086,CDM,302,RC,86008,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,18.6,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,17.71,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
IGE ALPHA GAL,300008087,CDM,302,RC,86008,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,18.6,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,17.71,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
F232 IgG OVALBUMIN,300008088,CDM,302,RC,86008,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,18.6,105,,,fee schedule,105% of GA fee schedule,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,17.71,100,,,fee schedule,100% of GA fee schedule,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
F233 IgG OVOMUCOID,300008089,CDM,302,RC,86008,HCPCS,outpatient,,,38,26.6,,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,34.2,90,,27.36,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,29.34,77.22,,23.47,percent of total billed charges,77.22% of total billed charges,18.6,105,,,fee schedule,105% of GA fee schedule,31.54,83,,25.23,percent of total billed charges,83% of total,36.1,95,,28.88,percent of total billed charges ,95% of total billed charges,30.4,80,,24.32,percent of total billed charges,78% of total billed charges,29.64,78,,23.712,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.71,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,17.71,100,,,fee schedule,100% of GA fee schedule,32.3,85,,25.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,30.02,79,,24.02,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ALLERGEN EGG WHITE PANEL CP,300008090,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANTI-DNASE,300008200,CDM,302,RC,86215,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,16.66,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,17.49,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,16.66,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,16.66,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
ANTI-ADRENAL ANTIBODY,300008201,CDM,302,RC,86255,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,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,15.16,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ANTI-MICROSOMAL ANTIBODY,300008206,CDM,302,RC,86376,HCPCS,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,23.28,160,,,fee schedule,160% of CMS fee schedule,18.92,130,,,fee schedule,130% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,19.22,105,,,fee schedule,105% of GA fee schedule,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,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,18.3,100,,,fee schedule,100% of GA fee schedule,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.53,93,,,fee schedule,93% of CMS fee schedule,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,13.53,450,
ANTI-NEUTROPHIL CYTOPLASMIC AB,300008208,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANTI-PARIETAL CELL ANTIBODY,300008210,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ASPERGILLUS ANTIBODY PROFILE,300008213,CDM,302,RC,86606,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
BLASTOMYCES ANTIBODY PROFILE,300008214,CDM,302,RC,86612,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,20.64,160,,,fee schedule,160% of CMS fee schedule,16.77,130,,,fee schedule,130% of CMS fee schedule,16.23,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,17.04,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,16.23,100,,,fee schedule,100% of GA fee schedule,12.9,100,,,fee schedule,100% of CMS 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,16.23,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,12.9,100,,,fee schedule,100% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,12,450,
BORDETELLA PERTOSSIS ANTIBODY,300008215,CDM,302,RC,86615,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
C2 COMPLEMENT ANTIGEN,300008218,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
C3 COMPLEMENT ANTIGEN,300008219,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
C5 COMPLEMENT ANTIGEN,300008220,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
CMV IgG,300008229,CDM,302,RC,86644,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
CMV IgM AB,300008230,CDM,302,RC,86645,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,26.96,160,,,fee schedule,160% of CMS fee schedule,21.91,130,,,fee schedule,130% of CMS fee schedule,21.19,100,,,fee schedule,100% of GA fee schedule,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,22.25,105,,,fee schedule,105% of GA fee schedule,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,21.19,100,,,fee schedule,100% of GA fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,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,21.19,100,,,fee schedule,100% of GA fee schedule,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.67,93,,,fee schedule,93% of CMS fee schedule,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,15.67,450,
CRYPTOCOCCUS ANTIBODY,300008232,CDM,302,RC,86641,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,23.06,160,,,fee schedule,160% of CMS fee schedule,18.73,130,,,fee schedule,130% of CMS fee schedule,18.13,100,,,fee schedule,100% of GA fee schedule,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,19.04,105,,,fee schedule,105% of GA fee schedule,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,18.13,100,,,fee schedule,100% of GA fee schedule,14.41,100,,,fee schedule,100% of CMS 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,18.13,100,,,fee schedule,100% of GA fee schedule,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.4,93,,,fee schedule,93% of CMS fee schedule,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,13.4,450,
EBV EARLY ANTIGEN AB IgG,300008240,CDM,302,RC,86663,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,13.12,100,,,fee schedule,100% of CMS fee schedule,20.99,160,,,fee schedule,160% of CMS fee schedule,17.06,130,,,fee schedule,130% of CMS fee schedule,16.5,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,17.33,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,13.12,100,,,fee schedule,100% of CMS fee schedule,16.5,100,,,fee schedule,100% of GA fee schedule,13.12,100,,,fee schedule,100% of CMS 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,16.5,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.2,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,13.12,100,,,fee schedule,100% of CMS fee schedule,13.12,100,,,fee schedule,100% of CMS fee schedule,12.2,450,
EBV ANTI-NUCLEAR ANTIGEN,300008241,CDM,302,RC,86664,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,15.29,100,,,fee schedule,100% of CMS fee schedule,24.46,160,,,fee schedule,160% of CMS fee schedule,19.88,130,,,fee schedule,130% of CMS fee schedule,19.24,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,20.2,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,15.29,100,,,fee schedule,100% of CMS fee schedule,19.24,100,,,fee schedule,100% of GA fee schedule,15.29,100,,,fee schedule,100% of CMS 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,19.24,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.22,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,15.29,100,,,fee schedule,100% of CMS fee schedule,15.29,100,,,fee schedule,100% of CMS fee schedule,14.22,450,
HEPATITIS BE ANTIGEN,300008253,CDM,302,RC,86707,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,18.51,160,,,fee schedule,160% of CMS fee schedule,15.04,130,,,fee schedule,130% of CMS fee schedule,14.54,100,,,fee schedule,100% of GA fee schedule,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,15.27,105,,,fee schedule,105% of GA fee schedule,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,14.54,100,,,fee schedule,100% of GA fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,14.54,100,,,fee schedule,100% of GA fee schedule,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.76,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,11.57,100,,,fee schedule,100% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,10.76,450,
HEPATITIS D ANTIBODY,300008254,CDM,302,RC,86692,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,17.16,100,,,fee schedule,100% of CMS fee schedule,27.46,160,,,fee schedule,160% of CMS fee schedule,22.31,130,,,fee schedule,130% of CMS fee schedule,21.58,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,22.66,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,17.16,100,,,fee schedule,100% of CMS fee schedule,21.58,100,,,fee schedule,100% of GA fee schedule,17.16,100,,,fee schedule,100% of CMS 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,21.58,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.96,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,17.16,100,,,fee schedule,100% of CMS fee schedule,17.16,100,,,fee schedule,100% of CMS fee schedule,15.96,450,
MYCOPLASMA PNEUMONIAE AB IgG,300008277,CDM,302,RC,86738,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,21.18,160,,,fee schedule,160% of CMS fee schedule,17.21,130,,,fee schedule,130% of CMS fee schedule,16.66,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,17.49,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,16.66,100,,,fee schedule,100% of GA fee schedule,13.24,100,,,fee schedule,100% of CMS 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,16.66,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.31,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,12.31,450,
MYCOPLASMA PNEUMONIAE AB IgM,300008278,CDM,302,RC,86738,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,21.18,160,,,fee schedule,160% of CMS fee schedule,17.21,130,,,fee schedule,130% of CMS fee schedule,16.66,100,,,fee schedule,100% of GA fee schedule,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,17.49,105,,,fee schedule,105% of GA fee schedule,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,16.66,100,,,fee schedule,100% of GA fee schedule,13.24,100,,,fee schedule,100% of CMS 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,16.66,100,,,fee schedule,100% of GA fee schedule,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.31,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,13.24,100,,,fee schedule,100% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,12.31,450,
PLATELET ANTIBODY INDIRECT,300008283,CDM,302,RC,86022,HCPCS,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,29.39,160,,,fee schedule,160% of CMS fee schedule,23.88,130,,,fee schedule,130% of CMS fee schedule,23.09,100,,,fee schedule,100% of GA fee schedule,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,24.24,105,,,fee schedule,105% of GA fee schedule,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,23.09,100,,,fee schedule,100% of GA fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,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,23.09,100,,,fee schedule,100% of GA fee schedule,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.08,93,,,fee schedule,93% of CMS fee schedule,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,17.08,450,
PNEUMOCOCCAL ANTIBODIES IGG,300008285,CDM,302,RC,86317,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,23.98,160,,,fee schedule,160% of CMS fee schedule,19.49,130,,,fee schedule,130% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,15.84,105,,,fee schedule,105% of GA fee schedule,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,14.99,100,,,fee schedule,100% of CMS 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,15.09,100,,,fee schedule,100% of GA fee schedule,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.94,93,,,fee schedule,93% of CMS fee schedule,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,14.99,100,,,fee schedule,100% of CMS fee schedule,13.94,450,
RUBELLA ANTIBODIES IgG,300008287,CDM,302,RC,86762,HCPCS,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
RUBELLA ANTIBODIES IGM,300008288,CDM,302,RC,86762,HCPCS,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
TETANUS ANTIBODY,300008294,CDM,302,RC,86774,HCPCS,outpatient,,,153,107.1,,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,14.8,100,,,fee schedule,100% of CMS fee schedule,23.68,160,,,fee schedule,160% of CMS fee schedule,19.24,130,,,fee schedule,130% of CMS fee schedule,18.61,100,,,fee schedule,100% of GA fee schedule,118.15,77.22,,94.52,percent of total billed charges,77.22% of total billed charges,19.54,105,,,fee schedule,105% of GA fee schedule,126.99,83,,101.59,percent of total billed charges,83% of total,145.35,95,,116.28,percent of total billed charges ,95% of total billed charges,122.4,80,,97.92,percent of total billed charges,78% of total billed charges,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,14.8,100,,,fee schedule,100% of CMS fee schedule,18.61,100,,,fee schedule,100% of GA fee schedule,14.8,100,,,fee schedule,100% of CMS fee schedule,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,18.61,100,,,fee schedule,100% of GA fee schedule,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.76,93,,,fee schedule,93% of CMS fee schedule,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,14.8,100,,,fee schedule,100% of CMS fee schedule,14.8,100,,,fee schedule,100% of CMS fee schedule,13.76,450,
THYROGLOBULIN ANTIBODY,300008297,CDM,302,RC,86800,HCPCS,outpatient,,,153,107.1,,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,25.46,160,,,fee schedule,160% of CMS fee schedule,20.68,130,,,fee schedule,130% of CMS fee schedule,20,100,,,fee schedule,100% of GA fee schedule,118.15,77.22,,94.52,percent of total billed charges,77.22% of total billed charges,21,105,,,fee schedule,105% of GA fee schedule,126.99,83,,101.59,percent of total billed charges,83% of total,145.35,95,,116.28,percent of total billed charges ,95% of total billed charges,122.4,80,,97.92,percent of total billed charges,78% of total billed charges,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,20,100,,,fee schedule,100% of GA fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,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,20,100,,,fee schedule,100% of GA fee schedule,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.8,93,,,fee schedule,93% of CMS fee schedule,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,14.8,450,
TOXOPLASMA IGG ANTIBODY,300008299,CDM,302,RC,86777,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
TOXOPLASMA IGM ANTIBODY,300008300,CDM,302,RC,86778,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,23.06,160,,,fee schedule,160% of CMS fee schedule,18.73,130,,,fee schedule,130% of CMS fee schedule,18.11,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,19.02,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,18.11,100,,,fee schedule,100% of GA fee schedule,14.41,100,,,fee schedule,100% of CMS 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,18.11,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.4,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,14.41,100,,,fee schedule,100% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,13.4,450,
ADENOVIRUS ANTIBODY,300008314,CDM,302,RC,86603,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,20.59,160,,,fee schedule,160% of CMS fee schedule,16.73,130,,,fee schedule,130% of CMS fee schedule,16.18,100,,,fee schedule,100% of GA fee schedule,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,16.99,105,,,fee schedule,105% of GA fee schedule,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,16.18,100,,,fee schedule,100% of GA fee schedule,12.87,100,,,fee schedule,100% of CMS 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,16.18,100,,,fee schedule,100% of GA fee schedule,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.97,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,12.87,100,,,fee schedule,100% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,11.97,450,
LEPTOSPIRA AGGLUTININS,300008316,CDM,302,RC,86720,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,16.2,100,,,fee schedule,100% of CMS fee schedule,25.92,160,,,fee schedule,160% of CMS fee schedule,21.06,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,16.2,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,16.2,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.07,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,16.2,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of CMS fee schedule,15.07,450,
COCCIDIOIDES ANTIBODY,300008323,CDM,302,RC,86635,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,18.35,160,,,fee schedule,160% of CMS fee schedule,14.91,130,,,fee schedule,130% of CMS fee schedule,14.43,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,15.15,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,14.43,100,,,fee schedule,100% of GA fee schedule,11.47,100,,,fee schedule,100% of CMS 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,14.43,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.67,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,11.47,100,,,fee schedule,100% of CMS fee schedule,10.67,450,
ANTI-CARDIOLIPIN IgG,300008324,CDM,302,RC,86147,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS 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,31.99,100,,,fee schedule,100% of GA fee schedule,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
ANTI-CARDIOLIPIN IgM,300008325,CDM,302,RC,86147,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS 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,31.99,100,,,fee schedule,100% of GA fee schedule,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
EPSTEIN BARR IgG ANTIBODY,300008327,CDM,302,RC,86665,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,29.02,160,,,fee schedule,160% of CMS fee schedule,23.58,130,,,fee schedule,130% of CMS fee schedule,22.82,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,23.96,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,22.82,100,,,fee schedule,100% of GA fee schedule,18.14,100,,,fee schedule,100% of CMS 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,22.82,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.87,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,16.87,450,
EPSTEIN BARR IgM ANTIBODY,300008329,CDM,302,RC,86665,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,29.02,160,,,fee schedule,160% of CMS fee schedule,23.58,130,,,fee schedule,130% of CMS fee schedule,22.82,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,23.96,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,22.82,100,,,fee schedule,100% of GA fee schedule,18.14,100,,,fee schedule,100% of CMS 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,22.82,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.87,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,18.14,100,,,fee schedule,100% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,16.87,450,
H-PYLORI IgM,300008331,CDM,302,RC,86677,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,26.96,160,,,fee schedule,160% of CMS fee schedule,21.91,130,,,fee schedule,130% of CMS fee schedule,18.25,100,,,fee schedule,100% of GA fee schedule,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,19.16,105,,,fee schedule,105% of GA fee schedule,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,18.25,100,,,fee schedule,100% of GA fee schedule,16.85,100,,,fee schedule,100% of CMS 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,18.25,100,,,fee schedule,100% of GA fee schedule,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.67,93,,,fee schedule,93% of CMS fee schedule,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,15.67,450,
ROCKY MT SPOTTED FEVER IgG,300008336,CDM,302,RC,86757,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,30.96,160,,,fee schedule,160% of CMS fee schedule,25.16,130,,,fee schedule,130% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,25.57,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,19.35,100,,,fee schedule,100% of CMS 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,24.35,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,18,450,
ROCKY MT SPOTTED FEVER IgM,300008337,CDM,302,RC,86757,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,30.96,160,,,fee schedule,160% of CMS fee schedule,25.16,130,,,fee schedule,130% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,25.57,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,19.35,100,,,fee schedule,100% of CMS 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,24.35,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,18,450,
HEPATITIS C ANTIBODY,300008354,CDM,302,RC,86803,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,22.83,160,,,fee schedule,160% of CMS fee schedule,18.55,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,14.27,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.27,93,,,fee schedule,93% of CMS fee schedule,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,14.27,100,,,fee schedule,100% of CMS fee schedule,10,450,
ANTI-STREPTOLYSIN,300008359,CDM,302,RC,86060,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,11.68,160,,,fee schedule,160% of CMS fee schedule,9.49,130,,,fee schedule,130% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,9.23,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,8.79,100,,,fee schedule,100% of GA fee schedule,7.3,100,,,fee schedule,100% of CMS 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,8.79,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.79,93,,,fee schedule,93% of CMS fee schedule,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,7.3,100,,,fee schedule,100% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,6.79,450,
RSV ANTIBODY IgG,300008360,CDM,302,RC,86756,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,15.89,100,,,fee schedule,100% of CMS fee schedule,25.42,160,,,fee schedule,160% of CMS fee schedule,20.66,130,,,fee schedule,130% of CMS fee schedule,16.21,100,,,fee schedule,100% of GA fee schedule,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,17.02,105,,,fee schedule,105% of GA fee schedule,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,15.89,100,,,fee schedule,100% of CMS fee schedule,16.21,100,,,fee schedule,100% of GA fee schedule,15.89,100,,,fee schedule,100% of CMS 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,16.21,100,,,fee schedule,100% of GA fee schedule,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.78,93,,,fee schedule,93% of CMS fee schedule,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,15.89,100,,,fee schedule,100% of CMS fee schedule,15.89,100,,,fee schedule,100% of CMS fee schedule,14.78,450,
ANTI-SSA,300008372,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
INSULIN ANTIBODY,300008376,CDM,302,RC,86337,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,34.26,160,,,fee schedule,160% of CMS fee schedule,27.83,130,,,fee schedule,130% of CMS fee schedule,26.93,100,,,fee schedule,100% of GA fee schedule,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,28.28,105,,,fee schedule,105% of GA fee schedule,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,26.93,100,,,fee schedule,100% of GA fee schedule,21.41,100,,,fee schedule,100% of CMS 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,26.93,100,,,fee schedule,100% of GA fee schedule,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.91,93,,,fee schedule,93% of CMS fee schedule,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,21.41,100,,,fee schedule,100% of CMS fee schedule,19.91,450,
ANTI-SSB,300008377,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
INSULIN ANTIBODY #2,300008378,CDM,302,RC,86337,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,34.26,160,,,fee schedule,160% of CMS fee schedule,27.83,130,,,fee schedule,130% of CMS fee schedule,26.93,100,,,fee schedule,100% of GA fee schedule,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,28.28,105,,,fee schedule,105% of GA fee schedule,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,26.93,100,,,fee schedule,100% of GA fee schedule,21.41,100,,,fee schedule,100% of CMS 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,26.93,100,,,fee schedule,100% of GA fee schedule,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.91,93,,,fee schedule,93% of CMS fee schedule,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,21.41,100,,,fee schedule,100% of CMS fee schedule,19.91,450,
INSULIN ANTIBODY #3,300008379,CDM,302,RC,86337,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,34.26,160,,,fee schedule,160% of CMS fee schedule,27.83,130,,,fee schedule,130% of CMS fee schedule,26.93,100,,,fee schedule,100% of GA fee schedule,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,28.28,105,,,fee schedule,105% of GA fee schedule,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,26.93,100,,,fee schedule,100% of GA fee schedule,21.41,100,,,fee schedule,100% of CMS 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,26.93,100,,,fee schedule,100% of GA fee schedule,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.91,93,,,fee schedule,93% of CMS fee schedule,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,21.41,100,,,fee schedule,100% of CMS fee schedule,21.41,100,,,fee schedule,100% of CMS fee schedule,19.91,450,
INSULIN ANTIBODIES CHG CP,300008380,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CD4,300008382,CDM,302,RC,86361,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,42.85,160,,,fee schedule,160% of CMS fee schedule,34.81,130,,,fee schedule,130% of CMS fee schedule,32.82,100,,,fee schedule,100% of GA fee schedule,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,34.46,105,,,fee schedule,105% of GA fee schedule,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,32.82,100,,,fee schedule,100% of GA fee schedule,26.78,100,,,fee schedule,100% of CMS 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,32.82,100,,,fee schedule,100% of GA fee schedule,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.91,93,,,fee schedule,93% of CMS fee schedule,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,26.78,100,,,fee schedule,100% of CMS fee schedule,24.91,450,
CD8,300008383,CDM,302,RC,86360,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,75.17,160,,,fee schedule,160% of CMS fee schedule,61.07,130,,,fee schedule,130% of CMS fee schedule,59.09,100,,,fee schedule,100% of GA fee schedule,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,62.04,105,,,fee schedule,105% of GA fee schedule,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,59.09,100,,,fee schedule,100% of GA fee schedule,46.98,100,,,fee schedule,100% of CMS 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,59.09,100,,,fee schedule,100% of GA fee schedule,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,43.69,93,,,fee schedule,93% of CMS fee schedule,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,46.98,100,,,fee schedule,100% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,43.69,450,
CD4/CD8 CP,300008384,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
"AMOEBA,PRECIPITINS",300008386,CDM,302,RC,86753,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,19.82,160,,,fee schedule,160% of CMS fee schedule,16.11,130,,,fee schedule,130% of CMS fee schedule,15.59,100,,,fee schedule,100% of GA fee schedule,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,16.37,105,,,fee schedule,105% of GA fee schedule,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,15.59,100,,,fee schedule,100% of GA fee schedule,12.39,100,,,fee schedule,100% of CMS 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,15.59,100,,,fee schedule,100% of GA fee schedule,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.52,93,,,fee schedule,93% of CMS fee schedule,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,11.52,450,
ECHINOCOCCUS IgM,300008389,CDM,302,RC,86682,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,20.82,160,,,fee schedule,160% of CMS fee schedule,16.91,130,,,fee schedule,130% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,17.17,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,13.01,100,,,fee schedule,100% of CMS 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,16.35,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.1,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,12.1,450,
ECHINOCOCCUS IgG,300008390,CDM,302,RC,86682,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,20.82,160,,,fee schedule,160% of CMS fee schedule,16.91,130,,,fee schedule,130% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,17.17,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,13.01,100,,,fee schedule,100% of CMS 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,16.35,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.1,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,12.1,450,
"PARVOVIRUS B12,ABS IGG IGM CP",300008396,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PARVOVIRUS IgG,300008397,CDM,302,RC,86747,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,24.05,160,,,fee schedule,160% of CMS fee schedule,19.54,130,,,fee schedule,130% of CMS fee schedule,18.9,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,19.85,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,18.9,100,,,fee schedule,100% of GA fee schedule,15.03,100,,,fee schedule,100% of CMS 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,18.9,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.98,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,13.98,450,
PARVOVIRUS IgM,300008398,CDM,302,RC,86747,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,24.05,160,,,fee schedule,160% of CMS fee schedule,19.54,130,,,fee schedule,130% of CMS fee schedule,18.9,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,19.85,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,18.9,100,,,fee schedule,100% of GA fee schedule,15.03,100,,,fee schedule,100% of CMS 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,18.9,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.98,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,15.03,100,,,fee schedule,100% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,13.98,450,
HERPES IGM CP,300008401,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HERPES I & II ANTIBOD IgG CP,300008402,CDM,302,RC,86694,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,15.36,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.63,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,,,,,other,not seperately reimbursable,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
HERPES I IgM,300008403,CDM,302,RC,86695,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"DIPHTHERIA TOXOID AB, IgG",300008404,CDM,302,RC,86648,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,15.21,100,,,fee schedule,100% of CMS fee schedule,24.34,160,,,fee schedule,160% of CMS fee schedule,19.77,130,,,fee schedule,130% of CMS fee schedule,19.13,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,20.09,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,15.21,100,,,fee schedule,100% of CMS fee schedule,19.13,100,,,fee schedule,100% of GA fee schedule,15.21,100,,,fee schedule,100% of CMS fee schedule,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,19.13,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.15,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,15.21,100,,,fee schedule,100% of CMS fee schedule,15.21,100,,,fee schedule,100% of CMS fee schedule,14.15,450,
HIV WESTERN BLOT,300008413,CDM,302,RC,86689,HCPCS,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,30.96,160,,,fee schedule,160% of CMS fee schedule,25.16,130,,,fee schedule,130% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,22.18,105,,,fee schedule,105% of GA fee schedule,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,21.12,100,,,fee schedule,100% of GA fee schedule,19.35,100,,,fee schedule,100% of CMS 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,21.12,100,,,fee schedule,100% of GA fee schedule,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18,93,,,fee schedule,93% of CMS fee schedule,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,18,450,
PM-1,300008414,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
RNP (RIBONUCLEIC PROTEIN),300008422,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
CAT SCRATCH IgG,300008433,CDM,302,RC,86609,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
CAT SCRATCH IgM,300008434,CDM,302,RC,86609,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
CAT SCRATCH ANTIBODIES CP,300008435,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANA (ANA-12),300008436,CDM,302,RC,86038,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,19.34,160,,,fee schedule,160% of CMS fee schedule,15.72,130,,,fee schedule,130% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.96,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,12.09,100,,,fee schedule,100% of CMS 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,15.2,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.24,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,11.24,450,
DNA (ANA-12),300008437,CDM,302,RC,86225,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,21.98,160,,,fee schedule,160% of CMS fee schedule,17.86,130,,,fee schedule,130% of CMS fee schedule,17.28,100,,,fee schedule,100% of GA fee schedule,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,18.14,105,,,fee schedule,105% of GA fee schedule,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,17.28,100,,,fee schedule,100% of GA fee schedule,13.74,100,,,fee schedule,100% of CMS 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,17.28,100,,,fee schedule,100% of GA fee schedule,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.78,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,13.74,100,,,fee schedule,100% of CMS fee schedule,13.74,100,,,fee schedule,100% of CMS fee schedule,12.78,450,
ENA (ANA-12),300008438,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ANTI-CENTROMERE (ANA-12),300008439,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
C3 (ANA-12),300008440,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
C4 (ANA-12),300008441,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
ANTI-SSA (ANA-12),300008442,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANTI-SSB (ANA-12),300008443,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
SCL-70 (ANA-12),300008444,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANIT-CARDIOLIPIN IgG (ANA-12),300008445,CDM,302,RC,86147,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS 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,31.99,100,,,fee schedule,100% of GA fee schedule,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
ANTI-CARDIOLIPIN IgM (ANA-12),300008446,CDM,302,RC,86147,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS 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,31.99,100,,,fee schedule,100% of GA fee schedule,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
ANIT-MICROSOMAL ANTI (ANA-12),300008447,CDM,302,RC,86376,HCPCS,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,23.28,160,,,fee schedule,160% of CMS fee schedule,18.92,130,,,fee schedule,130% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,19.22,105,,,fee schedule,105% of GA fee schedule,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,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,18.3,100,,,fee schedule,100% of GA fee schedule,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.53,93,,,fee schedule,93% of CMS fee schedule,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,13.53,450,
ANTI-THYROGLOBULIN (ANA-12),300008448,CDM,302,RC,86376,HCPCS,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,23.28,160,,,fee schedule,160% of CMS fee schedule,18.92,130,,,fee schedule,130% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,19.22,105,,,fee schedule,105% of GA fee schedule,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,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,18.3,100,,,fee schedule,100% of GA fee schedule,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.53,93,,,fee schedule,93% of CMS fee schedule,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,13.53,450,
ANA-12 CP,300008449,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANTI-SMITH ANTIBODY,300008450,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
LUPUS ERYTHEMATOSUS (DNP),300008452,CDM,302,RC,86038,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,19.34,160,,,fee schedule,160% of CMS fee schedule,15.72,130,,,fee schedule,130% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.96,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,12.09,100,,,fee schedule,100% of CMS 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,15.2,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.24,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,11.24,450,
H INFLUENZA,300008453,CDM,302,RC,86403,HCPCS,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,18.46,160,,,fee schedule,160% of CMS fee schedule,15,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,11.54,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.73,93,,,fee schedule,93% of CMS fee schedule,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,11.54,100,,,fee schedule,100% of CMS fee schedule,10,450,
N MENINGITIS,300008454,CDM,302,RC,86403,HCPCS,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,18.46,160,,,fee schedule,160% of CMS fee schedule,15,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,11.54,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.73,93,,,fee schedule,93% of CMS fee schedule,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,11.54,100,,,fee schedule,100% of CMS fee schedule,10,450,
STREP GROUP B,300008455,CDM,302,RC,86403,HCPCS,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,18.46,160,,,fee schedule,160% of CMS fee schedule,15,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,11.54,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.73,93,,,fee schedule,93% of CMS fee schedule,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,11.54,100,,,fee schedule,100% of CMS fee schedule,10,450,
STREP PNEUMOCOCCUS,300008456,CDM,302,RC,86403,HCPCS,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,18.46,160,,,fee schedule,160% of CMS fee schedule,15,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,167.57,77.22,,134.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,11.54,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.73,93,,,fee schedule,93% of CMS fee schedule,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,11.54,100,,,fee schedule,100% of CMS fee schedule,11.54,100,,,fee schedule,100% of CMS fee schedule,10,450,
COXSACKIE B,300008464,CDM,302,RC,86658,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
ANTI-NEUTROPHIL ANTIBODY,300008487,CDM,302,RC,86021,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
HERPES II IgM,300008489,CDM,302,RC,86696,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,30.96,160,,,fee schedule,160% of CMS fee schedule,25.16,130,,,fee schedule,130% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,25.57,105,,,fee schedule,105% of GA fee schedule,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,19.35,100,,,fee schedule,100% of CMS 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,24.35,100,,,fee schedule,100% of GA fee schedule,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,18,450,
HERPES I & II ANTIBODI IGM CP,300008490,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INHIBIN COOMBS EA TITER,300008494,CDM,302,RC,86977,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,87.91,66.1,,70.33,percent of total billed charges,66.1% of total billed charges,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,83.79,450,
C TRACHOMATIS IgG,300008497,CDM,302,RC,86631,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,18.91,160,,,fee schedule,160% of CMS fee schedule,15.37,130,,,fee schedule,130% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,15.61,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,11.82,100,,,fee schedule,100% of CMS 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,14.87,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.99,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,10.99,450,
C PNEUMONIAE IgG,300008498,CDM,302,RC,86631,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,18.91,160,,,fee schedule,160% of CMS fee schedule,15.37,130,,,fee schedule,130% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,15.61,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,11.82,100,,,fee schedule,100% of CMS 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,14.87,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.99,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,10.99,450,
C PSITTACI IgG,300008499,CDM,302,RC,86631,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,18.91,160,,,fee schedule,160% of CMS fee schedule,15.37,130,,,fee schedule,130% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,15.61,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,11.82,100,,,fee schedule,100% of CMS 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,14.87,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.99,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,10.99,450,
C TRACHOMATIS IgM,300008500,CDM,302,RC,86632,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,20.29,160,,,fee schedule,160% of CMS fee schedule,16.48,130,,,fee schedule,130% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,16.77,105,,,fee schedule,105% of GA fee schedule,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,12.68,100,,,fee schedule,100% of CMS 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,15.97,100,,,fee schedule,100% of GA fee schedule,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.79,93,,,fee schedule,93% of CMS fee schedule,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,11.79,450,
C PNEUMONIAE IgM,300008501,CDM,302,RC,86632,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,20.29,160,,,fee schedule,160% of CMS fee schedule,16.48,130,,,fee schedule,130% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,16.77,105,,,fee schedule,105% of GA fee schedule,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,12.68,100,,,fee schedule,100% of CMS 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,15.97,100,,,fee schedule,100% of GA fee schedule,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.79,93,,,fee schedule,93% of CMS fee schedule,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,11.79,450,
C PSITTACI IgM,300008502,CDM,302,RC,86632,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,20.29,160,,,fee schedule,160% of CMS fee schedule,16.48,130,,,fee schedule,130% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,16.77,105,,,fee schedule,105% of GA fee schedule,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,12.68,100,,,fee schedule,100% of CMS 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,15.97,100,,,fee schedule,100% of GA fee schedule,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.79,93,,,fee schedule,93% of CMS fee schedule,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,11.79,450,
CA 15-3,300008506,CDM,302,RC,86300,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,27.47,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,20.81,100,,,fee schedule,100% of CMS 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,26.16,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,450,
HLA PANEL,300008507,CDM,302,RC,86813,HCPCS,outpatient,,,856,599.2,,676.24,79,,540.99,percent of total billed charges,79% of total billed charges,770.4,90,,616.32,percent of total billed charges,90% of total billed charges,58,100,,,fee schedule,100% of CMS fee schedule,92.8,160,,,fee schedule,160% of CMS fee schedule,75.4,130,,,fee schedule,130% of CMS fee schedule,72.92,100,,,fee schedule,100% of GA fee schedule,661,77.22,,528.8,percent of total billed charges,77.22% of total billed charges,76.57,105,,,fee schedule,105% of GA fee schedule,710.48,83,,568.38,percent of total billed charges,83% of total,813.2,95,,650.56,percent of total billed charges ,95% of total billed charges,684.8,80,,547.84,percent of total billed charges,78% of total billed charges,667.68,78,,534.144,percent of total billed charges,78% of total billed charges,58,100,,,fee schedule,100% of CMS fee schedule,72.92,100,,,fee schedule,100% of GA fee schedule,58,100,,,fee schedule,100% of CMS fee schedule,770.4,90,,616.32,percent of total billed charges,90% of total billed charges,684.8,80,,547.84,percent of total billed charges,80% of total billed charges,72.92,100,,,fee schedule,100% of GA fee schedule,727.6,85,,582.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,53.94,93,,,fee schedule,93% of CMS fee schedule,676.24,79,,540.99,percent of total billed charges,79% of total billed charges,58,100,,,fee schedule,100% of CMS fee schedule,58,100,,,fee schedule,100% of CMS fee schedule,53.94,813.2,
EHRLICHIA CHAFFEENSIS IgG,300008509,CDM,302,RC,86666,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,16.29,160,,,fee schedule,160% of CMS fee schedule,13.23,130,,,fee schedule,130% of CMS fee schedule,12.8,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,13.44,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,12.8,100,,,fee schedule,100% of GA fee schedule,10.18,100,,,fee schedule,100% of CMS 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,12.8,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.47,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,9.47,450,
EHRLICHIA CHAFFEENSIS IgM,300008510,CDM,302,RC,86666,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,16.29,160,,,fee schedule,160% of CMS fee schedule,13.23,130,,,fee schedule,130% of CMS fee schedule,12.8,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,13.44,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,12.8,100,,,fee schedule,100% of GA fee schedule,10.18,100,,,fee schedule,100% of CMS 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,12.8,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.47,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,9.47,450,
MAG ANTIBODY,300008520,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
MAG ANTIBODY CP,300008521,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SLE SCREEN,300008531,CDM,302,RC,86038,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,19.34,160,,,fee schedule,160% of CMS fee schedule,15.72,130,,,fee schedule,130% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.96,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,15.2,100,,,fee schedule,100% of GA fee schedule,12.09,100,,,fee schedule,100% of CMS 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,15.2,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.24,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,11.24,450,
WEST NILE VIRUS IgG,300008532,CDM,302,RC,86788,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,26.96,160,,,fee schedule,160% of CMS fee schedule,21.91,130,,,fee schedule,130% of CMS fee schedule,21.19,100,,,fee schedule,100% of GA fee schedule,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,22.25,105,,,fee schedule,105% of GA fee schedule,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,21.19,100,,,fee schedule,100% of GA fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,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,21.19,100,,,fee schedule,100% of GA fee schedule,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.67,93,,,fee schedule,93% of CMS fee schedule,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,15.67,450,
WEST NILE VIRUS IgM,300008533,CDM,302,RC,86789,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
SACCHAROMYCES CEREVISIAE IgA,300008545,CDM,302,RC,86671,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,19.6,160,,,fee schedule,160% of CMS fee schedule,15.93,130,,,fee schedule,130% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,16.19,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,12.25,100,,,fee schedule,100% of CMS 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,15.42,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.39,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,12.25,100,,,fee schedule,100% of CMS fee schedule,11.39,450,
SACCHAROMYCES CEREVISIAE IgG,300008546,CDM,302,RC,86671,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,19.6,160,,,fee schedule,160% of CMS fee schedule,15.93,130,,,fee schedule,130% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,16.19,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,12.25,100,,,fee schedule,100% of CMS 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,15.42,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.39,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,12.25,100,,,fee schedule,100% of CMS fee schedule,11.39,450,
"ENCEPHALITIS,CALIFORNIA",300008558,CDM,302,RC,86651,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"ENCEPHALITIS,EASTERN EQUINE",300008559,CDM,302,RC,86652,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"ENCEPHALITIS,ST LOUIS",300008560,CDM,302,RC,86653,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"ENCEPHALITIS,WESTERN EQUINE",300008561,CDM,302,RC,86654,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"C-REACTIVE PROTEIN,HS",300008568,CDM,302,RC,86141,HCPCS,outpatient,,,145,101.5,,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,20.72,160,,,fee schedule,160% of CMS fee schedule,16.84,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,111.97,77.22,,89.58,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,120.35,83,,96.28,percent of total billed charges,83% of total,137.75,95,,110.2,percent of total billed charges ,95% of total billed charges,116,80,,92.8,percent of total billed charges,78% of total billed charges,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,12.95,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.04,93,,,fee schedule,93% of CMS fee schedule,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,12.04,450,
C1 ESTERASE INHIBITOR,300008572,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
HERPES I IgG,300008575,CDM,302,RC,86695,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
HERPES II IgG,300008576,CDM,302,RC,86696,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,30.96,160,,,fee schedule,160% of CMS fee schedule,25.16,130,,,fee schedule,130% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,25.57,105,,,fee schedule,105% of GA fee schedule,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,24.35,100,,,fee schedule,100% of GA fee schedule,19.35,100,,,fee schedule,100% of CMS 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,24.35,100,,,fee schedule,100% of GA fee schedule,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,18,450,
C1 ESTERASE INHIBITOR FUNCT,300008579,CDM,302,RC,86161,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
PHOSPHATIDYLSERINE ANTIBODIES,300008585,CDM,302,RC,86148,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,25.71,160,,,fee schedule,160% of CMS fee schedule,20.89,130,,,fee schedule,130% of CMS fee schedule,20.2,100,,,fee schedule,100% of GA fee schedule,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,21.21,105,,,fee schedule,105% of GA fee schedule,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,20.2,100,,,fee schedule,100% of GA fee schedule,16.07,100,,,fee schedule,100% of CMS 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,20.2,100,,,fee schedule,100% of GA fee schedule,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.95,93,,,fee schedule,93% of CMS fee schedule,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,14.95,450,
LIVER KIDNEY MICROSOME,300008598,CDM,302,RC,86376,HCPCS,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,23.28,160,,,fee schedule,160% of CMS fee schedule,18.92,130,,,fee schedule,130% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,19.22,105,,,fee schedule,105% of GA fee schedule,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,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,18.3,100,,,fee schedule,100% of GA fee schedule,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.53,93,,,fee schedule,93% of CMS fee schedule,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,13.53,450,
ANTI-STRIATED MUSCLE ANTIBODY,300008603,CDM,302,RC,86255,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
POLI VIRUS ANTIBODY TYPE 1,300008613,CDM,302,RC,86658,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
POLI VIRUS ANTIBODY TYPE 2,300008614,CDM,302,RC,86658,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
POLI VIRUS ANTIBODY TYPE 3,300008615,CDM,302,RC,86658,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
HEPATITIS A ANTIBODY-TOTAL,300008620,CDM,302,RC,86708,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,19.82,160,,,fee schedule,160% of CMS fee schedule,16.11,130,,,fee schedule,130% of CMS fee schedule,15.58,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,16.36,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,15.58,100,,,fee schedule,100% of GA fee schedule,12.39,100,,,fee schedule,100% of CMS 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,15.58,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.52,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,11.52,450,
MYOCARDIAL ANTIBODY,300008623,CDM,302,RC,86255,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ANTI-ISLET CELL ANTIBODY,300008625,CDM,302,RC,86341,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,37.71,160,,,fee schedule,160% of CMS fee schedule,30.64,130,,,fee schedule,130% of CMS fee schedule,24.89,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,26.13,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,24.89,100,,,fee schedule,100% of GA fee schedule,23.57,100,,,fee schedule,100% of CMS 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,24.89,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.92,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,21.92,450,
LEGIONELLA ANTIBODY,300008628,CDM,302,RC,86713,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,24.48,160,,,fee schedule,160% of CMS fee schedule,19.89,130,,,fee schedule,130% of CMS fee schedule,19.25,100,,,fee schedule,100% of GA fee schedule,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,20.21,105,,,fee schedule,105% of GA fee schedule,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,19.25,100,,,fee schedule,100% of GA fee schedule,15.3,100,,,fee schedule,100% of CMS 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,19.25,100,,,fee schedule,100% of GA fee schedule,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.23,93,,,fee schedule,93% of CMS fee schedule,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,15.3,100,,,fee schedule,100% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,14.23,450,
HEPATITIS B CORE TOTAL,300008629,CDM,302,RC,86704,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
COXSACKIE A SEROTYPE 7,300008630,CDM,302,RC,86658,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE A SEROTYPE 9,300008631,CDM,302,RC,86658,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE A SEROTYPE 10,300008632,CDM,302,RC,86658,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE A SEROTYPE 16,300008633,CDM,302,RC,86658,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,271.04,77.22,,216.83,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE A CP,300008634,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
COXSACKIE B SEROTYPE 1,300008635,CDM,302,RC,86658,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE B SEROTYPE 2,300008636,CDM,302,RC,86658,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE B SEROTYPE 3,300008637,CDM,302,RC,86658,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE B SEROTYPE 4,300008638,CDM,302,RC,86658,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE B SEROTYPE 5,300008639,CDM,302,RC,86658,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE B SEROTYPE 6,300008640,CDM,302,RC,86658,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,20.85,160,,,fee schedule,160% of CMS fee schedule,16.94,130,,,fee schedule,130% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,17.2,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of GA fee schedule,13.03,100,,,fee schedule,100% of CMS 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,16.38,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.12,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,13.03,100,,,fee schedule,100% of CMS fee schedule,13.03,100,,,fee schedule,100% of CMS fee schedule,12.12,450,
COXSACKIE B CP,300008641,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANTI-GLOMERULAR BASE IgA,300008653,CDM,302,RC,86255,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ANTI-GLOMERULAR BASE IgM,300008654,CDM,302,RC,86255,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ANTI-GLOMERULAR BASE MB AB CP,300008655,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HEPARIN ASSOCIATED ANTIBODY,300008677,CDM,302,RC,86022,HCPCS,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,29.39,160,,,fee schedule,160% of CMS fee schedule,23.88,130,,,fee schedule,130% of CMS fee schedule,23.09,100,,,fee schedule,100% of GA fee schedule,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,24.24,105,,,fee schedule,105% of GA fee schedule,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,23.09,100,,,fee schedule,100% of GA fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,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,23.09,100,,,fee schedule,100% of GA fee schedule,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.08,93,,,fee schedule,93% of CMS fee schedule,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,17.08,450,
GM2/TITER EA ANTIBODY I,300008693,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
GM2/TITER EA ANTIBODY II,300008694,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
GM2/TITER EA ANTIBODY III,300008695,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
GM2 CP,300008696,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HEPARIN ANTIBODY,300008698,CDM,302,RC,86022,HCPCS,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,29.39,160,,,fee schedule,160% of CMS fee schedule,23.88,130,,,fee schedule,130% of CMS fee schedule,23.09,100,,,fee schedule,100% of GA fee schedule,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,24.24,105,,,fee schedule,105% of GA fee schedule,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,23.09,100,,,fee schedule,100% of GA fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,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,23.09,100,,,fee schedule,100% of GA fee schedule,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.08,93,,,fee schedule,93% of CMS fee schedule,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,18.37,100,,,fee schedule,100% of CMS fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,17.08,450,
ASPRGILLUS FUMIGATUS #1,300008713,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
ASPERGILLUS FUMIGATUS #6,300008714,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
AUREOBASIDIUM PULLULANS,300008715,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
PIGEON SERUM,300008716,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
MICROPOLYSPORA FAENI,300008717,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
THERMOACTINOMYCES VULGARIS #1,300008718,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
ASPERGILLUS FLAVUS,300008719,CDM,302,RC,86606,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
ASPERGILLUS FUMIGATUS #2,300008720,CDM,302,RC,86606,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,13.13,450,
ASPERGILLUS FUMIGATUS #3,300008721,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
SACCHAROMONOSPORA VIRIDIS,300008722,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
THERMOACTINOMYCES CANDIDUS,300008723,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
THERMOACTINOMYCES SACCHARI,300008724,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
INDIRECT TITER,300008738,CDM,302,RC,86886,HCPCS,outpatient,,,293,205.1,,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,5.85,100,,,fee schedule,100% of GA fee schedule,226.25,77.22,,181,percent of total billed charges,77.22% of total billed charges,6.14,105,,,fee schedule,105% of GA fee schedule,243.19,83,,194.55,percent of total billed charges,83% of total,278.35,95,,222.68,percent of total billed charges ,95% of total billed charges,234.4,80,,187.52,percent of total billed charges,78% of total billed charges,228.54,78,,182.832,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,5.85,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,5.85,100,,,fee schedule,100% of GA fee schedule,249.05,85,,199.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,5.85,450,
RAPID HIV,300008769,CDM,302,RC,86703,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,13.71,100,,,fee schedule,100% of CMS fee schedule,21.94,160,,,fee schedule,160% of CMS fee schedule,17.82,130,,,fee schedule,130% of CMS fee schedule,14.96,100,,,fee schedule,100% of GA fee schedule,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,15.71,105,,,fee schedule,105% of GA fee schedule,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,13.71,100,,,fee schedule,100% of CMS fee schedule,14.96,100,,,fee schedule,100% of GA fee schedule,13.71,100,,,fee schedule,100% of CMS 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,14.96,100,,,fee schedule,100% of GA fee schedule,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.75,93,,,fee schedule,93% of CMS fee schedule,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,13.71,100,,,fee schedule,100% of CMS fee schedule,13.71,100,,,fee schedule,100% of CMS fee schedule,12.75,450,
HEPATITIS B SURFACE AB,300008774,CDM,302,RC,86706,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,17.18,160,,,fee schedule,160% of CMS fee schedule,13.96,130,,,fee schedule,130% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,14.19,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,10.74,100,,,fee schedule,100% of CMS 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,13.51,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.99,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,9.99,450,
HEPATITIS C ANTIBODY,300008775,CDM,302,RC,86803,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,22.83,160,,,fee schedule,160% of CMS fee schedule,18.55,130,,,fee schedule,130% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,10.5,105,,,fee schedule,105% of GA fee schedule,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,10,100,,,fee schedule,100% of GA fee schedule,14.27,100,,,fee schedule,100% of CMS 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,10,100,,,fee schedule,100% of GA fee schedule,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.27,93,,,fee schedule,93% of CMS fee schedule,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,14.27,100,,,fee schedule,100% of CMS fee schedule,14.27,100,,,fee schedule,100% of CMS fee schedule,10,450,
HEPATITIS A ANTIBODIES-TOTAL,300008776,CDM,302,RC,86708,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,19.82,160,,,fee schedule,160% of CMS fee schedule,16.11,130,,,fee schedule,130% of CMS fee schedule,15.58,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,16.36,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,15.58,100,,,fee schedule,100% of GA fee schedule,12.39,100,,,fee schedule,100% of CMS 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,15.58,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.52,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,11.52,450,
HEPATITIS B CORE TOTAL,300008777,CDM,302,RC,86704,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
HEPATITIS (ABC) CP,300008778,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CYCLIC CITRULINATED,300008779,CDM,302,RC,86200,HCPCS,outpatient,,,202,141.4,,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,20.72,160,,,fee schedule,160% of CMS fee schedule,16.84,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,155.98,77.22,,124.78,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,167.66,83,,134.13,percent of total billed charges,83% of total,191.9,95,,153.52,percent of total billed charges ,95% of total billed charges,161.6,80,,129.28,percent of total billed charges,78% of total billed charges,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,12.95,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.04,93,,,fee schedule,93% of CMS fee schedule,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,12.95,100,,,fee schedule,100% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,12.04,450,
HERPES VIRUS 6 IgM,300008796,CDM,302,RC,86790,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
C PNEUMONIAE IgM TITER,300008836,CDM,302,RC,86631,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,18.91,160,,,fee schedule,160% of CMS fee schedule,15.37,130,,,fee schedule,130% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,15.61,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,11.82,100,,,fee schedule,100% of CMS 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,14.87,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.99,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,10.99,450,
C TRACHOMATIS IgM TITER,300008837,CDM,302,RC,86631,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,18.91,160,,,fee schedule,160% of CMS fee schedule,15.37,130,,,fee schedule,130% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,15.61,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,11.82,100,,,fee schedule,100% of CMS 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,14.87,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.99,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,10.99,450,
C PSITACCI IgM TITER,300008838,CDM,302,RC,86631,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,18.91,160,,,fee schedule,160% of CMS fee schedule,15.37,130,,,fee schedule,130% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,15.61,105,,,fee schedule,105% of GA fee schedule,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,14.87,100,,,fee schedule,100% of GA fee schedule,11.82,100,,,fee schedule,100% of CMS 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,14.87,100,,,fee schedule,100% of GA fee schedule,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.99,93,,,fee schedule,93% of CMS fee schedule,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,11.82,100,,,fee schedule,100% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,10.99,450,
C PNEUMONIAE IgM TITER,300008839,CDM,302,RC,86632,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,20.29,160,,,fee schedule,160% of CMS fee schedule,16.48,130,,,fee schedule,130% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,16.77,105,,,fee schedule,105% of GA fee schedule,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,12.68,100,,,fee schedule,100% of CMS 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,15.97,100,,,fee schedule,100% of GA fee schedule,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.79,93,,,fee schedule,93% of CMS fee schedule,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,11.79,450,
C TRACHOMATIS IgM TITER,300008840,CDM,302,RC,86632,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,20.29,160,,,fee schedule,160% of CMS fee schedule,16.48,130,,,fee schedule,130% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,16.77,105,,,fee schedule,105% of GA fee schedule,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,12.68,100,,,fee schedule,100% of CMS 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,15.97,100,,,fee schedule,100% of GA fee schedule,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.79,93,,,fee schedule,93% of CMS fee schedule,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,11.79,450,
C PSITACCI IgM TITER,300008841,CDM,302,RC,86632,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,20.29,160,,,fee schedule,160% of CMS fee schedule,16.48,130,,,fee schedule,130% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,16.77,105,,,fee schedule,105% of GA fee schedule,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,15.97,100,,,fee schedule,100% of GA fee schedule,12.68,100,,,fee schedule,100% of CMS 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,15.97,100,,,fee schedule,100% of GA fee schedule,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.79,93,,,fee schedule,93% of CMS fee schedule,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,11.79,450,
C1Q BINDING,300008843,CDM,302,RC,86332,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,24.37,100,,,fee schedule,100% of CMS fee schedule,38.99,160,,,fee schedule,160% of CMS fee schedule,31.68,130,,,fee schedule,130% of CMS fee schedule,30.65,100,,,fee schedule,100% of GA fee schedule,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,32.18,105,,,fee schedule,105% of GA fee schedule,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,24.37,100,,,fee schedule,100% of CMS fee schedule,30.65,100,,,fee schedule,100% of GA fee schedule,24.37,100,,,fee schedule,100% of CMS 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,30.65,100,,,fee schedule,100% of GA fee schedule,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.66,93,,,fee schedule,93% of CMS fee schedule,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,24.37,100,,,fee schedule,100% of CMS fee schedule,24.37,100,,,fee schedule,100% of CMS fee schedule,22.66,450,
LYME WESTERN BLOT,300008850,CDM,302,RC,86617,HCPCS,outpatient,,,165,115.5,,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,15.49,100,,,fee schedule,100% of CMS fee schedule,24.78,160,,,fee schedule,160% of CMS fee schedule,20.14,130,,,fee schedule,130% of CMS fee schedule,19.48,100,,,fee schedule,100% of GA fee schedule,127.41,77.22,,101.93,percent of total billed charges,77.22% of total billed charges,20.45,105,,,fee schedule,105% of GA fee schedule,136.95,83,,109.56,percent of total billed charges,83% of total,156.75,95,,125.4,percent of total billed charges ,95% of total billed charges,132,80,,105.6,percent of total billed charges,78% of total billed charges,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,15.49,100,,,fee schedule,100% of CMS fee schedule,19.48,100,,,fee schedule,100% of GA fee schedule,15.49,100,,,fee schedule,100% of CMS 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,19.48,100,,,fee schedule,100% of GA fee schedule,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.41,93,,,fee schedule,93% of CMS fee schedule,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,15.49,100,,,fee schedule,100% of CMS fee schedule,15.49,100,,,fee schedule,100% of CMS fee schedule,14.41,450,
"HEPATITIS B CORE IgM, QUANT",300008857,CDM,302,RC,86705,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,11.77,100,,,fee schedule,100% of CMS fee schedule,18.83,160,,,fee schedule,160% of CMS fee schedule,15.3,130,,,fee schedule,130% of CMS fee schedule,14.8,100,,,fee schedule,100% of GA fee schedule,94.98,77.22,,75.98,percent of total billed charges,77.22% of total billed charges,15.54,105,,,fee schedule,105% of GA fee schedule,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,11.77,100,,,fee schedule,100% of CMS fee schedule,14.8,100,,,fee schedule,100% of GA fee schedule,11.77,100,,,fee schedule,100% of CMS 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,14.8,100,,,fee schedule,100% of GA fee schedule,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.95,93,,,fee schedule,93% of CMS fee schedule,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,11.77,100,,,fee schedule,100% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,10.95,450,
HEPATITIS B CORE TOTAL QUANT,300008858,CDM,302,RC,86704,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
HEPATITIS A VIRUS TOTAL QUANT,300008859,CDM,302,RC,86708,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,19.82,160,,,fee schedule,160% of CMS fee schedule,16.11,130,,,fee schedule,130% of CMS fee schedule,15.58,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,16.36,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,15.58,100,,,fee schedule,100% of GA fee schedule,12.39,100,,,fee schedule,100% of CMS 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,15.58,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.52,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,12.39,100,,,fee schedule,100% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,11.52,450,
PLATELET IgG ANTIBODY,300008879,CDM,302,RC,86023,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,19.94,160,,,fee schedule,160% of CMS fee schedule,16.2,130,,,fee schedule,130% of CMS fee schedule,15.66,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,16.44,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,15.66,100,,,fee schedule,100% of GA fee schedule,12.46,100,,,fee schedule,100% of CMS 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,15.66,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.59,93,,,fee schedule,93% of CMS fee schedule,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,11.59,450,
PLATELET IgM ANTIBODY,300008880,CDM,302,RC,86023,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,19.94,160,,,fee schedule,160% of CMS fee schedule,16.2,130,,,fee schedule,130% of CMS fee schedule,15.66,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,16.44,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,15.66,100,,,fee schedule,100% of GA fee schedule,12.46,100,,,fee schedule,100% of CMS 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,15.66,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.59,93,,,fee schedule,93% of CMS fee schedule,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,11.59,450,
HEPATITIS E IGM,300008908,CDM,302,RC,86790,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
HEPATITIS E IGG,300008909,CDM,302,RC,86790,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
TREPONEMA IGG,300008910,CDM,302,RC,86593,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,7.04,160,,,fee schedule,160% of CMS fee schedule,5.72,130,,,fee schedule,130% of CMS fee schedule,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,80.64,66.1,,64.51,percent of total billed charges,66.1% of total billed charges,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,4.4,100,,,fee schedule,100% of CMS 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,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.09,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,4.09,450,
TREPONEMA IGM,300008911,CDM,302,RC,86593,HCPCS,outpatient,,,122,85.4,,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,109.8,90,,87.84,percent of total billed charges,90% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,7.04,160,,,fee schedule,160% of CMS fee schedule,5.72,130,,,fee schedule,130% of CMS fee schedule,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,94.21,77.22,,75.37,percent of total billed charges,77.22% of total billed charges,80.64,66.1,,64.51,percent of total billed charges,66.1% of total billed charges,101.26,83,,81.01,percent of total billed charges,83% of total,115.9,95,,92.72,percent of total billed charges ,95% of total billed charges,97.6,80,,78.08,percent of total billed charges,78% of total billed charges,95.16,78,,76.128,percent of total billed charges,78% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,4.4,100,,,fee schedule,100% of CMS 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,76.86,63,,61.49,percent of total billed charges,63% of total billed charges,103.7,85,,82.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.09,93,,,fee schedule,93% of CMS fee schedule,96.38,79,,77.1,percent of total billed charges,79% of total billed charges,4.4,100,,,fee schedule,100% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,4.09,450,
TRICHINELLA ANTIBODY,300008914,CDM,302,RC,86784,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,12.56,100,,,fee schedule,100% of CMS fee schedule,20.1,160,,,fee schedule,160% of CMS fee schedule,16.33,130,,,fee schedule,130% of CMS fee schedule,15.8,100,,,fee schedule,100% of GA fee schedule,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,16.59,105,,,fee schedule,105% of GA fee schedule,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,12.56,100,,,fee schedule,100% of CMS fee schedule,15.8,100,,,fee schedule,100% of GA fee schedule,12.56,100,,,fee schedule,100% of CMS 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,15.8,100,,,fee schedule,100% of GA fee schedule,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.68,93,,,fee schedule,93% of CMS fee schedule,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,12.56,100,,,fee schedule,100% of CMS fee schedule,12.56,100,,,fee schedule,100% of CMS fee schedule,11.68,450,
FILARIA IgG4 ANTIBODY,300008915,CDM,302,RC,86682,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,20.82,160,,,fee schedule,160% of CMS fee schedule,16.91,130,,,fee schedule,130% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,17.17,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,13.01,100,,,fee schedule,100% of CMS 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,16.35,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.1,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,12.1,450,
STRONGYLOIDES ANTIBODY IgG,300008916,CDM,302,RC,86682,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,20.82,160,,,fee schedule,160% of CMS fee schedule,16.91,130,,,fee schedule,130% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,17.17,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,13.01,100,,,fee schedule,100% of CMS 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,16.35,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.1,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,12.1,450,
TOXOCARA ANTIBODY IgG,300008917,CDM,302,RC,86682,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,20.82,160,,,fee schedule,160% of CMS fee schedule,16.91,130,,,fee schedule,130% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,17.17,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,13.01,100,,,fee schedule,100% of CMS 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,16.35,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.1,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,12.1,450,
SCHISTOSOMA IgG ANTIBODY,300008918,CDM,302,RC,86682,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,20.82,160,,,fee schedule,160% of CMS fee schedule,16.91,130,,,fee schedule,130% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,17.17,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,16.35,100,,,fee schedule,100% of GA fee schedule,13.01,100,,,fee schedule,100% of CMS 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,16.35,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.1,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,12.1,450,
INHIBIN,300008919,CDM,302,RC,86336,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,15.59,100,,,fee schedule,100% of CMS fee schedule,24.94,160,,,fee schedule,160% of CMS fee schedule,20.27,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,15.59,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,15.59,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.5,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,15.59,100,,,fee schedule,100% of CMS fee schedule,15.59,100,,,fee schedule,100% of CMS fee schedule,14.5,450,
URTICARIA,300008944,CDM,302,RC,86376,HCPCS,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,23.28,160,,,fee schedule,160% of CMS fee schedule,18.92,130,,,fee schedule,130% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,19.22,105,,,fee schedule,105% of GA fee schedule,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,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,18.3,100,,,fee schedule,100% of GA fee schedule,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.53,93,,,fee schedule,93% of CMS fee schedule,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,13.53,450,
B2 GLYCOPROTEIN I IGA AB,300008945,CDM,302,RC,86146,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,31.99,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
B2 GLYCOPROTEIN IGM,300008946,CDM,302,RC,86146,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,31.99,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
B2 GLYCOPROTEIN IGG,300008947,CDM,302,RC,86146,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,31.99,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
CANDIDA ANTIBODY BY ID,300008951,CDM,302,RC,86628,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,19.22,160,,,fee schedule,160% of CMS fee schedule,15.61,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12.01,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.17,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,11.17,450,
HTLV CSF,300008954,CDM,302,RC,86790,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
"LYME ANTIBODIES,CSF",300008955,CDM,302,RC,86618,HCPCS,outpatient,,,384,268.8,,303.36,79,,242.69,percent of total billed charges,79% of total billed charges,345.6,90,,276.48,percent of total billed charges,90% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,27.25,160,,,fee schedule,160% of CMS fee schedule,22.14,130,,,fee schedule,130% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,296.52,77.22,,237.22,percent of total billed charges,77.22% of total billed charges,22.49,105,,,fee schedule,105% of GA fee schedule,318.72,83,,254.98,percent of total billed charges,83% of total,364.8,95,,291.84,percent of total billed charges ,95% of total billed charges,307.2,80,,245.76,percent of total billed charges,78% of total billed charges,299.52,78,,239.616,percent of total billed charges,78% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,345.6,90,,276.48,percent of total billed charges,90% of total billed charges,307.2,80,,245.76,percent of total billed charges,80% of total billed charges,21.42,100,,,fee schedule,100% of GA fee schedule,326.4,85,,261.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.84,93,,,fee schedule,93% of CMS fee schedule,303.36,79,,242.69,percent of total billed charges,79% of total billed charges,17.03,100,,,fee schedule,100% of CMS fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,15.84,450,
THYROGLOBULIN ANTIBODY,300008956,CDM,302,RC,86800,HCPCS,outpatient,,,153,107.1,,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,25.46,160,,,fee schedule,160% of CMS fee schedule,20.68,130,,,fee schedule,130% of CMS fee schedule,20,100,,,fee schedule,100% of GA fee schedule,118.15,77.22,,94.52,percent of total billed charges,77.22% of total billed charges,21,105,,,fee schedule,105% of GA fee schedule,126.99,83,,101.59,percent of total billed charges,83% of total,145.35,95,,116.28,percent of total billed charges ,95% of total billed charges,122.4,80,,97.92,percent of total billed charges,78% of total billed charges,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,20,100,,,fee schedule,100% of GA fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,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,20,100,,,fee schedule,100% of GA fee schedule,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.8,93,,,fee schedule,93% of CMS fee schedule,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,15.91,100,,,fee schedule,100% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,14.8,450,
LEUKOCYTE HISTAMINE RELEASE,300008957,CDM,302,RC,86343,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,19.94,160,,,fee schedule,160% of CMS fee schedule,16.2,130,,,fee schedule,130% of CMS fee schedule,15.67,100,,,fee schedule,100% of GA fee schedule,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,16.45,105,,,fee schedule,105% of GA fee schedule,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,15.67,100,,,fee schedule,100% of GA fee schedule,12.46,100,,,fee schedule,100% of CMS 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,15.67,100,,,fee schedule,100% of GA fee schedule,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.59,93,,,fee schedule,93% of CMS fee schedule,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,12.46,100,,,fee schedule,100% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,11.59,450,
"ANTIBODY IDENT, LEUKOCYTE ANTI",300008959,CDM,302,RC,86021,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
THYROID-MICROSOMAL ANTIBODIES,300008960,CDM,302,RC,86376,HCPCS,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,23.28,160,,,fee schedule,160% of CMS fee schedule,18.92,130,,,fee schedule,130% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,19.22,105,,,fee schedule,105% of GA fee schedule,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,18.3,100,,,fee schedule,100% of GA fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,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,18.3,100,,,fee schedule,100% of GA fee schedule,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.53,93,,,fee schedule,93% of CMS fee schedule,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,13.53,450,
RUBELLA SCREEN,300008967,CDM,302,RC,86762,HCPCS,outpatient,,,95,66.5,,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,85.5,90,,68.4,percent of total billed charges,90% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,23.02,160,,,fee schedule,160% of CMS fee schedule,18.71,130,,,fee schedule,130% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,73.36,77.22,,58.69,percent of total billed charges,77.22% of total billed charges,15.36,105,,,fee schedule,105% of GA fee schedule,78.85,83,,63.08,percent of total billed charges,83% of total,90.25,95,,72.2,percent of total billed charges ,95% of total billed charges,76,80,,60.8,percent of total billed charges,78% of total billed charges,74.1,78,,59.28,percent of total billed charges,78% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.63,100,,,fee schedule,100% of GA fee schedule,14.39,100,,,fee schedule,100% of CMS 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,14.63,100,,,fee schedule,100% of GA fee schedule,80.75,85,,64.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.38,93,,,fee schedule,93% of CMS fee schedule,75.05,79,,60.04,percent of total billed charges,79% of total billed charges,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,13.38,450,
VARICELLA IgG,300008968,CDM,302,RC,86787,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
MUMPS IgG,300008969,CDM,302,RC,86735,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,13.05,100,,,fee schedule,100% of CMS fee schedule,20.88,160,,,fee schedule,160% of CMS fee schedule,16.97,130,,,fee schedule,130% of CMS fee schedule,16.41,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,17.23,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,13.05,100,,,fee schedule,100% of CMS fee schedule,16.41,100,,,fee schedule,100% of GA fee schedule,13.05,100,,,fee schedule,100% of CMS 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,16.41,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.14,93,,,fee schedule,93% of CMS fee schedule,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,13.05,100,,,fee schedule,100% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,12.14,450,
RUBEOLA IgG,300008970,CDM,302,RC,86765,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
ANTI-A TITER COMBS EA TITER,300008972,CDM,302,RC,86941,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,19.38,160,,,fee schedule,160% of CMS fee schedule,15.74,130,,,fee schedule,130% of CMS fee schedule,15.23,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,15.99,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,15.23,100,,,fee schedule,100% of GA fee schedule,12.11,100,,,fee schedule,100% of CMS 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,15.23,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.26,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,11.26,450,
ANTI-B TITER COOMBS EA TITER,300008973,CDM,302,RC,86941,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,19.38,160,,,fee schedule,160% of CMS fee schedule,15.74,130,,,fee schedule,130% of CMS fee schedule,15.23,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,15.99,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,15.23,100,,,fee schedule,100% of GA fee schedule,12.11,100,,,fee schedule,100% of CMS 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,15.23,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.26,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,12.11,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,11.26,450,
ASPERGILLUS,300008977,CDM,302,RC,86606,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
GEK DIFFUSION,300008978,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
RF IgG,300009002,CDM,302,RC,86431,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,9.07,160,,,fee schedule,160% of CMS fee schedule,7.37,130,,,fee schedule,130% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,7.5,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,5.67,100,,,fee schedule,100% of CMS 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,7.14,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.27,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,5.27,450,
RF IgM,300009003,CDM,302,RC,86431,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,9.07,160,,,fee schedule,160% of CMS fee schedule,7.37,130,,,fee schedule,130% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,7.5,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,5.67,100,,,fee schedule,100% of CMS 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,7.14,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.27,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,5.27,450,
RF IgA,300009004,CDM,302,RC,86431,HCPCS,outpatient,,,131,91.7,,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,117.9,90,,94.32,percent of total billed charges,90% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,9.07,160,,,fee schedule,160% of CMS fee schedule,7.37,130,,,fee schedule,130% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,101.16,77.22,,80.93,percent of total billed charges,77.22% of total billed charges,7.5,105,,,fee schedule,105% of GA fee schedule,108.73,83,,86.98,percent of total billed charges,83% of total,124.45,95,,99.56,percent of total billed charges ,95% of total billed charges,104.8,80,,83.84,percent of total billed charges,78% of total billed charges,102.18,78,,81.744,percent of total billed charges,78% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,7.14,100,,,fee schedule,100% of GA fee schedule,5.67,100,,,fee schedule,100% of CMS 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,7.14,100,,,fee schedule,100% of GA fee schedule,111.35,85,,89.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.27,93,,,fee schedule,93% of CMS fee schedule,103.49,79,,82.79,percent of total billed charges,79% of total billed charges,5.67,100,,,fee schedule,100% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,5.27,450,
"RF IgG, IgM, IgA CP",300009005,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANTI-CARDIOLIPIN IgA,300009026,CDM,302,RC,86147,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,40.72,160,,,fee schedule,160% of CMS fee schedule,33.09,130,,,fee schedule,130% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,33.59,105,,,fee schedule,105% of GA fee schedule,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,31.99,100,,,fee schedule,100% of GA fee schedule,25.45,100,,,fee schedule,100% of CMS 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,31.99,100,,,fee schedule,100% of GA fee schedule,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.67,93,,,fee schedule,93% of CMS fee schedule,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,23.67,450,
NEUROMYELITIS OPTICA ANTIBODY,300009045,CDM,302,RC,86255,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ST LOUIS IgM,300009050,CDM,302,RC,86654,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
CALIFORNIA ENCEPH AB IgM,300009051,CDM,302,RC,86651,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
EASTERN IgM,300009052,CDM,302,RC,86652,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
WESTERN EQIOME ENCEPH AB IgM,300009053,CDM,302,RC,86654,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
DENGUE FEVER VIRUS AB IGM,300009054,CDM,302,RC,86790,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
DENGUE FEVER VIRUS AB IGG,300009055,CDM,302,RC,86790,HCPCS,outpatient,,,357,249.9,,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,321.3,90,,257.04,percent of total billed charges,90% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,20.61,160,,,fee schedule,160% of CMS fee schedule,16.74,130,,,fee schedule,130% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,275.68,77.22,,220.54,percent of total billed charges,77.22% of total billed charges,17.01,105,,,fee schedule,105% of GA fee schedule,296.31,83,,237.05,percent of total billed charges,83% of total,339.15,95,,271.32,percent of total billed charges ,95% of total billed charges,285.6,80,,228.48,percent of total billed charges,78% of total billed charges,278.46,78,,222.768,percent of total billed charges,78% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,16.2,100,,,fee schedule,100% of GA fee schedule,12.88,100,,,fee schedule,100% of CMS 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,16.2,100,,,fee schedule,100% of GA fee schedule,303.45,85,,242.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.98,93,,,fee schedule,93% of CMS fee schedule,282.03,79,,225.62,percent of total billed charges,79% of total billed charges,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,11.98,450,
IGA I,300009071,CDM,302,RC,86329,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,22.48,160,,,fee schedule,160% of CMS fee schedule,18.27,130,,,fee schedule,130% of CMS fee schedule,17.66,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,18.54,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,17.66,100,,,fee schedule,100% of GA fee schedule,14.05,100,,,fee schedule,100% of CMS 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,17.66,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.07,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,14.05,100,,,fee schedule,100% of CMS fee schedule,13.07,450,
IGA II,300009072,CDM,302,RC,86329,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,22.48,160,,,fee schedule,160% of CMS fee schedule,18.27,130,,,fee schedule,130% of CMS fee schedule,17.66,100,,,fee schedule,100% of GA fee schedule,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,18.54,105,,,fee schedule,105% of GA fee schedule,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,17.66,100,,,fee schedule,100% of GA fee schedule,14.05,100,,,fee schedule,100% of CMS 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,17.66,100,,,fee schedule,100% of GA fee schedule,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.07,93,,,fee schedule,93% of CMS fee schedule,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,14.05,100,,,fee schedule,100% of CMS fee schedule,14.05,100,,,fee schedule,100% of CMS fee schedule,13.07,450,
LYMPHOCYTE TRANSFORMATION #2,300009089,CDM,302,RC,86353,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,78.45,160,,,fee schedule,160% of CMS fee schedule,63.74,130,,,fee schedule,130% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,64.72,105,,,fee schedule,105% of GA fee schedule,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,61.64,100,,,fee schedule,100% of GA fee schedule,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.6,93,,,fee schedule,93% of CMS fee schedule,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,45.6,450,
LYMPHOCYTE TRANSFORMATION #3,300009090,CDM,302,RC,86353,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,78.45,160,,,fee schedule,160% of CMS fee schedule,63.74,130,,,fee schedule,130% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,64.72,105,,,fee schedule,105% of GA fee schedule,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,61.64,100,,,fee schedule,100% of GA fee schedule,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.6,93,,,fee schedule,93% of CMS fee schedule,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,45.6,450,
LYMPHOCYTE TRANSFORMATION #4,300009091,CDM,302,RC,86353,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,78.45,160,,,fee schedule,160% of CMS fee schedule,63.74,130,,,fee schedule,130% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,64.72,105,,,fee schedule,105% of GA fee schedule,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,61.64,100,,,fee schedule,100% of GA fee schedule,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.6,93,,,fee schedule,93% of CMS fee schedule,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,45.6,450,
LYMPHOCYTE TRANSFORMATION #5,300009092,CDM,302,RC,86353,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,78.45,160,,,fee schedule,160% of CMS fee schedule,63.74,130,,,fee schedule,130% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,64.72,105,,,fee schedule,105% of GA fee schedule,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,61.64,100,,,fee schedule,100% of GA fee schedule,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.6,93,,,fee schedule,93% of CMS fee schedule,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,45.6,450,
LYMPHOCYTE TRANSFORMATION,300009094,CDM,302,RC,86353,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,78.45,160,,,fee schedule,160% of CMS fee schedule,63.74,130,,,fee schedule,130% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,64.72,105,,,fee schedule,105% of GA fee schedule,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,61.64,100,,,fee schedule,100% of GA fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,61.64,100,,,fee schedule,100% of GA fee schedule,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.6,93,,,fee schedule,93% of CMS fee schedule,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,49.03,100,,,fee schedule,100% of CMS fee schedule,49.03,100,,,fee schedule,100% of CMS fee schedule,45.6,450,
ANTI STRIATED MUSCLE SCREEN,300009131,CDM,302,RC,86255,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,15.16,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
COCCIDIOIDES ANTIBODY IgG,300009146,CDM,302,RC,86635,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,18.35,160,,,fee schedule,160% of CMS fee schedule,14.91,130,,,fee schedule,130% of CMS fee schedule,14.43,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,15.15,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,14.43,100,,,fee schedule,100% of GA fee schedule,11.47,100,,,fee schedule,100% of CMS 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,14.43,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.67,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,11.47,100,,,fee schedule,100% of CMS fee schedule,10.67,450,
COCCIDIOIDES ANTIBODY IgM,300009147,CDM,302,RC,86635,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,18.35,160,,,fee schedule,160% of CMS fee schedule,14.91,130,,,fee schedule,130% of CMS fee schedule,14.43,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,15.15,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,14.43,100,,,fee schedule,100% of GA fee schedule,11.47,100,,,fee schedule,100% of CMS 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,14.43,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.67,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,11.47,100,,,fee schedule,100% of CMS fee schedule,11.47,100,,,fee schedule,100% of CMS fee schedule,10.67,450,
CHROMOGRANIN A,300009152,CDM,302,RC,86316,HCPCS,outpatient,,,282,197.4,,222.78,79,,178.22,percent of total billed charges,79% of total billed charges,253.8,90,,203.04,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,217.76,77.22,,174.21,percent of total billed charges,77.22% of total billed charges,27.47,105,,,fee schedule,105% of GA fee schedule,234.06,83,,187.25,percent of total billed charges,83% of total,267.9,95,,214.32,percent of total billed charges ,95% of total billed charges,225.6,80,,180.48,percent of total billed charges,78% of total billed charges,219.96,78,,175.968,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,26.16,100,,,fee schedule,100% of GA fee schedule,20.81,100,,,fee schedule,100% of CMS 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,26.16,100,,,fee schedule,100% of GA fee schedule,239.7,85,,191.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,222.78,79,,178.22,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,450,
FLUORESCENT ANTIBODY SCREEN,300009153,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
FLUORSCENT NONINFECT ANTI II,300009154,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
ACREMONIUM,300009162,CDM,302,RC,86331,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
ASPERGILLUS NIGER,300009163,CDM,302,RC,86606,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
ANTI CHROMATIN AP,300009164,CDM,302,RC,86235,HCPCS,outpatient,,,300,210,,237,79,,189.6,percent of total billed charges,79% of total billed charges,270,90,,216,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,231.66,77.22,,185.33,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,249,83,,199.2,percent of total billed charges,83% of total,285,95,,228,percent of total billed charges ,95% of total billed charges,240,80,,192,percent of total billed charges,78% of total billed charges,234,78,,187.2,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,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,22.55,100,,,fee schedule,100% of GA fee schedule,255,85,,204,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,237,79,,189.6,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANCA SCRN W/REFLEX ANCA TITER,300009171,CDM,302,RC,86021,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
MYELOPEROXIDASE ANTIBODY,300009172,CDM,302,RC,86021,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
PROTEINASE 3 ANTIBODY,300009173,CDM,302,RC,86021,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
SACCHARO CEREVISIA ANTIBDY IgA,300009174,CDM,302,RC,86671,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,19.6,160,,,fee schedule,160% of CMS fee schedule,15.93,130,,,fee schedule,130% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,16.19,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,12.25,100,,,fee schedule,100% of CMS 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,15.42,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.39,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,12.25,100,,,fee schedule,100% of CMS fee schedule,11.39,450,
SACCHAROM CEREVISI ANTIBDY IgG,300009175,CDM,302,RC,86671,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,19.6,160,,,fee schedule,160% of CMS fee schedule,15.93,130,,,fee schedule,130% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,16.19,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,15.42,100,,,fee schedule,100% of GA fee schedule,12.25,100,,,fee schedule,100% of CMS 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,15.42,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.39,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,12.25,100,,,fee schedule,100% of CMS fee schedule,12.25,100,,,fee schedule,100% of CMS fee schedule,11.39,450,
C1Q,300009230,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
HEPATITIS B SURFACE AB QT,300009286,CDM,302,RC,86706,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,17.18,160,,,fee schedule,160% of CMS fee schedule,13.96,130,,,fee schedule,130% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,14.19,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,13.51,100,,,fee schedule,100% of GA fee schedule,10.74,100,,,fee schedule,100% of CMS 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,13.51,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.99,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,9.99,450,
ANA/RA CP,300009301,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BORDETELLA PERTUSSIS IgG,300040902,CDM,302,RC,86615,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
BORDETELLA PERTUSSIS IgM,300040903,CDM,302,RC,86615,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
H PYLORI IgA,300040929,CDM,302,RC,86677,HCPCS,outpatient,,,116,81.2,,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,104.4,90,,83.52,percent of total billed charges,90% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,26.96,160,,,fee schedule,160% of CMS fee schedule,21.91,130,,,fee schedule,130% of CMS fee schedule,18.25,100,,,fee schedule,100% of GA fee schedule,89.58,77.22,,71.66,percent of total billed charges,77.22% of total billed charges,19.16,105,,,fee schedule,105% of GA fee schedule,96.28,83,,77.02,percent of total billed charges,83% of total,110.2,95,,88.16,percent of total billed charges ,95% of total billed charges,92.8,80,,74.24,percent of total billed charges,78% of total billed charges,90.48,78,,72.384,percent of total billed charges,78% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,18.25,100,,,fee schedule,100% of GA fee schedule,16.85,100,,,fee schedule,100% of CMS 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,18.25,100,,,fee schedule,100% of GA fee schedule,98.6,85,,78.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.67,93,,,fee schedule,93% of CMS fee schedule,91.64,79,,73.31,percent of total billed charges,79% of total billed charges,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,15.67,450,
QUANTIFERON TB,300040932,CDM,302,RC,86480,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,61.98,100,,,fee schedule,100% of CMS fee schedule,99.17,160,,,fee schedule,160% of CMS fee schedule,80.57,130,,,fee schedule,130% of CMS fee schedule,77.93,100,,,fee schedule,100% of GA fee schedule,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,81.83,105,,,fee schedule,105% of GA fee schedule,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,61.98,100,,,fee schedule,100% of CMS fee schedule,77.93,100,,,fee schedule,100% of GA fee schedule,61.98,100,,,fee schedule,100% of CMS 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,77.93,100,,,fee schedule,100% of GA fee schedule,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,57.64,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,61.98,100,,,fee schedule,100% of CMS fee schedule,61.98,100,,,fee schedule,100% of CMS fee schedule,57.64,450,
C1Q LEVEL,300040952,CDM,302,RC,86160,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,19.2,160,,,fee schedule,160% of CMS fee schedule,15.6,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.16,93,,,fee schedule,93% of CMS fee schedule,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,11.16,450,
HLA-B57,300081381,CDM,302,RC,81381,HCPCS,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,169.9,100,,,fee schedule,100% of CMS fee schedule,271.84,160,,,fee schedule,160% of CMS fee schedule,220.87,130,,,fee schedule,130% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,42,105,,,fee schedule,105% of GA fee schedule,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,169.9,100,,,fee schedule,100% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,169.9,100,,,fee schedule,100% of CMS 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,40,100,,,fee schedule,100% of GA fee schedule,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,158.01,93,,,fee schedule,93% of CMS fee schedule,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,169.9,100,,,fee schedule,100% of CMS fee schedule,169.9,100,,,fee schedule,100% of CMS fee schedule,40,450,
U1 RNP SNRNP,300083516,CDM,302,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
RAETA RHEUMATIOD ARTH,300083520,CDM,302,RC,83520,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
QUALITATIVE IMMUNOASSAY,300086021,CDM,302,RC,86021,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,24.08,160,,,fee schedule,160% of CMS fee schedule,19.57,130,,,fee schedule,130% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,19.88,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,18.93,100,,,fee schedule,100% of GA fee schedule,15.05,100,,,fee schedule,100% of CMS 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,18.93,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,14,450,
RABIES RESPONSE TITER,300086317,CDM,302,RC,86317,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,23.98,160,,,fee schedule,160% of CMS fee schedule,19.49,130,,,fee schedule,130% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,15.84,105,,,fee schedule,105% of GA fee schedule,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,14.99,100,,,fee schedule,100% of CMS 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,15.09,100,,,fee schedule,100% of GA fee schedule,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.94,93,,,fee schedule,93% of CMS fee schedule,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,14.99,100,,,fee schedule,100% of CMS fee schedule,13.94,450,
IA-2 ANTIBODY,300086341,CDM,302,RC,86341,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,37.71,160,,,fee schedule,160% of CMS fee schedule,30.64,130,,,fee schedule,130% of CMS fee schedule,24.89,100,,,fee schedule,100% of GA fee schedule,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,26.13,105,,,fee schedule,105% of GA fee schedule,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,24.89,100,,,fee schedule,100% of GA fee schedule,23.57,100,,,fee schedule,100% of CMS 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,24.89,100,,,fee schedule,100% of GA fee schedule,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.92,93,,,fee schedule,93% of CMS fee schedule,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,23.57,100,,,fee schedule,100% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,21.92,450,
CD3 CELLS,300086359,CDM,302,RC,86359,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,60.37,160,,,fee schedule,160% of CMS fee schedule,49.05,130,,,fee schedule,130% of CMS fee schedule,29.62,100,,,fee schedule,100% of GA fee schedule,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,31.1,105,,,fee schedule,105% of GA fee schedule,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,29.62,100,,,fee schedule,100% of GA fee schedule,37.73,100,,,fee schedule,100% of CMS 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,29.62,100,,,fee schedule,100% of GA fee schedule,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.09,93,,,fee schedule,93% of CMS fee schedule,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,29.62,450,
MYELIN OLIGODENDROCYTE,300086362,CDM,302,RC,86362,HCPCS,outpatient,,,1000,700,,790,79,,632,percent of total billed charges,79% of total billed charges,900,90,,720,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,772.2,77.22,,617.76,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,830,83,,664,percent of total billed charges,83% of total,950,95,,760,percent of total billed charges ,95% of total billed charges,800,80,,640,percent of total billed charges,78% of total billed charges,780,78,,624,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,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,9.64,100,,,fee schedule,100% of GA fee schedule,850,85,,680,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,790,79,,632,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,950,
TISSUE TYPING IMMUNOASSAY,300086808,CDM,302,RC,86808,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,29.68,100,,,fee schedule,100% of CMS fee schedule,47.49,160,,,fee schedule,160% of CMS fee schedule,38.58,130,,,fee schedule,130% of CMS fee schedule,37.32,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,39.19,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,29.68,100,,,fee schedule,100% of CMS fee schedule,37.32,100,,,fee schedule,100% of GA fee schedule,29.68,100,,,fee schedule,100% of CMS 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,37.32,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.6,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,29.68,100,,,fee schedule,100% of CMS fee schedule,29.68,100,,,fee schedule,100% of CMS fee schedule,27.6,450,
TISSUE TYPING IMMUNOASSAY,300086849,CDM,302,RC,86849,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,71.44,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,68.04,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
ASPERGILLUS ANTIGEN SERUM,300087305,CDM,302,RC,87305,HCPCS,outpatient,,,225,157.5,,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,173.75,77.22,,139,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,186.75,83,,149.4,percent of total billed charges,83% of total,213.75,95,,171,percent of total billed charges ,95% of total billed charges,180,80,,144,percent of total billed charges,78% of total billed charges,175.5,78,,140.4,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,191.25,85,,153,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
CYTOPLASMIC ANTIBODY P-ANCA,300098208,CDM,302,RC,86036,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.64,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,450,
CYTOPLASMIC ANTIBODY C-ANCA,300098209,CDM,302,RC,86036,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.64,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,450,
CYTOPLASMIC AB ATYPICAL pANCA,300098210,CDM,302,RC,86036,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.64,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,450,
C ANCA TITER,300098211,CDM,302,RC,86037,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.64,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,450,
P ANCA TITER,300098212,CDM,302,RC,86037,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.64,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,450,
ATYPICAL P ANCA TITER,300098213,CDM,302,RC,86037,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,10.12,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS 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,9.64,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.64,450,
CYTOPLASMIC AB TITER,300098214,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PNEUMOCCAL IM 14 SEROTYPE,300863170,CDM,302,RC,86317,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,23.98,160,,,fee schedule,160% of CMS fee schedule,19.49,130,,,fee schedule,130% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,15.84,105,,,fee schedule,105% of GA fee schedule,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,15.09,100,,,fee schedule,100% of GA fee schedule,14.99,100,,,fee schedule,100% of CMS 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,15.09,100,,,fee schedule,100% of GA fee schedule,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.94,93,,,fee schedule,93% of CMS fee schedule,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,14.99,100,,,fee schedule,100% of CMS fee schedule,14.99,100,,,fee schedule,100% of CMS fee schedule,13.94,450,
ANTI U3 RNP (Fibrillarin) RDL,302000000,CDM,302,RC,86235,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
INTERSTITIAL LUNG DISEASE,3020000002,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CP MYOMARKER 3 PLUS PROFILE,302000001,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANT1 U2 RNP Ab RDL,302000005,CDM,302,RC,86235,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANTI EJ Ab RDL,302000006,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI PL-12 Ab RDL,302000016,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI U1 RNP Ab RDL,302000035,CDM,302,RC,86235,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
NEUTROPHIL AB ID & HLA SCRN CP,302000101,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANTI SS A 52kD Ab IgG RDL,302000235,CDM,302,RC,86235,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANTI PL-7 Ab RDL,302000516,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
CANDIDA ALBICANS COMPONENT,302000628,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
GLUTEN SENSITIVITY CASCADE,302003516,CDM,302,RC,83516,HCPCS,outpatient,,,275,192.5,,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,247.5,90,,198,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,212.36,77.22,,169.89,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,228.25,83,,182.6,percent of total billed charges,83% of total,261.25,95,,209,percent of total billed charges ,95% of total billed charges,220,80,,176,percent of total billed charges,78% of total billed charges,214.5,78,,171.6,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,247.5,90,,198,percent of total billed charges,90% of total billed charges,220,80,,176,percent of total billed charges,80% of total billed charges,13.45,100,,,fee schedule,100% of GA fee schedule,233.75,85,,187,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,217.25,79,,173.8,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI TIF 1gamma Ab RDL,302006235,CDM,302,RC,86235,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
B-CELL GENE REARRGT IgH IgK CP,302081200,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
IGH GENE REARRANGE AMP METH,302081261,CDM,302,RC,81261,HCPCS,outpatient,,,885,619.5,,699.15,79,,559.32,percent of total billed charges,79% of total billed charges,796.5,90,,637.2,percent of total billed charges,90% of total billed charges,197.99,100,,,fee schedule,100% of CMS fee schedule,316.78,160,,,fee schedule,160% of CMS fee schedule,257.39,130,,,fee schedule,130% of CMS fee schedule,244,100,,,fee schedule,100% of GA fee schedule,683.4,77.22,,546.72,percent of total billed charges,77.22% of total billed charges,256.2,105,,,fee schedule,105% of GA fee schedule,734.55,83,,587.64,percent of total billed charges,83% of total,840.75,95,,672.6,percent of total billed charges ,95% of total billed charges,708,80,,566.4,percent of total billed charges,78% of total billed charges,690.3,78,,552.24,percent of total billed charges,78% of total billed charges,197.99,100,,,fee schedule,100% of CMS fee schedule,244,100,,,fee schedule,100% of GA fee schedule,197.99,100,,,fee schedule,100% of CMS fee schedule,796.5,90,,637.2,percent of total billed charges,90% of total billed charges,708,80,,566.4,percent of total billed charges,80% of total billed charges,244,100,,,fee schedule,100% of GA fee schedule,752.25,85,,601.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,184.13,93,,,fee schedule,93% of CMS fee schedule,699.15,79,,559.32,percent of total billed charges,79% of total billed charges,197.99,100,,,fee schedule,100% of CMS fee schedule,197.99,100,,,fee schedule,100% of CMS fee schedule,184.13,840.75,
IGK REARRANGE ABN CLONAL POP,302081264,CDM,302,RC,81264,HCPCS,outpatient,,,861,602.7,,680.19,79,,544.15,percent of total billed charges,79% of total billed charges,774.9,90,,619.92,percent of total billed charges,90% of total billed charges,172.73,100,,,fee schedule,100% of CMS fee schedule,276.37,160,,,fee schedule,160% of CMS fee schedule,224.55,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,664.86,77.22,,531.89,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,714.63,83,,571.7,percent of total billed charges,83% of total,817.95,95,,654.36,percent of total billed charges ,95% of total billed charges,688.8,80,,551.04,percent of total billed charges,78% of total billed charges,671.58,78,,537.264,percent of total billed charges,78% of total billed charges,172.73,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,172.73,100,,,fee schedule,100% of CMS fee schedule,774.9,90,,619.92,percent of total billed charges,90% of total billed charges,688.8,80,,551.04,percent of total billed charges,80% of total billed charges,98.4,100,,,fee schedule,100% of GA fee schedule,731.85,85,,585.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,160.64,93,,,fee schedule,93% of CMS fee schedule,680.19,79,,544.15,percent of total billed charges,79% of total billed charges,172.73,100,,,fee schedule,100% of CMS fee schedule,172.73,100,,,fee schedule,100% of CMS fee schedule,98.4,817.95,
ANTI-SYNTHETASE PROFILE CP,302083500,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BULLOUS PEMPHIGOID 180/230,302083516,CDM,302,RC,83516,HCPCS,outpatient,,,200,140,,158,79,,126.4,percent of total billed charges,79% of total billed charges,180,90,,144,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,154.44,77.22,,123.55,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,166,83,,132.8,percent of total billed charges,83% of total,190,95,,152,percent of total billed charges ,95% of total billed charges,160,80,,128,percent of total billed charges,78% of total billed charges,156,78,,124.8,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,170,85,,136,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,158,79,,126.4,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI MDA 5 Ab CADM-140 RDL,302083520,CDM,302,RC,83520,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
MUSHROOM ALLERGEN,302086003,CDM,302,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BLACKBERRY ALLERGEN,302086013,CDM,302,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
RASPBERRY ALLERGEN,302086023,CDM,302,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ANTI JO-1 Ab RDL,302086235,CDM,302,RC,86235,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANTI-MYOCARDIAL ANTIBODIES CP,302086256,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CP HNK1 (CD57) PROFILE,302086300,CDM,302,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HUMAN EPIDIDYMIS PROTEIN 4 HE4,302086305,CDM,302,RC,86305,HCPCS,outpatient,,,522,365.4,,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,33.3,160,,,fee schedule,160% of CMS fee schedule,27.05,130,,,fee schedule,130% of CMS fee schedule,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,403.09,77.22,,322.47,percent of total billed charges,77.22% of total billed charges,345.04,66.1,,276.03,percent of total billed charges,66.1% of total billed charges,433.26,83,,346.61,percent of total billed charges,83% of total,495.9,95,,396.72,percent of total billed charges ,95% of total billed charges,417.6,80,,334.08,percent of total billed charges,78% of total billed charges,407.16,78,,325.728,percent of total billed charges,78% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,20.81,100,,,fee schedule,100% of CMS 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,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.35,93,,,fee schedule,93% of CMS fee schedule,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,19.35,495.9,
ZINC TRANSPORT 8 ANTIBODY,302086341,CDM,302,RC,,,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,170.1,450,
MONONUCLEAR CELL ANTIGEN QUANT,302086356,CDM,302,RC,86356,HCPCS,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,42.85,160,,,fee schedule,160% of CMS fee schedule,34.81,130,,,fee schedule,130% of CMS fee schedule,32.83,100,,,fee schedule,100% of GA fee schedule,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,34.47,105,,,fee schedule,105% of GA fee schedule,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,32.83,100,,,fee schedule,100% of GA fee schedule,26.78,100,,,fee schedule,100% of CMS 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,32.83,100,,,fee schedule,100% of GA fee schedule,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,24.91,93,,,fee schedule,93% of CMS fee schedule,79,79,,63.2,percent of total billed charges,79% of total billed charges,26.78,100,,,fee schedule,100% of CMS fee schedule,26.78,100,,,fee schedule,100% of CMS fee schedule,24.91,450,
NATURAL KILLER CELLS TOTAL CNT,302086357,CDM,302,RC,86357,HCPCS,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,60.37,160,,,fee schedule,160% of CMS fee schedule,49.05,130,,,fee schedule,130% of CMS fee schedule,29.62,100,,,fee schedule,100% of GA fee schedule,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,31.1,105,,,fee schedule,105% of GA fee schedule,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,29.62,100,,,fee schedule,100% of GA fee schedule,37.73,100,,,fee schedule,100% of CMS 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,29.62,100,,,fee schedule,100% of GA fee schedule,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.09,93,,,fee schedule,93% of CMS fee schedule,79,79,,63.2,percent of total billed charges,79% of total billed charges,37.73,100,,,fee schedule,100% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,29.62,450,
CANIGG CANDIDA ALBICANS IGG,302086628,CDM,302,RC,86628,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,19.22,160,,,fee schedule,160% of CMS fee schedule,15.61,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12.01,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.17,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,11.17,450,
BULLOUS PEMPHIGOID 180 IgG,302183516,CDM,302,RC,83516,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI PM/SCL-100 Ab RDL,302186235,CDM,302,RC,86235,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,28.69,160,,,fee schedule,160% of CMS fee schedule,23.31,130,,,fee schedule,130% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,23.68,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,22.55,100,,,fee schedule,100% of GA fee schedule,17.93,100,,,fee schedule,100% of CMS 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,22.55,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.67,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,16.67,450,
ANTI-SARCOLEMMA,302186256,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
CANIGM CANDIDA ALBICANS IGM,302186628,CDM,302,RC,86628,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,19.22,160,,,fee schedule,160% of CMS fee schedule,15.61,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12.01,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.17,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,11.17,450,
BULLOUS PEMPHIGOID 280 IgG,302283516,CDM,302,RC,83516,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI-INTERMYOFIBRILLAR,302286256,CDM,302,RC,86256,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,19.28,160,,,fee schedule,160% of CMS fee schedule,15.67,130,,,fee schedule,130% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,15.92,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,15.16,100,,,fee schedule,100% of GA fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,15.16,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.21,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,11.21,450,
CANIGA CANDIDA ALBICANS IGA,302286628,CDM,302,RC,86628,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,19.22,160,,,fee schedule,160% of CMS fee schedule,15.61,130,,,fee schedule,130% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.86,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,15.1,100,,,fee schedule,100% of GA fee schedule,12.01,100,,,fee schedule,100% of CMS 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,15.1,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.17,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,11.17,450,
BULLOUS PEMPHIGOID 180/280-CP,302383516,CDM,302,RC,83516,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,14.12,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.45,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,,,,,other,not seperately reimbursable,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI KU Ab RDL,302583516,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI NXP-2 P140 Ab RDL,302683516,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI MI-2 Ab RDL,302783516,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI-HMGCR Ab RDL,302783520,CDM,302,RC,83520,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
ANTI OJ Ab RDL,302883516,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI SAE1 Ab IgG RDL,302883520,CDM,302,RC,83520,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,27.63,160,,,fee schedule,160% of CMS fee schedule,22.45,130,,,fee schedule,130% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,17.09,105,,,fee schedule,105% of GA fee schedule,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,16.28,100,,,fee schedule,100% of GA fee schedule,17.27,100,,,fee schedule,100% of CMS 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,16.28,100,,,fee schedule,100% of GA fee schedule,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.06,93,,,fee schedule,93% of CMS fee schedule,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,16.06,450,
ANTI SRP Ab RDL,302983516,CDM,302,RC,83516,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,14.12,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,13.45,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,13.45,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
ANTI-BODY SCREEN,390000021,CDM,302,RC,86850,HCPCS,outpatient,,,247,172.9,,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,222.3,90,,177.84,percent of total billed charges,90% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,72.49,160,,,Fee Schedule,160% of CMS OPPS rate,58.9,130,,,Fee Schedule,130% of CMS OPPS rate,15.23,100,,,fee schedule,100% of GA fee schedule,190.73,77.22,,152.58,percent of total billed charges,77.22% of total billed charges,15.99,105,,,fee schedule,105% of GA fee schedule,205.01,83,,164.01,percent of total billed charges,83% of total,234.65,95,,187.72,percent of total billed charges ,95% of total billed charges,197.6,80,,158.08,percent of total billed charges,78% of total billed charges,192.66,78,,154.128,percent of total billed charges,78% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,15.23,100,,,fee schedule,100% of GA fee schedule,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,15.23,100,,,fee schedule,100% of GA fee schedule,209.95,85,,167.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,42.13,93,,,fee schedule,93% of CMS OPPS rate,195.13,79,,156.1,percent of total billed charges,79% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,15.23,450,
DIRECT COOMBS,390000023,CDM,302,RC,86880,HCPCS,outpatient,,,163,114.1,,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,6.75,100,,,fee schedule,100% of GA fee schedule,125.87,77.22,,100.7,percent of total billed charges,77.22% of total billed charges,7.09,105,,,fee schedule,105% of GA fee schedule,135.29,83,,108.23,percent of total billed charges,83% of total,154.85,95,,123.88,percent of total billed charges ,95% of total billed charges,130.4,80,,104.32,percent of total billed charges,78% of total billed charges,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,6.75,100,,,fee schedule,100% of GA fee schedule,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,6.75,100,,,fee schedule,100% of GA fee schedule,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,6.75,450,
ANTIBODY I. D. PANEL,390000026,CDM,302,RC,86870,HCPCS,outpatient,,,708,495.6,,559.32,79,,447.46,percent of total billed charges,79% of total billed charges,637.2,90,,509.76,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,6.12,100,,,fee schedule,100% of GA fee schedule,546.72,77.22,,437.38,percent of total billed charges,77.22% of total billed charges,6.43,105,,,fee schedule,105% of GA fee schedule,587.64,83,,470.11,percent of total billed charges,83% of total,672.6,95,,538.08,percent of total billed charges ,95% of total billed charges,566.4,80,,453.12,percent of total billed charges,78% of total billed charges,552.24,78,,441.792,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,6.12,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,637.2,90,,509.76,percent of total billed charges,90% of total billed charges,566.4,80,,453.12,percent of total billed charges,80% of total billed charges,6.12,100,,,fee schedule,100% of GA fee schedule,601.8,85,,481.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,559.32,79,,447.46,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,6.12,672.6,
LEWIS NEUTRALIZATION,390000185,CDM,302,RC,86382,HCPCS,outpatient,,,239,167.3,,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,16.91,100,,,fee schedule,100% of CMS fee schedule,27.06,160,,,fee schedule,160% of CMS fee schedule,21.98,130,,,fee schedule,130% of CMS fee schedule,21.26,100,,,fee schedule,100% of GA fee schedule,184.56,77.22,,147.65,percent of total billed charges,77.22% of total billed charges,22.32,105,,,fee schedule,105% of GA fee schedule,198.37,83,,158.7,percent of total billed charges,83% of total,227.05,95,,181.64,percent of total billed charges ,95% of total billed charges,191.2,80,,152.96,percent of total billed charges,78% of total billed charges,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,16.91,100,,,fee schedule,100% of CMS fee schedule,21.26,100,,,fee schedule,100% of GA fee schedule,16.91,100,,,fee schedule ,100% of CMS 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,21.26,100,,,fee schedule,100% of GA fee schedule,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.73,93,,,fee schedule,93% of CMS fee schedule,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,16.91,100,,,fee schedule,100% of CMS fee schedule,16.91,100,,,fee schedule,100% of CMS fee schedule,15.73,450,
PREWARM ANTIBODY SC BILL ONLY,390000195,CDM,302,RC,86940,HCPCS,outpatient,,,210,147,,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,8.77,100,,,fee schedule,100% of CMS fee schedule,14.03,160,,,fee schedule,160% of CMS fee schedule,11.4,130,,,fee schedule,130% of CMS fee schedule,10.31,100,,,fee schedule,100% of GA fee schedule,162.16,77.22,,129.73,percent of total billed charges,77.22% of total billed charges,10.83,105,,,fee schedule,105% of GA fee schedule,174.3,83,,139.44,percent of total billed charges,83% of total,199.5,95,,159.6,percent of total billed charges ,95% of total billed charges,168,80,,134.4,percent of total billed charges,78% of total billed charges,163.8,78,,131.04,percent of total billed charges,78% of total billed charges,8.77,100,,,fee schedule,100% of CMS fee schedule,10.31,100,,,fee schedule,100% of GA fee schedule,8.77,100,,,fee schedule ,100% of CMS 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,10.31,100,,,fee schedule,100% of GA fee schedule,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.16,93,,,fee schedule,93% of CMS fee schedule,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,8.77,100,,,fee schedule,100% of CMS fee schedule,8.77,100,,,fee schedule,100% of CMS fee schedule,8.16,450,
TRANSFUSION REACTION,390000307,CDM,302,RC,86078,HCPCS,outpatient,,,705,493.5,,556.95,79,,445.56,percent of total billed charges,79% of total billed charges,634.5,90,,507.6,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,45,100,,,fee schedule,100% of GA fee schedule,544.4,77.22,,435.52,percent of total billed charges,77.22% of total billed charges,47.25,105,,,fee schedule,105% of GA fee schedule,585.15,83,,468.12,percent of total billed charges,83% of total,669.75,95,,535.8,percent of total billed charges ,95% of total billed charges,564,80,,451.2,percent of total billed charges,78% of total billed charges,549.9,78,,439.92,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,45,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,634.5,90,,507.6,percent of total billed charges,90% of total billed charges,564,80,,451.2,percent of total billed charges,80% of total billed charges,45,100,,,fee schedule,100% of GA fee schedule,599.25,85,,479.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,556.95,79,,445.56,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,45,669.75,
ELUTION TEST,390000321,CDM,302,RC,86860,HCPCS,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,6.12,100,,,fee schedule,100% of GA fee schedule,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,6.43,105,,,fee schedule,105% of GA fee schedule,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,6.12,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,6.12,100,,,fee schedule,100% of GA fee schedule,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,6.12,450,
ANTIBODY SCREEN,390000509,CDM,302,RC,,,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,49.58,66.1,,39.66,percent of total billed charges,66.1% of total billed charges,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,47.25,63,,37.8,percent of total billed charges,63% of total billed charges,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.25,450,
CMV NEGATIVE COM,390000513,CDM,302,RC,,,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.2,450,
ANTIBODY WORK-UP,390000529,CDM,302,RC,86870,HCPCS,outpatient,,,708,495.6,,559.32,79,,447.46,percent of total billed charges,79% of total billed charges,637.2,90,,509.76,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,6.12,100,,,fee schedule,100% of GA fee schedule,546.72,77.22,,437.38,percent of total billed charges,77.22% of total billed charges,6.43,105,,,fee schedule,105% of GA fee schedule,587.64,83,,470.11,percent of total billed charges,83% of total,672.6,95,,538.08,percent of total billed charges ,95% of total billed charges,566.4,80,,453.12,percent of total billed charges,78% of total billed charges,552.24,78,,441.792,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,6.12,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,637.2,90,,509.76,percent of total billed charges,90% of total billed charges,566.4,80,,453.12,percent of total billed charges,80% of total billed charges,6.12,100,,,fee schedule,100% of GA fee schedule,601.8,85,,481.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,559.32,79,,447.46,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,6.12,672.6,
IRRADIATION,390000546,CDM,302,RC,86945,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,53.65,160,,,Fee Schedule,160% of CMS OPPS rate,43.59,130,,,Fee Schedule,130% of CMS OPPS rate,36.05,100,,,fee schedule,100% of GA fee schedule,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,37.85,105,,,fee schedule,105% of GA fee schedule,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,36.05,100,,,fee schedule,100% of GA fee schedule,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,36.05,100,,,fee schedule,100% of GA fee schedule,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.18,93,,,fee schedule,93% of CMS OPPS rate,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.18,450,
ER TB TEST INTRADERMAL,450086580,CDM,302,RC,86580,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,8.54,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,8.13,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,450,
"RT SKIN TEST,UNLISTED",450086586,CDM,302,RC,86486,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,4.99,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,5.24,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,4.99,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,4.99,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,4.99,450,
SDC TB SKIN TEST,490086580,CDM,302,RC,86580,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,8.54,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,8.13,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,450,
TB INTRADERMAL TEST,761086580,CDM,302,RC,86580,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,8.54,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,8.13,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,450,
TB SKIN TEST PPD,86580,CDM,302,RC,86580,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,8.54,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,8.13,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,8.13,450,
WBC & DIFF,300000005,CDM,305,RC,85007,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,6.08,160,,,fee schedule,160% of CMS fee schedule,4.94,130,,,fee schedule,130% of CMS fee schedule,4.33,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,4.55,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,4.33,100,,,fee schedule,100% of GA fee schedule,3.8,100,,,fee schedule,100% of CMS 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,4.33,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.53,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,3.8,100,,,fee schedule,100% of CMS fee schedule,3.53,450,
ESR (SED RATE) NON-AUTOMATED,300000008,CDM,305,RC,85651,HCPCS,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,6.83,160,,,fee schedule,160% of CMS fee schedule,5.55,130,,,fee schedule,130% of CMS fee schedule,4.46,100,,,fee schedule,100% of GA fee schedule,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,4.68,105,,,fee schedule,105% of GA fee schedule,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.46,100,,,fee schedule,100% of GA fee schedule,4.27,100,,,fee schedule,100% of CMS 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,4.46,100,,,fee schedule,100% of GA fee schedule,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.97,93,,,fee schedule,93% of CMS fee schedule,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.97,450,
PLATELET COUNT AUTOMATED,300000009,CDM,305,RC,85049,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,4.48,100,,,fee schedule,100% of CMS fee schedule,7.17,160,,,fee schedule,160% of CMS fee schedule,5.82,130,,,fee schedule,130% of CMS fee schedule,5.63,100,,,fee schedule,100% of GA fee schedule,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,5.91,105,,,fee schedule,105% of GA fee schedule,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,4.48,100,,,fee schedule,100% of CMS fee schedule,5.63,100,,,fee schedule,100% of GA fee schedule,4.48,100,,,fee schedule,100% of CMS 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,5.63,100,,,fee schedule,100% of GA fee schedule,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.17,93,,,fee schedule,93% of CMS fee schedule,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,4.48,100,,,fee schedule,100% of CMS fee schedule,4.48,100,,,fee schedule,100% of CMS fee schedule,4.17,450,
RETICULOCYTE COUNT MANUAL,300000010,CDM,305,RC,85044,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,4.31,100,,,fee schedule,100% of CMS fee schedule,6.9,160,,,fee schedule,160% of CMS fee schedule,5.6,130,,,fee schedule,130% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,5.68,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,4.31,100,,,fee schedule,100% of CMS fee schedule,5.41,100,,,fee schedule,100% of GA fee schedule,4.31,100,,,fee schedule,100% of CMS 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,5.41,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.01,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,4.31,100,,,fee schedule,100% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,4.01,450,
BLEEDING TIME,300000011,CDM,305,RC,85002,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,4.82,100,,,fee schedule,100% of CMS fee schedule,7.71,160,,,fee schedule,160% of CMS fee schedule,6.27,130,,,fee schedule,130% of CMS fee schedule,5.66,100,,,fee schedule,100% of GA fee schedule,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,5.94,105,,,fee schedule,105% of GA fee schedule,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,4.82,100,,,fee schedule,100% of CMS fee schedule,5.66,100,,,fee schedule,100% of GA fee schedule,4.82,100,,,fee schedule,100% of CMS 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,5.66,100,,,fee schedule,100% of GA fee schedule,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.48,93,,,fee schedule,93% of CMS fee schedule,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,4.82,100,,,fee schedule,100% of CMS fee schedule,4.82,100,,,fee schedule,100% of CMS fee schedule,4.48,450,
PROTHROMBIN TIME,300000014,CDM,305,RC,85610,HCPCS,outpatient,,,112,78.4,,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,6.86,160,,,fee schedule,160% of CMS fee schedule,5.58,130,,,fee schedule,130% of CMS fee schedule,4.94,100,,,fee schedule,100% of GA fee schedule,86.49,77.22,,69.19,percent of total billed charges,77.22% of total billed charges,5.19,105,,,fee schedule,105% of GA fee schedule,92.96,83,,74.37,percent of total billed charges,83% of total,106.4,95,,85.12,percent of total billed charges ,95% of total billed charges,89.6,80,,71.68,percent of total billed charges,78% of total billed charges,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,4.94,100,,,fee schedule,100% of GA fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,4.94,100,,,fee schedule,100% of GA fee schedule,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.99,93,,,fee schedule,93% of CMS fee schedule,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,3.99,450,
PARTIAL THROMBOPLASTIN TIME,300000015,CDM,305,RC,85730,HCPCS,outpatient,,,156,109.2,,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,9.62,160,,,fee schedule,160% of CMS fee schedule,7.81,130,,,fee schedule,130% of CMS fee schedule,7.54,100,,,fee schedule,100% of GA fee schedule,120.46,77.22,,96.37,percent of total billed charges,77.22% of total billed charges,7.92,105,,,fee schedule,105% of GA fee schedule,129.48,83,,103.58,percent of total billed charges,83% of total,148.2,95,,118.56,percent of total billed charges ,95% of total billed charges,124.8,80,,99.84,percent of total billed charges,78% of total billed charges,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,7.54,100,,,fee schedule,100% of GA fee schedule,6.01,100,,,fee schedule,100% of CMS 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,7.54,100,,,fee schedule,100% of GA fee schedule,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.59,93,,,fee schedule,93% of CMS fee schedule,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,6.01,100,,,fee schedule,100% of CMS fee schedule,5.59,450,
LEE WHITE CLOTTING TIME,300000018,CDM,305,RC,85345,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,4.69,100,,,fee schedule,100% of CMS fee schedule,7.5,160,,,fee schedule,160% of CMS fee schedule,6.1,130,,,fee schedule,130% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,4.57,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,4.69,100,,,fee schedule,100% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,4.69,100,,,fee schedule,100% of CMS 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,4.35,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.36,93,,,fee schedule,93% of CMS fee schedule,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,4.69,100,,,fee schedule,100% of CMS fee schedule,4.69,100,,,fee schedule,100% of CMS fee schedule,4.35,450,
SICKLE CELL SCREEN,300000019,CDM,305,RC,85660,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,8.82,160,,,fee schedule,160% of CMS fee schedule,7.16,130,,,fee schedule,130% of CMS fee schedule,6.94,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,7.29,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,6.94,100,,,fee schedule,100% of GA fee schedule,5.51,100,,,fee schedule,100% of CMS fee schedule,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,6.94,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.12,93,,,fee schedule,93% of CMS fee schedule,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,5.51,100,,,fee schedule,100% of CMS fee schedule,5.12,450,
FEBRILE AGGLUTINATION PKG,300000034,CDM,305,RC,86000,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,11.17,160,,,fee schedule,160% of CMS fee schedule,9.07,130,,,fee schedule,130% of CMS fee schedule,8.78,100,,,fee schedule,100% of GA fee schedule,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,9.22,105,,,fee schedule,105% of GA fee schedule,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,8.78,100,,,fee schedule,100% of GA fee schedule,6.98,100,,,fee schedule,100% of CMS 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,8.78,100,,,fee schedule,100% of GA fee schedule,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.49,93,,,fee schedule,93% of CMS fee schedule,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,6.98,100,,,fee schedule,100% of CMS fee schedule,6.49,450,
F TULARENSIS,300000035,CDM,305,RC,86000,HCPCS,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,11.17,160,,,fee schedule,160% of CMS fee schedule,9.07,130,,,fee schedule,130% of CMS fee schedule,8.78,100,,,fee schedule,100% of GA fee schedule,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,9.22,105,,,fee schedule,105% of GA fee schedule,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,8.78,100,,,fee schedule,100% of GA fee schedule,6.98,100,,,fee schedule,100% of CMS 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,8.78,100,,,fee schedule,100% of GA fee schedule,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.49,93,,,fee schedule,93% of CMS fee schedule,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,6.98,100,,,fee schedule,100% of CMS fee schedule,6.49,450,
HEMOGLOBIN,300000129,CDM,305,RC,85018,HCPCS,outpatient,,,52,36.4,,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,46.8,90,,37.44,percent of total billed charges,90% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,3.79,160,,,fee schedule,160% of CMS fee schedule,3.08,130,,,fee schedule,130% of CMS fee schedule,2.98,100,,,fee schedule,100% of GA fee schedule,40.15,77.22,,32.12,percent of total billed charges,77.22% of total billed charges,3.13,105,,,fee schedule,105% of GA fee schedule,43.16,83,,34.53,percent of total billed charges,83% of total,49.4,95,,39.52,percent of total billed charges ,95% of total billed charges,41.6,80,,33.28,percent of total billed charges,78% of total billed charges,40.56,78,,32.448,percent of total billed charges,78% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,2.98,100,,,fee schedule,100% of GA fee schedule,2.37,100,,,fee schedule,100% of CMS 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,2.98,100,,,fee schedule,100% of GA fee schedule,44.2,85,,35.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.2,93,,,fee schedule,93% of CMS fee schedule,41.08,79,,32.86,percent of total billed charges,79% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,2.2,450,
CLOTTING TIME,300000147,CDM,305,RC,85348,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,4.49,100,,,fee schedule,100% of CMS fee schedule,7.18,160,,,fee schedule,160% of CMS fee schedule,5.84,130,,,fee schedule,130% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,4.57,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,4.49,100,,,fee schedule,100% of CMS fee schedule,4.35,100,,,fee schedule,100% of GA fee schedule,4.49,100,,,fee schedule,100% of CMS 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,4.35,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.18,93,,,fee schedule,93% of CMS fee schedule,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,4.49,100,,,fee schedule,100% of CMS fee schedule,4.49,100,,,fee schedule,100% of CMS fee schedule,4.18,450,
HEMATOCRIT,300000154,CDM,305,RC,85014,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,3.79,160,,,fee schedule,160% of CMS fee schedule,3.08,130,,,fee schedule,130% of CMS fee schedule,2.98,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,3.13,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,2.98,100,,,fee schedule,100% of GA fee schedule,2.37,100,,,fee schedule,100% of CMS 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,2.98,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.2,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,2.37,100,,,fee schedule,100% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,2.2,450,
CBC WITHOUT DIFF,300000156,CDM,305,RC,85027,HCPCS,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,10.35,160,,,fee schedule,160% of CMS fee schedule,8.41,130,,,fee schedule,130% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,8.55,105,,,fee schedule,105% of GA fee schedule,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,8.14,100,,,fee schedule,100% of GA fee schedule,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.02,93,,,fee schedule,93% of CMS fee schedule,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.02,450,
CBC MANUAL DIFFERENTIAL WBC,300000184,CDM,305,RC,85007,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,6.08,160,,,fee schedule,160% of CMS fee schedule,4.94,130,,,fee schedule,130% of CMS fee schedule,4.33,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,4.55,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,4.33,100,,,fee schedule,100% of GA fee schedule,3.8,100,,,fee schedule,100% of CMS 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,4.33,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.53,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,3.8,100,,,fee schedule,100% of CMS fee schedule,3.8,100,,,fee schedule,100% of CMS fee schedule,3.53,450,
FETAL BLEED SCREEN,300000192,CDM,305,RC,85460,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,12.37,160,,,fee schedule,160% of CMS fee schedule,10.05,130,,,fee schedule,130% of CMS fee schedule,3.04,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,3.19,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,3.04,100,,,fee schedule,100% of GA fee schedule,7.73,100,,,fee schedule,100% of CMS 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,3.04,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.19,93,,,fee schedule,93% of CMS fee schedule,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,7.73,100,,,fee schedule,100% of CMS fee schedule,3.04,450,
"FIBRINOGEN,QUANT",300000198,CDM,305,RC,85384,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,15.55,160,,,fee schedule,160% of CMS fee schedule,12.64,130,,,fee schedule,130% of CMS fee schedule,10.68,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,11.21,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,10.68,100,,,fee schedule,100% of GA fee schedule,9.72,100,,,fee schedule,100% of CMS 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,10.68,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.04,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,9.72,100,,,fee schedule,100% of CMS fee schedule,9.72,100,,,fee schedule,100% of CMS fee schedule,9.04,450,
FIBRIN DEGRADATION PROD,300000250,CDM,305,RC,85362,HCPCS,outpatient,,,208,145.6,,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,11.02,160,,,fee schedule,160% of CMS fee schedule,8.96,130,,,fee schedule,130% of CMS fee schedule,8.66,100,,,fee schedule,100% of GA fee schedule,160.62,77.22,,128.5,percent of total billed charges,77.22% of total billed charges,9.09,105,,,fee schedule,105% of GA fee schedule,172.64,83,,138.11,percent of total billed charges,83% of total,197.6,95,,158.08,percent of total billed charges ,95% of total billed charges,166.4,80,,133.12,percent of total billed charges,78% of total billed charges,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,8.66,100,,,fee schedule,100% of GA fee schedule,6.89,100,,,fee schedule,100% of CMS 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,8.66,100,,,fee schedule,100% of GA fee schedule,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.41,93,,,fee schedule,93% of CMS fee schedule,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,6.89,100,,,fee schedule,100% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,6.41,450,
WBC,300000314,CDM,305,RC,85048,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,2.54,100,,,fee schedule,100% of CMS fee schedule,4.06,160,,,fee schedule,160% of CMS fee schedule,3.3,130,,,fee schedule,130% of CMS fee schedule,3.2,100,,,fee schedule,100% of GA fee schedule,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,3.36,105,,,fee schedule,105% of GA fee schedule,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,2.54,100,,,fee schedule,100% of CMS fee schedule,3.2,100,,,fee schedule,100% of GA fee schedule,2.54,100,,,fee schedule,100% of CMS 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,3.2,100,,,fee schedule,100% of GA fee schedule,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.36,93,,,fee schedule,93% of CMS fee schedule,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,2.54,100,,,fee schedule,100% of CMS fee schedule,2.54,100,,,fee schedule,100% of CMS fee schedule,2.36,450,
RBC,300000347,CDM,305,RC,85041,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,3.02,100,,,fee schedule,100% of CMS fee schedule,4.83,160,,,fee schedule,160% of CMS fee schedule,3.93,130,,,fee schedule,130% of CMS fee schedule,3.78,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,3.97,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,3.02,100,,,fee schedule,100% of CMS fee schedule,3.78,100,,,fee schedule,100% of GA fee schedule,3.02,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,3.78,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.81,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,3.02,100,,,fee schedule,100% of CMS fee schedule,3.02,100,,,fee schedule,100% of CMS fee schedule,2.81,450,
LUPUS-LIKE ANTI,300000373,CDM,305,RC,85705,HCPCS,outpatient,,,220,154,,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,198,90,,158.4,percent of total billed charges,90% of total billed charges,9.63,100,,,fee schedule,100% of CMS fee schedule,15.41,160,,,fee schedule,160% of CMS fee schedule,12.52,130,,,fee schedule,130% of CMS fee schedule,12.11,100,,,fee schedule,100% of GA fee schedule,169.88,77.22,,135.9,percent of total billed charges,77.22% of total billed charges,12.72,105,,,fee schedule,105% of GA fee schedule,182.6,83,,146.08,percent of total billed charges,83% of total,209,95,,167.2,percent of total billed charges ,95% of total billed charges,176,80,,140.8,percent of total billed charges,78% of total billed charges,171.6,78,,137.28,percent of total billed charges,78% of total billed charges,9.63,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of GA fee schedule,9.63,100,,,fee schedule,100% of CMS 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,12.11,100,,,fee schedule,100% of GA fee schedule,187,85,,149.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.96,93,,,fee schedule,93% of CMS fee schedule,173.8,79,,139.04,percent of total billed charges,79% of total billed charges,9.63,100,,,fee schedule,100% of CMS fee schedule,9.63,100,,,fee schedule,100% of CMS fee schedule,8.96,450,
CBC W DIFF,300000490,CDM,305,RC,85025,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,12.43,160,,,fee schedule,160% of CMS fee schedule,10.1,130,,,fee schedule,130% of CMS fee schedule,9.77,100,,,fee schedule,100% of GA fee schedule,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,10.26,105,,,fee schedule,105% of GA fee schedule,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,9.77,100,,,fee schedule,100% of GA fee schedule,7.77,100,,,fee schedule,100% of CMS 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,9.77,100,,,fee schedule,100% of GA fee schedule,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.23,93,,,fee schedule,93% of CMS fee schedule,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,7.77,100,,,fee schedule,100% of CMS fee schedule,7.77,100,,,fee schedule,100% of CMS fee schedule,7.23,450,
ALLERGEN TILAPIA,300001863,CDM,305,RC,86003,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEANUT ALLERGEN CP,300005000,CDM,305,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PEANUT F423,300005001,CDM,305,RC,86003,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEANUT F422,300005002,CDM,305,RC,86003,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEANUT F424,300005003,CDM,305,RC,86003,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEANUT F427,300005004,CDM,305,RC,86003,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEANUT F352,300005005,CDM,305,RC,86003,HCPCS,outpatient,,,28,19.6,,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,25.2,90,,20.16,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,21.62,77.22,,17.3,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,23.24,83,,18.59,percent of total billed charges,83% of total,26.6,95,,21.28,percent of total billed charges ,95% of total billed charges,22.4,80,,17.92,percent of total billed charges,78% of total billed charges,21.84,78,,17.472,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,23.8,85,,19.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.12,79,,17.7,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MILK ALLERGEN CP,300005006,CDM,305,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MILK F78,300005007,CDM,305,RC,86003,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MILK F76,300005008,CDM,305,RC,86003,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MILK F77,300005009,CDM,305,RC,86003,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HAMSTER EPI ALLERGEN,300005010,CDM,305,RC,86003,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
RABBIT EPI ALLERGEN,300005011,CDM,305,RC,86003,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BLUEBERRY ALLERGEN,300006001,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ASPERGILLUS FAVUS IGG,300006003,CDM,305,RC,86003,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PROTEIN ANTIGEN,300008008,CDM,305,RC,85302,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,19.22,160,,,fee schedule,160% of CMS fee schedule,15.61,130,,,fee schedule,130% of CMS fee schedule,15.12,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.88,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,15.12,100,,,fee schedule,100% of GA fee schedule,12.01,100,,,fee schedule,100% of CMS 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,15.12,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.17,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,11.17,450,
PROTEIN S TOTAL,300008009,CDM,305,RC,85305,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,18.58,160,,,fee schedule,160% of CMS fee schedule,15.09,130,,,fee schedule,130% of CMS fee schedule,14.58,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,15.31,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,14.58,100,,,fee schedule,100% of GA fee schedule,11.61,100,,,fee schedule,100% of CMS 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,14.58,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.8,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,11.61,100,,,fee schedule,100% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,10.8,450,
ANTI-THROMBIN III,300008014,CDM,305,RC,85300,HCPCS,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,18.96,160,,,fee schedule,160% of CMS fee schedule,15.41,130,,,fee schedule,130% of CMS fee schedule,14.9,100,,,fee schedule,100% of GA fee schedule,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,15.65,105,,,fee schedule,105% of GA fee schedule,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,14.9,100,,,fee schedule,100% of GA fee schedule,11.85,100,,,fee schedule,100% of CMS 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,14.9,100,,,fee schedule,100% of GA fee schedule,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.02,93,,,fee schedule,93% of CMS fee schedule,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,11.85,100,,,fee schedule,100% of CMS fee schedule,11.02,450,
RAST SOUTHEAST,300008029,CDM,305,RC,86003,HCPCS,outpatient,,,242,169.4,,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,186.87,77.22,,149.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,200.86,83,,160.69,percent of total billed charges,83% of total,229.9,95,,183.92,percent of total billed charges ,95% of total billed charges,193.6,80,,154.88,percent of total billed charges,78% of total billed charges,188.76,78,,151.008,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
KLEIHAUHER-BETKE,300008040,CDM,305,RC,85460,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,12.37,160,,,fee schedule,160% of CMS fee schedule,10.05,130,,,fee schedule,130% of CMS fee schedule,3.04,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,3.19,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,3.04,100,,,fee schedule,100% of GA fee schedule,7.73,100,,,fee schedule,100% of CMS 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,3.04,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.19,93,,,fee schedule,93% of CMS fee schedule,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,7.73,100,,,fee schedule,100% of CMS fee schedule,7.73,100,,,fee schedule,100% of CMS fee schedule,3.04,450,
VISCOSITY SR OR WB,300008045,CDM,305,RC,85810,HCPCS,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,11.67,100,,,fee schedule,100% of CMS fee schedule,18.67,160,,,fee schedule,160% of CMS fee schedule,15.17,130,,,fee schedule,130% of CMS fee schedule,14.69,100,,,fee schedule,100% of GA fee schedule,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,15.42,105,,,fee schedule,105% of GA fee schedule,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,11.67,100,,,fee schedule,100% of CMS fee schedule,14.69,100,,,fee schedule,100% of GA fee schedule,11.67,100,,,fee schedule,100% of CMS 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,14.69,100,,,fee schedule,100% of GA fee schedule,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.85,93,,,fee schedule,93% of CMS fee schedule,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,11.67,100,,,fee schedule,100% of CMS fee schedule,11.67,100,,,fee schedule,100% of CMS fee schedule,10.85,450,
D-DIMER,300008047,CDM,305,RC,85379,HCPCS,outpatient,,,257,179.9,,203.03,79,,162.42,percent of total billed charges,79% of total billed charges,231.3,90,,185.04,percent of total billed charges,90% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,16.29,160,,,fee schedule,160% of CMS fee schedule,13.23,130,,,fee schedule,130% of CMS fee schedule,12.8,100,,,fee schedule,100% of GA fee schedule,198.46,77.22,,158.77,percent of total billed charges,77.22% of total billed charges,13.44,105,,,fee schedule,105% of GA fee schedule,213.31,83,,170.65,percent of total billed charges,83% of total,244.15,95,,195.32,percent of total billed charges ,95% of total billed charges,205.6,80,,164.48,percent of total billed charges,78% of total billed charges,200.46,78,,160.368,percent of total billed charges,78% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,12.8,100,,,fee schedule,100% of GA fee schedule,10.18,100,,,fee schedule,100% of CMS 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,12.8,100,,,fee schedule,100% of GA fee schedule,218.45,85,,174.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.47,93,,,fee schedule,93% of CMS fee schedule,203.03,79,,162.42,percent of total billed charges,79% of total billed charges,10.18,100,,,fee schedule,100% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,9.47,450,
RAST FOOD,300008048,CDM,305,RC,86003,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
"RAST,FOOD (6->)",300008059,CDM,305,RC,86003,HCPCS,outpatient,,,216,151.2,,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,194.4,90,,155.52,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,166.8,77.22,,133.44,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,179.28,83,,143.42,percent of total billed charges,83% of total,205.2,95,,164.16,percent of total billed charges ,95% of total billed charges,172.8,80,,138.24,percent of total billed charges,78% of total billed charges,168.48,78,,134.784,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,183.6,85,,146.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,170.64,79,,136.51,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ALLERGEN IGE AUREOBASIN PULL,300008099,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BRUCELLA ABORTUS ANTIBODY,300008217,CDM,305,RC,86000,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,11.17,160,,,fee schedule,160% of CMS fee schedule,9.07,130,,,fee schedule,130% of CMS fee schedule,8.78,100,,,fee schedule,100% of GA fee schedule,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,9.22,105,,,fee schedule,105% of GA fee schedule,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,8.78,100,,,fee schedule,100% of GA fee schedule,6.98,100,,,fee schedule,100% of CMS 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,8.78,100,,,fee schedule,100% of GA fee schedule,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.49,93,,,fee schedule,93% of CMS fee schedule,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,6.98,100,,,fee schedule,100% of CMS fee schedule,6.98,100,,,fee schedule,100% of CMS fee schedule,6.49,450,
EUGLOBIN LYSIS TIME,300008242,CDM,305,RC,85360,HCPCS,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,13.46,160,,,fee schedule,160% of CMS fee schedule,10.93,130,,,fee schedule,130% of CMS fee schedule,10.57,100,,,fee schedule,100% of GA fee schedule,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,11.1,105,,,fee schedule,105% of GA fee schedule,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,10.57,100,,,fee schedule,100% of GA fee schedule,8.41,100,,,fee schedule,100% of CMS fee schedule,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,10.57,100,,,fee schedule,100% of GA fee schedule,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.82,93,,,fee schedule,93% of CMS fee schedule,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,8.41,100,,,fee schedule,100% of CMS fee schedule,8.41,100,,,fee schedule,100% of CMS fee schedule,7.82,450,
FACTOR 2,300008247,CDM,305,RC,85210,HCPCS,outpatient,,,227,158.9,,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,12.98,100,,,fee schedule,100% of CMS fee schedule,20.77,160,,,fee schedule,160% of CMS fee schedule,16.87,130,,,fee schedule,130% of CMS fee schedule,16.33,100,,,fee schedule,100% of GA fee schedule,175.29,77.22,,140.23,percent of total billed charges,77.22% of total billed charges,17.15,105,,,fee schedule,105% of GA fee schedule,188.41,83,,150.73,percent of total billed charges,83% of total,215.65,95,,172.52,percent of total billed charges ,95% of total billed charges,181.6,80,,145.28,percent of total billed charges,78% of total billed charges,177.06,78,,141.648,percent of total billed charges,78% of total billed charges,12.98,100,,,fee schedule,100% of CMS fee schedule,16.33,100,,,fee schedule,100% of GA fee schedule,12.98,100,,,fee schedule,100% of CMS 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,16.33,100,,,fee schedule,100% of GA fee schedule,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.07,93,,,fee schedule,93% of CMS fee schedule,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,12.98,100,,,fee schedule,100% of CMS fee schedule,12.98,100,,,fee schedule,100% of CMS fee schedule,12.07,450,
HEMOGLOBIN S,300008258,CDM,305,RC,85660,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,8.82,160,,,fee schedule,160% of CMS fee schedule,7.16,130,,,fee schedule,130% of CMS fee schedule,6.94,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,7.29,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,6.94,100,,,fee schedule,100% of GA fee schedule,5.51,100,,,fee schedule,100% of CMS fee schedule,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,6.94,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.12,93,,,fee schedule,93% of CMS fee schedule,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,5.51,100,,,fee schedule,100% of CMS fee schedule,5.51,100,,,fee schedule,100% of CMS fee schedule,5.12,450,
LUPUS ANTICOAGULATION,300008260,CDM,305,RC,85732,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,10.35,160,,,fee schedule,160% of CMS fee schedule,8.41,130,,,fee schedule,130% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,8.55,105,,,fee schedule,105% of GA fee schedule,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,8.14,100,,,fee schedule,100% of GA fee schedule,6.47,100,,,fee schedule,100% of CMS 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,8.14,100,,,fee schedule,100% of GA fee schedule,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.02,93,,,fee schedule,93% of CMS fee schedule,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.02,450,
LEUKOCYTE ALKALINE PHOSPHATASE,300008262,CDM,305,RC,85540,HCPCS,outpatient,,,263,184.1,,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,8.6,100,,,fee schedule,100% of CMS fee schedule,13.76,160,,,fee schedule,160% of CMS fee schedule,11.18,130,,,fee schedule,130% of CMS fee schedule,7.6,100,,,fee schedule,100% of GA fee schedule,203.09,77.22,,162.47,percent of total billed charges,77.22% of total billed charges,7.98,105,,,fee schedule,105% of GA fee schedule,218.29,83,,174.63,percent of total billed charges,83% of total,249.85,95,,199.88,percent of total billed charges ,95% of total billed charges,210.4,80,,168.32,percent of total billed charges,78% of total billed charges,205.14,78,,164.112,percent of total billed charges,78% of total billed charges,8.6,100,,,fee schedule,100% of CMS fee schedule,7.6,100,,,fee schedule,100% of GA fee schedule,8.6,100,,,fee schedule,100% of CMS 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,7.6,100,,,fee schedule,100% of GA fee schedule,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8,93,,,fee schedule,93% of CMS fee schedule,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,8.6,100,,,fee schedule,100% of CMS fee schedule,8.6,100,,,fee schedule,100% of CMS fee schedule,7.6,450,
VON WILLEBRAND FACTOR ASSAY,300008308,CDM,305,RC,85245,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,36.7,160,,,fee schedule,160% of CMS fee schedule,29.82,130,,,fee schedule,130% of CMS fee schedule,28.85,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,30.29,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,28.85,100,,,fee schedule,100% of GA fee schedule,22.94,100,,,fee schedule,100% of CMS 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,28.85,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.33,93,,,fee schedule,93% of CMS fee schedule,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,21.33,450,
ECHINOCOCCUS  IGE,300008388,CDM,305,RC,86003,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
"RASTS,MOSQUITO",300008463,CDM,305,RC,86003,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
FACTOR 8,300008465,CDM,305,RC,85240,HCPCS,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,28.64,160,,,fee schedule,160% of CMS fee schedule,23.27,130,,,fee schedule,130% of CMS fee schedule,22.52,100,,,fee schedule,100% of GA fee schedule,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,23.65,105,,,fee schedule,105% of GA fee schedule,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,22.52,100,,,fee schedule,100% of GA fee schedule,17.9,100,,,fee schedule,100% of CMS 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,22.52,100,,,fee schedule,100% of GA fee schedule,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.65,93,,,fee schedule,93% of CMS fee schedule,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,16.65,450,
FACTOR 1X,300008505,CDM,305,RC,85250,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,19.04,100,,,fee schedule,100% of CMS fee schedule,30.46,160,,,fee schedule,160% of CMS fee schedule,24.75,130,,,fee schedule,130% of CMS fee schedule,23.94,100,,,fee schedule,100% of GA fee schedule,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,25.14,105,,,fee schedule,105% of GA fee schedule,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,19.04,100,,,fee schedule,100% of CMS fee schedule,23.94,100,,,fee schedule,100% of GA fee schedule,19.04,100,,,fee schedule,100% of CMS 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,23.94,100,,,fee schedule,100% of GA fee schedule,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.71,93,,,fee schedule,93% of CMS fee schedule,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,19.04,100,,,fee schedule,100% of CMS fee schedule,19.04,100,,,fee schedule,100% of CMS fee schedule,17.71,450,
VON WILLEBRAND ANTIGEN,300008525,CDM,305,RC,85246,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,36.7,160,,,fee schedule,160% of CMS fee schedule,29.82,130,,,fee schedule,130% of CMS fee schedule,28.85,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,30.29,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,28.85,100,,,fee schedule,100% of GA fee schedule,22.94,100,,,fee schedule,100% of CMS 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,28.85,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.33,93,,,fee schedule,93% of CMS fee schedule,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,21.33,450,
LYSOZYME,300008526,CDM,305,RC,85549,HCPCS,outpatient,,,64,44.8,,50.56,79,,40.45,percent of total billed charges,79% of total billed charges,57.6,90,,46.08,percent of total billed charges,90% of total billed charges,18.75,100,,,fee schedule,100% of CMS fee schedule,30,160,,,fee schedule,160% of CMS fee schedule,24.38,130,,,fee schedule,130% of CMS fee schedule,23.59,100,,,fee schedule,100% of GA fee schedule,49.42,77.22,,39.54,percent of total billed charges,77.22% of total billed charges,24.77,105,,,fee schedule,105% of GA fee schedule,53.12,83,,42.5,percent of total billed charges,83% of total,60.8,95,,48.64,percent of total billed charges ,95% of total billed charges,51.2,80,,40.96,percent of total billed charges,78% of total billed charges,49.92,78,,39.936,percent of total billed charges,78% of total billed charges,18.75,100,,,fee schedule,100% of CMS fee schedule,23.59,100,,,fee schedule,100% of GA fee schedule,18.75,100,,,fee schedule,100% of CMS 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,23.59,100,,,fee schedule,100% of GA fee schedule,54.4,85,,43.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.44,93,,,fee schedule,93% of CMS fee schedule,50.56,79,,40.45,percent of total billed charges,79% of total billed charges,18.75,100,,,fee schedule,100% of CMS fee schedule,18.75,100,,,fee schedule,100% of CMS fee schedule,17.44,450,
FACTOR X III,300008527,CDM,305,RC,85291,HCPCS,outpatient,,,204,142.8,,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,9.11,100,,,fee schedule,100% of CMS fee schedule,14.58,160,,,fee schedule,160% of CMS fee schedule,11.84,130,,,fee schedule,130% of CMS fee schedule,11.18,100,,,fee schedule,100% of GA fee schedule,157.53,77.22,,126.02,percent of total billed charges,77.22% of total billed charges,11.74,105,,,fee schedule,105% of GA fee schedule,169.32,83,,135.46,percent of total billed charges,83% of total,193.8,95,,155.04,percent of total billed charges ,95% of total billed charges,163.2,80,,130.56,percent of total billed charges,78% of total billed charges,159.12,78,,127.296,percent of total billed charges,78% of total billed charges,9.11,100,,,fee schedule,100% of CMS fee schedule,11.18,100,,,fee schedule,100% of GA fee schedule,9.11,100,,,fee schedule,100% of CMS 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,11.18,100,,,fee schedule,100% of GA fee schedule,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.47,93,,,fee schedule,93% of CMS fee schedule,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,9.11,100,,,fee schedule,100% of CMS fee schedule,9.11,100,,,fee schedule,100% of CMS fee schedule,8.47,450,
THROMBIN TIME,300008529,CDM,305,RC,85670,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,9.23,160,,,fee schedule,160% of CMS fee schedule,7.5,130,,,fee schedule,130% of CMS fee schedule,7.26,100,,,fee schedule,100% of GA fee schedule,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,7.62,105,,,fee schedule,105% of GA fee schedule,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,7.26,100,,,fee schedule,100% of GA fee schedule,5.77,100,,,fee schedule,100% of CMS 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,7.26,100,,,fee schedule,100% of GA fee schedule,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.37,93,,,fee schedule,93% of CMS fee schedule,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,5.77,100,,,fee schedule,100% of CMS fee schedule,5.77,100,,,fee schedule,100% of CMS fee schedule,5.37,450,
PROTEIN C FUNCTIONAL,300008535,CDM,305,RC,85303,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,13.84,100,,,fee schedule,100% of CMS fee schedule,22.14,160,,,fee schedule,160% of CMS fee schedule,17.99,130,,,fee schedule,130% of CMS fee schedule,17.39,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,18.26,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,13.84,100,,,fee schedule,100% of CMS fee schedule,17.39,100,,,fee schedule,100% of GA fee schedule,13.84,100,,,fee schedule,100% of CMS 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,17.39,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.87,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,13.84,100,,,fee schedule,100% of CMS fee schedule,13.84,100,,,fee schedule,100% of CMS fee schedule,12.87,450,
BANANA ALLERGEN,300008549,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CORN ALLERGEN,300008550,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
EGG WHITE ALLERGEN,300008551,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MILK ALLERGEN,300008552,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ORANGE ALLERGEN,300008553,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEANUT ALLERGEN,300008554,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PECAN ALLERGEN,300008555,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
RICE ALLERGEN,300008556,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
VON WILLEBRAND MULTIMERIC,300008577,CDM,305,RC,85247,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,36.7,160,,,fee schedule,160% of CMS fee schedule,29.82,130,,,fee schedule,130% of CMS fee schedule,28.85,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,30.29,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,28.85,100,,,fee schedule,100% of GA fee schedule,22.94,100,,,fee schedule,100% of CMS 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,28.85,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.33,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,22.94,100,,,fee schedule,100% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,21.33,450,
FACTOR VII,300008604,CDM,305,RC,85230,HCPCS,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,28.64,160,,,fee schedule,160% of CMS fee schedule,23.27,130,,,fee schedule,130% of CMS fee schedule,22.52,100,,,fee schedule,100% of GA fee schedule,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,23.65,105,,,fee schedule,105% of GA fee schedule,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,22.52,100,,,fee schedule,100% of GA fee schedule,17.9,100,,,fee schedule,100% of CMS 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,22.52,100,,,fee schedule,100% of GA fee schedule,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.65,93,,,fee schedule,93% of CMS fee schedule,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,16.65,450,
PROTEIN S FUNCTIONAL,300008606,CDM,305,RC,85306,HCPCS,outpatient,,,143,100.1,,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,24.51,160,,,fee schedule,160% of CMS fee schedule,19.92,130,,,fee schedule,130% of CMS fee schedule,19.27,100,,,fee schedule,100% of GA fee schedule,110.42,77.22,,88.34,percent of total billed charges,77.22% of total billed charges,20.23,105,,,fee schedule,105% of GA fee schedule,118.69,83,,94.95,percent of total billed charges,83% of total,135.85,95,,108.68,percent of total billed charges ,95% of total billed charges,114.4,80,,91.52,percent of total billed charges,78% of total billed charges,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,19.27,100,,,fee schedule,100% of GA fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,19.27,100,,,fee schedule,100% of GA fee schedule,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.25,93,,,fee schedule,93% of CMS fee schedule,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,14.25,450,
SHRIMP ALLERGEN,300008607,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SOYBEAN ALLERGEN,300008608,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WHEAT ALLERGEN,300008609,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WALNUT ALLERGEN,300008610,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
FACTOR V,300008656,CDM,305,RC,85220,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,17.65,100,,,fee schedule,100% of CMS fee schedule,28.24,160,,,fee schedule,160% of CMS fee schedule,22.95,130,,,fee schedule,130% of CMS fee schedule,22.19,100,,,fee schedule,100% of GA fee schedule,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,23.3,105,,,fee schedule,105% of GA fee schedule,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,17.65,100,,,fee schedule,100% of CMS fee schedule,22.19,100,,,fee schedule,100% of GA fee schedule,17.65,100,,,fee schedule,100% of CMS 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,22.19,100,,,fee schedule,100% of GA fee schedule,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.41,93,,,fee schedule,93% of CMS fee schedule,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,17.65,100,,,fee schedule,100% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,16.41,450,
ACTUATED PROTEIN C RESISTANCE,300008697,CDM,305,RC,85307,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,24.51,160,,,fee schedule,160% of CMS fee schedule,19.92,130,,,fee schedule,130% of CMS fee schedule,19.27,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,20.23,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,19.27,100,,,fee schedule,100% of GA fee schedule,15.32,100,,,fee schedule,100% of CMS 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,19.27,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.25,93,,,fee schedule,93% of CMS fee schedule,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,14.25,450,
"ALLERGEN,MOLD,PHOMA BETAE",300008725,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
"ALLERGEN,FOOD,BEEF",300008726,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
"ALLERGEN,FOOD,PORK",300008727,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
"ALLERGEN,EPIDER & AMIMAL PROT",300008728,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
LATEX ALLERGEN,300008861,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PT 1:1 MIX,300008866,CDM,305,RC,85610,HCPCS,outpatient,,,112,78.4,,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,6.86,160,,,fee schedule,160% of CMS fee schedule,5.58,130,,,fee schedule,130% of CMS fee schedule,4.94,100,,,fee schedule,100% of GA fee schedule,86.49,77.22,,69.19,percent of total billed charges,77.22% of total billed charges,5.19,105,,,fee schedule,105% of GA fee schedule,92.96,83,,74.37,percent of total billed charges,83% of total,106.4,95,,85.12,percent of total billed charges ,95% of total billed charges,89.6,80,,71.68,percent of total billed charges,78% of total billed charges,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,4.94,100,,,fee schedule,100% of GA fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,4.94,100,,,fee schedule,100% of GA fee schedule,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.99,93,,,fee schedule,93% of CMS fee schedule,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,3.99,450,
CLAM ALLERGEN,300008871,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SCALLOP ALLERGEN,300008872,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CRAB ALLERGEN,300008873,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
OYSTER ALLERGEN,300008874,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
LOBSTER ALLERGEN,300008875,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BLUE MUSSEL ALLERGEN,300008876,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BEEF ALLERGEN,300008877,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
POTOTO ALLERGEN,300008878,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SALMON ALLERGEN,300008949,CDM,305,RC,86003,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,6.57,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
IMPORTED FIRE ANTS ALLERGEN,300008950,CDM,305,RC,86003,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,6.57,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ALLERGEN SPECIFIC IgE,300008976,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ECHIGE,300008981,CDM,305,RC,86003,HCPCS,outpatient,,,174,121.8,,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,134.36,77.22,,107.49,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,144.42,83,,115.54,percent of total billed charges,83% of total,165.3,95,,132.24,percent of total billed charges ,95% of total billed charges,139.2,80,,111.36,percent of total billed charges,78% of total billed charges,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PLASMINOGEN ACTIVATOR INHIBIT,300008987,CDM,305,RC,85415,HCPCS,outpatient,,,88,61.6,,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,79.2,90,,63.36,percent of total billed charges,90% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,27.5,160,,,fee schedule,160% of CMS fee schedule,22.35,130,,,fee schedule,130% of CMS fee schedule,21.62,100,,,fee schedule,100% of GA fee schedule,67.95,77.22,,54.36,percent of total billed charges,77.22% of total billed charges,22.7,105,,,fee schedule,105% of GA fee schedule,73.04,83,,58.43,percent of total billed charges,83% of total,83.6,95,,66.88,percent of total billed charges ,95% of total billed charges,70.4,80,,56.32,percent of total billed charges,78% of total billed charges,68.64,78,,54.912,percent of total billed charges,78% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,21.62,100,,,fee schedule,100% of GA fee schedule,17.19,100,,,fee schedule,100% of CMS 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,21.62,100,,,fee schedule,100% of GA fee schedule,74.8,85,,59.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.99,93,,,fee schedule,93% of CMS fee schedule,69.52,79,,55.62,percent of total billed charges,79% of total billed charges,17.19,100,,,fee schedule,100% of CMS fee schedule,17.19,100,,,fee schedule,100% of CMS fee schedule,15.99,450,
"OSMOTIC FRAGILITY,ERYTHROCYTE",300008991,CDM,305,RC,85555,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,7.47,100,,,fee schedule,100% of CMS fee schedule,11.95,160,,,fee schedule,160% of CMS fee schedule,9.71,130,,,fee schedule,130% of CMS fee schedule,8.41,100,,,fee schedule,100% of GA fee schedule,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,8.83,105,,,fee schedule,105% of GA fee schedule,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,7.47,100,,,fee schedule,100% of CMS fee schedule,8.41,100,,,fee schedule,100% of GA fee schedule,7.47,100,,,fee schedule,100% of CMS 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,8.41,100,,,fee schedule,100% of GA fee schedule,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.95,93,,,fee schedule,93% of CMS fee schedule,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,7.47,100,,,fee schedule,100% of CMS fee schedule,7.47,100,,,fee schedule,100% of CMS fee schedule,6.95,450,
STRAWBERRY ALLERGEN,300008995,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
LETTUCE ALLERGEN,300008996,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CABBAGE ALLERGEN,300008997,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
"OSMOTIC FRAGILITY, QUANT",300008998,CDM,305,RC,85557,HCPCS,outpatient,,,470,329,,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,13.36,100,,,fee schedule,100% of CMS fee schedule,21.38,160,,,fee schedule,160% of CMS fee schedule,17.37,130,,,fee schedule,130% of CMS fee schedule,16.79,100,,,fee schedule,100% of GA fee schedule,362.93,77.22,,290.34,percent of total billed charges,77.22% of total billed charges,17.63,105,,,fee schedule,105% of GA fee schedule,390.1,83,,312.08,percent of total billed charges,83% of total,446.5,95,,357.2,percent of total billed charges ,95% of total billed charges,376,80,,300.8,percent of total billed charges,78% of total billed charges,366.6,78,,293.28,percent of total billed charges,78% of total billed charges,13.36,100,,,fee schedule,100% of CMS fee schedule,16.79,100,,,fee schedule,100% of GA fee schedule,13.36,100,,,fee schedule,100% of CMS 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,16.79,100,,,fee schedule,100% of GA fee schedule,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.42,93,,,fee schedule,93% of CMS fee schedule,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,13.36,100,,,fee schedule,100% of CMS fee schedule,13.36,100,,,fee schedule,100% of CMS fee schedule,12.42,450,
DOG DANDER ALLERGEN,300008999,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
YELLOW HORNET AG,300009006,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WHITE HORNET AG,300009007,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WASP AG,300009008,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
YELLOW JACKET AG,300009009,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HONEY BEE AG,300009010,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MAIZE ALLERGEN,300009011,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
APPLE ALLERGEN,300009012,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
C HERBARUM ALLERGEN,300009013,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COMMON RAGWEED,300009014,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PLANTAIN ENGLISH ALLERGEN,300009015,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BAHAI GRASS,300009016,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ASPERGILLUS FLAVUS IGE,300009017,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HELMINTHOSPORIUM HALO AG,300009018,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BOX ELDER ALLERGEN,300009019,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ELM ALLERGEN,300009020,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COTTON WOOD ALLERGEN,300009021,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
LAMBS QUARTER ALLERGEN,300009022,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COMMON PIGWEED ALLERGEN,300009023,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PULLULANS ALLERGEN,300009024,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PHOMA ALLERGEN,300009025,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
TIMOTHY GRASS ALLERGEN,300009027,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SYCAMORE TREES ALLERGEN,300009028,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PTERONYSSINUS,300009029,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
JOHNSON GRASS ALLERGEN,300009030,CDM,305,RC,86003,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SHEEP SORREL ALLERGEN,300009031,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CEDAR TREES ALLERGEN,300009032,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BIRCH TREE ALLERGEN,300009033,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ANTITHROMBIN PANEL,300009040,CDM,305,RC,85300,HCPCS,outpatient,,,252,176.4,,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,226.8,90,,181.44,percent of total billed charges,90% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,18.96,160,,,fee schedule,160% of CMS fee schedule,15.41,130,,,fee schedule,130% of CMS fee schedule,14.9,100,,,fee schedule,100% of GA fee schedule,194.59,77.22,,155.67,percent of total billed charges,77.22% of total billed charges,15.65,105,,,fee schedule,105% of GA fee schedule,209.16,83,,167.33,percent of total billed charges,83% of total,239.4,95,,191.52,percent of total billed charges ,95% of total billed charges,201.6,80,,161.28,percent of total billed charges,78% of total billed charges,196.56,78,,157.248,percent of total billed charges,78% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,14.9,100,,,fee schedule,100% of GA fee schedule,11.85,100,,,fee schedule,100% of CMS 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,14.9,100,,,fee schedule,100% of GA fee schedule,214.2,85,,171.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.02,93,,,fee schedule,93% of CMS fee schedule,199.08,79,,159.26,percent of total billed charges,79% of total billed charges,11.85,100,,,fee schedule,100% of CMS fee schedule,11.85,100,,,fee schedule,100% of CMS fee schedule,11.02,450,
ALPHA 2 ANTIPLASMIN ACTIVITY,300009041,CDM,305,RC,85410,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,7.71,100,,,fee schedule,100% of CMS fee schedule,12.34,160,,,fee schedule,160% of CMS fee schedule,10.02,130,,,fee schedule,130% of CMS fee schedule,9.69,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,10.17,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,7.71,100,,,fee schedule,100% of CMS fee schedule,9.69,100,,,fee schedule,100% of GA fee schedule,7.71,100,,,fee schedule,100% of CMS 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,9.69,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.17,93,,,fee schedule,93% of CMS fee schedule,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,7.71,100,,,fee schedule,100% of CMS fee schedule,7.71,100,,,fee schedule,100% of CMS fee schedule,7.17,450,
"PROTEIN S FREE, ANTIGEN",300009042,CDM,305,RC,85306,HCPCS,outpatient,,,143,100.1,,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,24.51,160,,,fee schedule,160% of CMS fee schedule,19.92,130,,,fee schedule,130% of CMS fee schedule,19.27,100,,,fee schedule,100% of GA fee schedule,110.42,77.22,,88.34,percent of total billed charges,77.22% of total billed charges,20.23,105,,,fee schedule,105% of GA fee schedule,118.69,83,,94.95,percent of total billed charges,83% of total,135.85,95,,108.68,percent of total billed charges ,95% of total billed charges,114.4,80,,91.52,percent of total billed charges,78% of total billed charges,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,19.27,100,,,fee schedule,100% of GA fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,19.27,100,,,fee schedule,100% of GA fee schedule,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.25,93,,,fee schedule,93% of CMS fee schedule,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,15.32,100,,,fee schedule,100% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,14.25,450,
ASPERGILLUS NIGER IGE,300009046,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ASPERGILLUS NIGER IGG,300009047,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ASPERGILLUS FUMIGATUS IGG,300009048,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ASPERGILLUS FUMIGATUS IGE,300009049,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SQUID ALLERGEN,300009087,CDM,305,RC,86003,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,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,6.57,100,,,fee schedule,100% of GA fee schedule,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BARLEY ALLERGN,300009088,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
FACTOR XII,300009096,CDM,305,RC,85280,HCPCS,outpatient,,,174,121.8,,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,156.6,90,,125.28,percent of total billed charges,90% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,30.96,160,,,fee schedule,160% of CMS fee schedule,25.16,130,,,fee schedule,130% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,134.36,77.22,,107.49,percent of total billed charges,77.22% of total billed charges,25.56,105,,,fee schedule,105% of GA fee schedule,144.42,83,,115.54,percent of total billed charges,83% of total,165.3,95,,132.24,percent of total billed charges ,95% of total billed charges,139.2,80,,111.36,percent of total billed charges,78% of total billed charges,135.72,78,,108.576,percent of total billed charges,78% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,24.34,100,,,fee schedule,100% of GA fee schedule,19.35,100,,,fee schedule,100% of CMS 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,24.34,100,,,fee schedule,100% of GA fee schedule,147.9,85,,118.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18,93,,,fee schedule,93% of CMS fee schedule,137.46,79,,109.97,percent of total billed charges,79% of total billed charges,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,18,450,
DEER ALLEGERN,300009140,CDM,305,RC,86003,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COW ALLERGEN,300009150,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HAZEL NUT ALLERGEN,300009161,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEACH ALLERGEN,300009165,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HEPARIN ACTIVITY ANTI XA,300009176,CDM,305,RC,85520,HCPCS,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,13.09,100,,,fee schedule,100% of CMS fee schedule,20.94,160,,,fee schedule,160% of CMS fee schedule,17.02,130,,,fee schedule,130% of CMS fee schedule,16.46,100,,,fee schedule,100% of GA fee schedule,328.19,77.22,,262.55,percent of total billed charges,77.22% of total billed charges,17.28,105,,,fee schedule,105% of GA fee schedule,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,13.09,100,,,fee schedule,100% of CMS fee schedule,16.46,100,,,fee schedule,100% of GA fee schedule,13.09,100,,,fee schedule,100% of CMS fee schedule,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,16.46,100,,,fee schedule,100% of GA fee schedule,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.17,93,,,fee schedule,93% of CMS fee schedule,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,13.09,100,,,fee schedule,100% of CMS fee schedule,13.09,100,,,fee schedule,100% of CMS fee schedule,12.17,450,
COUMADIN CLINIC INR,300009181,CDM,305,RC,85610,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,6.86,160,,,fee schedule,160% of CMS fee schedule,5.58,130,,,fee schedule,130% of CMS fee schedule,4.94,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,5.19,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,4.94,100,,,fee schedule,100% of GA fee schedule,4.29,100,,,fee schedule,100% of CMS 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,4.94,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.99,93,,,fee schedule,93% of CMS fee schedule,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,4.29,100,,,fee schedule,100% of CMS fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,3.99,450,
WATY ALLERGEN,300009189,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CHICKEN ALLERGEN,300009204,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CHOCOLATE ALLERGEN,300009205,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
GARLIC ALLERGEN,300009206,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
OAT ALLERGEN,300009207,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PORK ALLERGEN,300009208,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
TOMATO ALLERGEN,300009209,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PEPPER BLACK ALLERGEN,300009210,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ONION ALLERGEN,300009211,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
LEMON ALLERGEN,300009212,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
VANILLA ALLERGEN,300009213,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COFFEE ALLERGEN,300009214,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CINNAMON ALLERGEN,300009215,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
TRYPTASE,300009216,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COCKELBUR AG,300009237,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
GOLDEN ROD AG,300009238,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
RYE GRASS AG,300009239,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
SWEET GUM AG,300009240,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PINE AG,300009241,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
OAT CULTIVATED AG,300009242,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WHEAT CULTIVATED AG,300009243,CDM,305,RC,86003,HCPCS,outpatient,,,14,9.8,,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,12.6,90,,10.08,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,10.81,77.22,,8.65,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,11.62,83,,9.3,percent of total billed charges,83% of total,13.3,95,,10.64,percent of total billed charges ,95% of total billed charges,11.2,80,,8.96,percent of total billed charges,78% of total billed charges,10.92,78,,8.736,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,11.9,85,,9.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,11.06,79,,8.85,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
KENTUCKY BLUE GRASS,300009244,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ORCHARD GRASS ALLERGEN,300009245,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ALMOND ALLERGEN,300009246,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COCKROACH ALLERGEN,300009247,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MARSH ELDER,300009251,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PINTO ALLERGEN,300009279,CDM,305,RC,86003,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MOSQUITO ALLERGEN,300009283,CDM,305,RC,86003,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MACADAMIA ALLERGEN,300009800,CDM,305,RC,86003,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HORMODENDRUM CLADOSPORIUM,300040914,CDM,305,RC,86003,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WHITE PINE ALLERGEN,300040915,CDM,305,RC,86003,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CANDIDA ALBICANS AG,300040916,CDM,305,RC,86003,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MEADOW FESCUE AG,300040917,CDM,305,RC,86003,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BERMUDA GRASS ALLERGEN,300040918,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
A ALTERNATE ALLERGEN,300040919,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
OAK ALLERGEN,300040920,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PENICILLIUM NATATUM ALLERGEN,300040921,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CAT DANDER ALLERGEN,300040922,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
EGG YOLK ALLERGEN,300040923,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HOUSEDUST MITES ALLERGEN,300040924,CDM,305,RC,86003,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,6.57,100,,,fee schedule,100% of GA fee schedule,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
CASHEW ALLERGEN,300040951,CDM,305,RC,86003,HCPCS,outpatient,,,40,28,,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,36,90,,28.8,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,30.89,77.22,,24.71,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,33.2,83,,26.56,percent of total billed charges,83% of total,38,95,,30.4,percent of total billed charges ,95% of total billed charges,32,80,,25.6,percent of total billed charges,78% of total billed charges,31.2,78,,24.96,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,34,85,,27.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,31.6,79,,25.28,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PTT MIXING,300085730,CDM,305,RC,85730,HCPCS,outpatient,,,156,109.2,,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,9.62,160,,,fee schedule,160% of CMS fee schedule,7.81,130,,,fee schedule,130% of CMS fee schedule,7.54,100,,,fee schedule,100% of GA fee schedule,120.46,77.22,,96.37,percent of total billed charges,77.22% of total billed charges,7.92,105,,,fee schedule,105% of GA fee schedule,129.48,83,,103.58,percent of total billed charges,83% of total,148.2,95,,118.56,percent of total billed charges ,95% of total billed charges,124.8,80,,99.84,percent of total billed charges,78% of total billed charges,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,7.54,100,,,fee schedule,100% of GA fee schedule,6.01,100,,,fee schedule,100% of CMS 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,7.54,100,,,fee schedule,100% of GA fee schedule,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.59,93,,,fee schedule,93% of CMS fee schedule,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,6.01,100,,,fee schedule,100% of CMS fee schedule,6.01,100,,,fee schedule,100% of CMS fee schedule,5.59,450,
SPINACH ALLERGEN,300086003,CDM,305,RC,86003,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
TEA ALLERGEN,300086004,CDM,305,RC,86003,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
GREEN BEAN ALLERGAN,300086005,CDM,305,RC,86003,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
DRVVT SCREEN,300087215,CDM,305,RC,85613,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,9.58,100,,,fee schedule,100% of CMS fee schedule,15.33,160,,,fee schedule,160% of CMS fee schedule,12.45,130,,,fee schedule,130% of CMS fee schedule,12.03,100,,,fee schedule,100% of GA fee schedule,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,12.63,105,,,fee schedule,105% of GA fee schedule,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,9.58,100,,,fee schedule,100% of CMS fee schedule,12.03,100,,,fee schedule,100% of GA fee schedule,9.58,100,,,fee schedule,100% of CMS 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,12.03,100,,,fee schedule,100% of GA fee schedule,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.91,93,,,fee schedule,93% of CMS fee schedule,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,9.58,100,,,fee schedule,100% of CMS fee schedule,9.58,100,,,fee schedule,100% of CMS fee schedule,8.91,450,
CLADOSPORIUM AG CHILD,300186003,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
RHC HCT SPUN MICROHEMATOCRIT,300800335,CDM,305,RC,85013,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,7,100,,,fee schedule,100% of CMS fee schedule,11.2,160,,,fee schedule,160% of CMS fee schedule,9.1,130,,,fee schedule,130% of CMS fee schedule,2.98,100,,,fee schedule,100% of GA fee schedule,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,3.13,105,,,fee schedule,105% of GA fee schedule,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,7,100,,,fee schedule,100% of CMS fee schedule,2.98,100,,,fee schedule,100% of GA fee schedule,7,100,,,fee schedule,100% of CMS 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,2.98,100,,,fee schedule,100% of GA fee schedule,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.51,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,7,100,,,fee schedule,100% of CMS fee schedule,7,100,,,fee schedule,100% of CMS fee schedule,2.98,450,
CRAYFISH ALLERGEN,301086003,CDM,305,RC,86003,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WHITE MULBERRY AG,305008603,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
WHITE HICKORY ALLERGEN,305018603,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
HEXAGONAL PHASE PHOSPHOLIPID,305085598,CDM,305,RC,85598,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,28.77,160,,,fee schedule,160% of CMS fee schedule,23.37,130,,,fee schedule,130% of CMS fee schedule,20.24,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,21.25,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,20.24,100,,,fee schedule,100% of GA fee schedule,17.98,100,,,fee schedule,100% of CMS 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,20.24,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.72,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,17.98,100,,,fee schedule,100% of CMS fee schedule,17.98,100,,,fee schedule,100% of CMS fee schedule,16.72,450,
MUGWORT ALLERGEN,305086003,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
TUNA ALLERGEN,305186003,CDM,305,RC,86003,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
TURKEY ALLERGEN,305286003,CDM,305,RC,86003,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
FLOUNDER ALLERGEN,305386003,CDM,305,RC,86003,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
BRAZIL NUT ALLERGEN,305486003,CDM,305,RC,86003,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
PISTACHIO ALLERGEN,305586003,CDM,305,RC,86003,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
MOUSE URINE ALLERGEN,305686003,CDM,305,RC,86003,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
COMMON REED ALLERGEN,305786003,CDM,305,RC,86003,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
ALFALFA ALLERGEN,305986003,CDM,305,RC,86003,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,8.35,160,,,fee schedule,160% of CMS fee schedule,6.79,130,,,fee schedule,130% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,6.9,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,6.57,100,,,fee schedule,100% of GA fee schedule,5.22,100,,,fee schedule,100% of CMS 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,6.57,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.85,93,,,fee schedule,93% of CMS fee schedule,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,4.85,450,
GROUP B STREP TEST,300000171,CDM,306,RC,87802,HCPCS,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,12.73,100,,,fee schedule,100% of CMS fee schedule,20.37,160,,,fee schedule,160% of CMS fee schedule,16.55,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,12.73,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,12.73,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.84,93,,,fee schedule,93% of CMS fee schedule,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,12.73,100,,,fee schedule,100% of CMS fee schedule,12.73,100,,,fee schedule,100% of CMS fee schedule,11.84,450,
STREP SCREEN,300000217,CDM,306,RC,87880,HCPCS,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,26.45,160,,,fee schedule,160% of CMS fee schedule,21.49,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16.53,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.37,93,,,fee schedule,93% of CMS fee schedule,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,16.53,100,,,fee schedule,100% of CMS fee schedule,15.08,450,
HEPATITIS B SURFACE ANTIGEN,300000384,CDM,306,RC,87340,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,16.53,160,,,fee schedule,160% of CMS fee schedule,13.43,130,,,fee schedule,130% of CMS fee schedule,12.99,100,,,fee schedule,100% of GA fee schedule,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,13.64,105,,,fee schedule,105% of GA fee schedule,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,12.99,100,,,fee schedule,100% of GA fee schedule,10.33,100,,,fee schedule,100% of CMS 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,12.99,100,,,fee schedule,100% of GA fee schedule,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.61,93,,,fee schedule,93% of CMS fee schedule,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,9.61,450,
CRYPTOCOCCAL ANTIGEN,300000561,CDM,306,RC,87327,HCPCS,outpatient,,,79,55.3,,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,21.47,160,,,fee schedule,160% of CMS fee schedule,17.45,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,61,77.22,,48.8,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,65.57,83,,52.46,percent of total billed charges,83% of total,75.05,95,,60.04,percent of total billed charges ,95% of total billed charges,63.2,80,,50.56,percent of total billed charges,78% of total billed charges,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.42,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.48,93,,,fee schedule,93% of CMS fee schedule,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,13.42,100,,,fee schedule,100% of CMS fee schedule,13.42,100,,,fee schedule,100% of CMS fee schedule,12.48,450,
HEPATITIS C RNA(DNA-PCR) QUANT,300003160,CDM,306,RC,87522,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS 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,53.87,100,,,fee schedule,100% of GA fee schedule,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
INFECTIOUS AGENT ANTIGEN,300007486,CDM,306,RC,87486,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
INFECTIOUS AGENT ANTIGEN,300007581,CDM,306,RC,87581,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
SARS,300007633,CDM,306,RC,87633,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,666.85,160,,,fee schedule,160% of CMS fee schedule,541.81,130,,,fee schedule,130% of CMS fee schedule,193.9,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,203.6,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,193.9,100,,,fee schedule,100% of GA fee schedule,416.78,100,,,fee schedule,100% of CMS 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,193.9,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,387.61,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,193.05,666.85,
AMPLIFIED PROBE,300007798,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
H-PYLOR STOOL ANTIGEN,300008062,CDM,306,RC,87449,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
GC/CHLAMYDIA DNA PROBE,300008068,CDM,306,RC,87590,HCPCS,outpatient,,,102,71.4,,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,26.88,100,,,fee schedule,100% of CMS fee schedule,43.01,160,,,fee schedule,160% of CMS fee schedule,34.94,130,,,fee schedule,130% of CMS fee schedule,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,78.76,77.22,,63.01,percent of total billed charges,77.22% of total billed charges,67.42,66.1,,53.94,percent of total billed charges,66.1% of total billed charges,84.66,83,,67.73,percent of total billed charges,83% of total,96.9,95,,77.52,percent of total billed charges ,95% of total billed charges,81.6,80,,65.28,percent of total billed charges,78% of total billed charges,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,26.88,100,,,fee schedule,100% of CMS fee schedule,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,26.88,100,,,fee schedule,100% of CMS 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,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25,93,,,fee schedule,93% of CMS fee schedule,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,26.88,100,,,fee schedule,100% of CMS fee schedule,26.88,100,,,fee schedule,100% of CMS fee schedule,25,450,
GROUP B BY PCR AMP PROBE TECH,300008080,CDM,306,RC,87150,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,35.09,100,,,fee schedule,100% of CMS 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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,32.63,450,
CRYSTOSPORIDIUM ANTIGEN BY EIA,300008085,CDM,306,RC,87328,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,22.11,160,,,fee schedule,160% of CMS fee schedule,17.97,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.82,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.85,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,13.82,100,,,fee schedule,100% of CMS fee schedule,12.85,450,
HEPATITIS BE ANTIBODY,300008252,CDM,306,RC,87350,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,18.45,160,,,fee schedule,160% of CMS fee schedule,14.99,130,,,fee schedule,130% of CMS fee schedule,14.49,100,,,fee schedule,100% of GA fee schedule,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,15.21,105,,,fee schedule,105% of GA fee schedule,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,14.49,100,,,fee schedule,100% of GA fee schedule,11.53,100,,,fee schedule,100% of CMS 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,14.49,100,,,fee schedule,100% of GA fee schedule,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.72,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,10.72,450,
"HIV RNA,PCR QUANT",300008346,CDM,306,RC,87536,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,136.16,160,,,fee schedule,160% of CMS fee schedule,110.63,130,,,fee schedule,130% of CMS fee schedule,56.5,100,,,fee schedule,100% of GA fee schedule,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,59.33,105,,,fee schedule,105% of GA fee schedule,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,56.5,100,,,fee schedule,100% of GA fee schedule,85.1,100,,,fee schedule,100% of CMS 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,56.5,100,,,fee schedule,100% of GA fee schedule,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,79.14,93,,,fee schedule,93% of CMS fee schedule,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,85.1,100,,,fee schedule,100% of CMS fee schedule,85.1,100,,,fee schedule,100% of CMS fee schedule,56.5,450,
HEPATITIS C RNA QUAL,300008351,CDM,306,RC,87521,HCPCS,outpatient,,,602,421.4,,475.58,79,,380.46,percent of total billed charges,79% of total billed charges,541.8,90,,433.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,464.86,77.22,,371.89,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,499.66,83,,399.73,percent of total billed charges,83% of total,571.9,95,,457.52,percent of total billed charges ,95% of total billed charges,481.6,80,,385.28,percent of total billed charges,78% of total billed charges,469.56,78,,375.648,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,541.8,90,,433.44,percent of total billed charges,90% of total billed charges,481.6,80,,385.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,511.7,85,,409.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,475.58,79,,380.46,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,571.9,
HIV DNA (PCR) QUAL,300008356,CDM,306,RC,87390,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,24.06,100,,,fee schedule,100% of CMS fee schedule,38.5,160,,,fee schedule,160% of CMS fee schedule,31.28,130,,,fee schedule,130% of CMS fee schedule,19.25,100,,,fee schedule,100% of GA fee schedule,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,20.21,105,,,fee schedule,105% of GA fee schedule,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,24.06,100,,,fee schedule,100% of CMS fee schedule,19.25,100,,,fee schedule,100% of GA fee schedule,24.06,100,,,fee schedule,100% of CMS 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,19.25,100,,,fee schedule,100% of GA fee schedule,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.38,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,24.06,100,,,fee schedule,100% of CMS fee schedule,24.06,100,,,fee schedule,100% of CMS fee schedule,19.25,450,
"EBSTEIN BARR,PCR",300008363,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
NOT OTHER WISE SPECIFIC AMP PR,300008364,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
"CYTOMEGALOVIRUS,DIRECT PROBE",300008366,CDM,306,RC,87495,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,30.03,100,,,fee schedule,100% of CMS fee schedule,48.05,160,,,fee schedule,160% of CMS fee schedule,39.04,130,,,fee schedule,130% of CMS fee schedule,24.8,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,26.04,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,30.03,100,,,fee schedule,100% of CMS fee schedule,24.8,100,,,fee schedule,100% of GA fee schedule,30.03,100,,,fee schedule,100% of CMS 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,24.8,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.93,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,30.03,100,,,fee schedule,100% of CMS fee schedule,30.03,100,,,fee schedule,100% of CMS fee schedule,24.8,450,
"CYTOMEGALOVIRUS,AMPLIFIED PROB",300008367,CDM,306,RC,87496,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
"CMV,PCR COMPONENT",300008368,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
MYCOPLASMA BY DNA/PCR,300008407,CDM,306,RC,87581,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,197.5,79,,158,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
"HCV,GENOTYPING",300008408,CDM,306,RC,87902,HCPCS,outpatient,,,661,462.7,,522.19,79,,417.75,percent of total billed charges,79% of total billed charges,594.9,90,,475.92,percent of total billed charges,90% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,411.92,160,,,fee schedule,160% of CMS fee schedule,334.69,130,,,fee schedule,130% of CMS fee schedule,109.67,100,,,fee schedule,100% of GA fee schedule,510.42,77.22,,408.34,percent of total billed charges,77.22% of total billed charges,115.15,105,,,fee schedule,105% of GA fee schedule,548.63,83,,438.9,percent of total billed charges,83% of total,627.95,95,,502.36,percent of total billed charges ,95% of total billed charges,528.8,80,,423.04,percent of total billed charges,78% of total billed charges,515.58,78,,412.464,percent of total billed charges,78% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,109.67,100,,,fee schedule,100% of GA fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,594.9,90,,475.92,percent of total billed charges,90% of total billed charges,528.8,80,,423.04,percent of total billed charges,80% of total billed charges,109.67,100,,,fee schedule,100% of GA fee schedule,561.85,85,,449.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,239.43,93,,,fee schedule,93% of CMS fee schedule,522.19,79,,417.75,percent of total billed charges,79% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,109.67,627.95,
HISTOPLASMA ANTIGEN,300008480,CDM,306,RC,87385,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,15.08,100,,,fee schedule,100% of GA fee schedule,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
TOXIN A,300008484,CDM,306,RC,87449,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
C DIFFICILE ANTIGEN,300008485,CDM,306,RC,87324,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
HEPATITIS B VIRAL DNA(QUANT),300008504,CDM,306,RC,87517,HCPCS,outpatient,,,435,304.5,,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,335.91,77.22,,268.73,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,361.05,83,,288.84,percent of total billed charges,83% of total,413.25,95,,330.6,percent of total billed charges ,95% of total billed charges,348,80,,278.4,percent of total billed charges,78% of total billed charges,339.3,78,,271.44,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,348,80,,278.4,percent of total billed charges,80% of total billed charges,53.87,100,,,fee schedule,100% of GA fee schedule,369.75,85,,295.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
HERPES SIMPLEX VIRUS BY PCR AR,300008562,CDM,306,RC,87529,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
C DIFFICLE TOXIN PCR,300008565,CDM,306,RC,87493,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,59.63,160,,,fee schedule,160% of CMS fee schedule,48.45,130,,,fee schedule,130% of CMS fee schedule,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,109.73,66.1,,87.78,percent of total billed charges,66.1% of total billed charges,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,37.27,100,,,fee schedule,100% of CMS 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,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,34.66,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,37.27,100,,,fee schedule,100% of CMS fee schedule,34.66,450,
CRYTOCOCCUS ANTIGEN,300008589,CDM,306,RC,87449,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
INFLUENZA,300008593,CDM,306,RC,87804,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,26.48,160,,,fee schedule,160% of CMS fee schedule,21.52,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16.55,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.39,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,450,
"ENTAMOEBA ANTIGEN,EIA",300008646,CDM,306,RC,87337,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
GIARDIA EIA,300008678,CDM,306,RC,87328,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,22.11,160,,,fee schedule,160% of CMS fee schedule,17.97,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.82,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.85,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,13.82,100,,,fee schedule,100% of CMS fee schedule,12.85,450,
GIARDIA LAMBLIA,300008679,CDM,306,RC,87329,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
ENTAMOEBA HISTOLYTICAL,300008680,CDM,306,RC,87336,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,16,100,,,fee schedule,100% of CMS fee schedule,25.6,160,,,fee schedule,160% of CMS fee schedule,20.8,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,16,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.88,93,,,fee schedule,93% of CMS fee schedule,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,16,100,,,fee schedule,100% of CMS fee schedule,16,100,,,fee schedule,100% of CMS fee schedule,14.88,450,
CRYPTOSPORIDIUM PARVIAN,300008681,CDM,306,RC,87328,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,22.11,160,,,fee schedule,160% of CMS fee schedule,17.97,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.82,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.85,93,,,fee schedule,93% of CMS fee schedule,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,13.82,100,,,fee schedule,100% of CMS fee schedule,13.82,100,,,fee schedule,100% of CMS fee schedule,12.85,450,
"ENTEROVIRUS DNA,PCR",300008736,CDM,306,RC,87498,HCPCS,outpatient,,,192,134.4,,151.68,79,,121.34,percent of total billed charges,79% of total billed charges,172.8,90,,138.24,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,148.26,77.22,,118.61,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,159.36,83,,127.49,percent of total billed charges,83% of total,182.4,95,,145.92,percent of total billed charges ,95% of total billed charges,153.6,80,,122.88,percent of total billed charges,78% of total billed charges,149.76,78,,119.808,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,163.2,85,,130.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,151.68,79,,121.34,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
C TRACHOMATIS,300008770,CDM,306,RC,87491,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
N GONORRHEA,300008771,CDM,306,RC,87591,HCPCS,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,22.49,105,,,fee schedule,105% of GA fee schedule,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,21.42,100,,,fee schedule,100% of GA fee schedule,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,21.42,450,
HEPATITIS B SURFACE AG,300008773,CDM,306,RC,87340,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,16.53,160,,,fee schedule,160% of CMS fee schedule,13.43,130,,,fee schedule,130% of CMS fee schedule,12.99,100,,,fee schedule,100% of GA fee schedule,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,13.64,105,,,fee schedule,105% of GA fee schedule,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,12.99,100,,,fee schedule,100% of GA fee schedule,10.33,100,,,fee schedule,100% of CMS 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,12.99,100,,,fee schedule,100% of GA fee schedule,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.61,93,,,fee schedule,93% of CMS fee schedule,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,9.61,450,
HERPES VIRUS 6 IgG,300008795,CDM,306,RC,87533,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,41.76,100,,,fee schedule,100% of CMS fee schedule,66.82,160,,,fee schedule,160% of CMS fee schedule,54.29,130,,,fee schedule,130% of CMS fee schedule,52.5,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,55.13,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,41.76,100,,,fee schedule,100% of CMS fee schedule,52.5,100,,,fee schedule,100% of GA fee schedule,41.76,100,,,fee schedule,100% of CMS 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,52.5,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,38.84,93,,,fee schedule,93% of CMS fee schedule,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,41.76,100,,,fee schedule,100% of CMS fee schedule,41.76,100,,,fee schedule,100% of CMS fee schedule,38.84,450,
HBsAG CONFIRMATION,300008842,CDM,306,RC,87341,HCPCS,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,16.53,160,,,fee schedule,160% of CMS fee schedule,13.43,130,,,fee schedule,130% of CMS fee schedule,12.99,100,,,fee schedule,100% of GA fee schedule,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,13.64,105,,,fee schedule,105% of GA fee schedule,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,12.99,100,,,fee schedule,100% of GA fee schedule,10.33,100,,,fee schedule,100% of CMS 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,12.99,100,,,fee schedule,100% of GA fee schedule,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.61,93,,,fee schedule,93% of CMS fee schedule,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,10.33,100,,,fee schedule,100% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,9.61,450,
HEP C VIRUS RNA-QUANT REAL TM,300008860,CDM,306,RC,87522,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS 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,53.87,100,,,fee schedule,100% of GA fee schedule,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
HEP B VIRUS RNA-QUANT REAL TM,300008863,CDM,306,RC,87517,HCPCS,outpatient,,,435,304.5,,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,335.91,77.22,,268.73,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,361.05,83,,288.84,percent of total billed charges,83% of total,413.25,95,,330.6,percent of total billed charges ,95% of total billed charges,348,80,,278.4,percent of total billed charges,78% of total billed charges,339.3,78,,271.44,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,348,80,,278.4,percent of total billed charges,80% of total billed charges,53.87,100,,,fee schedule,100% of GA fee schedule,369.75,85,,295.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
HEPATITIS C RNA b DNA,300008881,CDM,306,RC,87522,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS 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,53.87,100,,,fee schedule,100% of GA fee schedule,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
INFLUENZA A,300008882,CDM,306,RC,87804,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,26.48,160,,,fee schedule,160% of CMS fee schedule,21.52,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16.55,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.39,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,450,
INFLUENZA B,300008883,CDM,306,RC,87804,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,26.48,160,,,fee schedule,160% of CMS fee schedule,21.52,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16.55,100,,,fee schedule,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.39,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,450,
EBVQU,300008964,CDM,306,RC,87799,HCPCS,outpatient,,,480,336,,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,432,90,,345.6,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,370.66,77.22,,296.53,percent of total billed charges,77.22% of total billed charges,317.28,66.1,,253.82,percent of total billed charges,66.1% of total billed charges,398.4,83,,318.72,percent of total billed charges,83% of total,456,95,,364.8,percent of total billed charges ,95% of total billed charges,384,80,,307.2,percent of total billed charges,78% of total billed charges,374.4,78,,299.52,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,42.84,100,,,fee schedule,100% of CMS 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,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,408,85,,326.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,456,
CMVQU,300008965,CDM,306,RC,87497,HCPCS,outpatient,,,313,219.1,,247.27,79,,197.82,percent of total billed charges,79% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,241.7,77.22,,193.36,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,259.79,83,,207.83,percent of total billed charges,83% of total,297.35,95,,237.88,percent of total billed charges ,95% of total billed charges,250.4,80,,200.32,percent of total billed charges,78% of total billed charges,244.14,78,,195.312,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS 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,53.87,100,,,fee schedule,100% of GA fee schedule,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,247.27,79,,197.82,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
HBV GENOTYPE,300009063,CDM,306,RC,87912,HCPCS,outpatient,,,668,467.6,,527.72,79,,422.18,percent of total billed charges,79% of total billed charges,601.2,90,,480.96,percent of total billed charges,90% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,411.92,160,,,fee schedule,160% of CMS fee schedule,334.69,130,,,fee schedule,130% of CMS fee schedule,95.9,100,,,fee schedule,100% of GA fee schedule,515.83,77.22,,412.66,percent of total billed charges,77.22% of total billed charges,100.7,105,,,fee schedule,105% of GA fee schedule,554.44,83,,443.55,percent of total billed charges,83% of total,634.6,95,,507.68,percent of total billed charges ,95% of total billed charges,534.4,80,,427.52,percent of total billed charges,78% of total billed charges,521.04,78,,416.832,percent of total billed charges,78% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,95.9,100,,,fee schedule,100% of GA fee schedule,257.45,100,,,fee schedule,100% of CMS 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,95.9,100,,,fee schedule,100% of GA fee schedule,567.8,85,,454.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,239.43,93,,,fee schedule,93% of CMS fee schedule,527.72,79,,422.18,percent of total billed charges,79% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,95.9,634.6,
HISTOPLASMA ANTIGEN UR,300009064,CDM,306,RC,87385,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,21.2,160,,,fee schedule,160% of CMS fee schedule,17.23,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,15.08,100,,,fee schedule,100% of GA fee schedule,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.32,93,,,fee schedule,93% of CMS fee schedule,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,12.32,450,
HEPCRNARTR,300009076,CDM,306,RC,87522,HCPCS,outpatient,,,157,109.9,,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,141.3,90,,113.04,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,121.24,77.22,,96.99,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,130.31,83,,104.25,percent of total billed charges,83% of total,149.15,95,,119.32,percent of total billed charges ,95% of total billed charges,125.6,80,,100.48,percent of total billed charges,78% of total billed charges,122.46,78,,97.968,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS 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,53.87,100,,,fee schedule,100% of GA fee schedule,133.45,85,,106.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,124.03,79,,99.22,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
LEGIONELLA PNEU ANTIGEN UR,300009112,CDM,306,RC,87449,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
STREP PNEUMONIA URINE,300009113,CDM,306,RC,87899,HCPCS,outpatient,,,153,107.1,,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,25.71,160,,,fee schedule,160% of CMS fee schedule,20.89,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,118.15,77.22,,94.52,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,126.99,83,,101.59,percent of total billed charges,83% of total,145.35,95,,116.28,percent of total billed charges ,95% of total billed charges,122.4,80,,97.92,percent of total billed charges,78% of total billed charges,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.95,93,,,fee schedule,93% of CMS fee schedule,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,16.07,100,,,fee schedule,100% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,14.95,450,
LYME PCR,300009151,CDM,306,RC,87476,HCPCS,outpatient,,,271,189.7,,214.09,79,,171.27,percent of total billed charges,79% of total billed charges,243.9,90,,195.12,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,209.27,77.22,,167.42,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,224.93,83,,179.94,percent of total billed charges,83% of total,257.45,95,,205.96,percent of total billed charges ,95% of total billed charges,216.8,80,,173.44,percent of total billed charges,78% of total billed charges,211.38,78,,169.104,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,230.35,85,,184.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,214.09,79,,171.27,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
CLOSTRIDIUM TOXIN A/B,300009170,CDM,306,RC,87493,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,59.63,160,,,fee schedule,160% of CMS fee schedule,48.45,130,,,fee schedule,130% of CMS fee schedule,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,109.73,66.1,,87.78,percent of total billed charges,66.1% of total billed charges,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,37.27,100,,,fee schedule,100% of CMS 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,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,34.66,93,,,fee schedule,93% of CMS fee schedule,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,37.27,100,,,fee schedule,100% of CMS fee schedule,37.27,100,,,fee schedule,100% of CMS fee schedule,34.66,450,
BK POLYOMA VIRUS UA,300009178,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
BK POLYOMA VIRUS WB,300009179,CDM,306,RC,87799,HCPCS,outpatient,,,480,336,,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,432,90,,345.6,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,370.66,77.22,,296.53,percent of total billed charges,77.22% of total billed charges,317.28,66.1,,253.82,percent of total billed charges,66.1% of total billed charges,398.4,83,,318.72,percent of total billed charges,83% of total,456,95,,364.8,percent of total billed charges ,95% of total billed charges,384,80,,307.2,percent of total billed charges,78% of total billed charges,374.4,78,,299.52,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,42.84,100,,,fee schedule,100% of CMS 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,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,408,85,,326.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,456,
PHENOSENSE INTEGRASE INHIBITOR,300009199,CDM,306,RC,87903,HCPCS,outpatient,,,1820,1274,,1437.8,79,,1150.24,percent of total billed charges,79% of total billed charges,1638,90,,1310.4,percent of total billed charges,90% of total billed charges,488.66,100,,,fee schedule,100% of CMS fee schedule,781.86,160,,,fee schedule,160% of CMS fee schedule,635.26,130,,,fee schedule,130% of CMS fee schedule,425.3,100,,,fee schedule,100% of GA fee schedule,1405.4,77.22,,1124.32,percent of total billed charges,77.22% of total billed charges,446.57,105,,,fee schedule,105% of GA fee schedule,1510.6,83,,1208.48,percent of total billed charges,83% of total,1729,95,,1383.2,percent of total billed charges ,95% of total billed charges,1456,80,,1164.8,percent of total billed charges,78% of total billed charges,1419.6,78,,1135.68,percent of total billed charges,78% of total billed charges,488.66,100,,,fee schedule,100% of CMS fee schedule,425.3,100,,,fee schedule,100% of GA fee schedule,488.66,100,,,fee schedule,100% of CMS fee schedule,1638,90,,1310.4,percent of total billed charges,90% of total billed charges,1456,80,,1164.8,percent of total billed charges,80% of total billed charges,425.3,100,,,fee schedule,100% of GA fee schedule,1547,85,,1237.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,454.45,93,,,fee schedule,93% of CMS fee schedule,1437.8,79,,1150.24,percent of total billed charges,79% of total billed charges,488.66,100,,,fee schedule,100% of CMS fee schedule,488.66,100,,,fee schedule,100% of CMS fee schedule,425.3,1729,
HIV 1 GENOTYPING,300009200,CDM,306,RC,87901,HCPCS,outpatient,,,245,171.5,,193.55,79,,154.84,percent of total billed charges,79% of total billed charges,220.5,90,,176.4,percent of total billed charges,90% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,411.92,160,,,fee schedule,160% of CMS fee schedule,334.69,130,,,fee schedule,130% of CMS fee schedule,109.67,100,,,fee schedule,100% of GA fee schedule,189.19,77.22,,151.35,percent of total billed charges,77.22% of total billed charges,115.15,105,,,fee schedule,105% of GA fee schedule,203.35,83,,162.68,percent of total billed charges,83% of total,232.75,95,,186.2,percent of total billed charges ,95% of total billed charges,196,80,,156.8,percent of total billed charges,78% of total billed charges,191.1,78,,152.88,percent of total billed charges,78% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,109.67,100,,,fee schedule,100% of GA fee schedule,257.45,100,,,fee schedule,100% of CMS 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,109.67,100,,,fee schedule,100% of GA fee schedule,208.25,85,,166.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,239.43,93,,,fee schedule,93% of CMS fee schedule,193.55,79,,154.84,percent of total billed charges,79% of total billed charges,257.45,100,,,fee schedule,100% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,109.67,450,
"PARVOVIRUS B-19 DNA,QUAL PCR",300009202,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
HIV 1 RNA QUAL TMA,300009203,CDM,306,RC,87535,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,24.67,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,450,
VARICELLA ZOSTER PCR,300009231,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
WEST NILE,300009232,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
NOROVIRUS RNA,300009262,CDM,306,RC,87798,HCPCS,outpatient,,,527,368.9,,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,406.95,77.22,,325.56,percent of total billed charges,77.22% of total billed charges,25.9,105,,,fee schedule,105% of GA fee schedule,437.41,83,,349.93,percent of total billed charges,83% of total,500.65,95,,400.52,percent of total billed charges ,95% of total billed charges,421.6,80,,337.28,percent of total billed charges,78% of total billed charges,411.06,78,,328.848,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,474.3,90,,379.44,percent of total billed charges,90% of total billed charges,421.6,80,,337.28,percent of total billed charges,80% of total billed charges,24.67,100,,,fee schedule,100% of GA fee schedule,447.95,85,,358.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,416.33,79,,333.06,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,24.67,500.65,
BD AFFIRM VAGINAL PATHOGENS,300009266,CDM,306,RC,87800,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,43.67,100,,,fee schedule,100% of CMS fee schedule,69.87,160,,,fee schedule,160% of CMS fee schedule,56.77,130,,,fee schedule,130% of CMS fee schedule,49.59,100,,,fee schedule,100% of GA fee schedule,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,52.07,105,,,fee schedule,105% of GA fee schedule,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,43.67,100,,,fee schedule,100% of CMS fee schedule,49.59,100,,,fee schedule,100% of GA fee schedule,43.67,100,,,fee schedule,100% of CMS 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,49.59,100,,,fee schedule,100% of GA fee schedule,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.61,93,,,fee schedule,93% of CMS fee schedule,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,43.67,100,,,fee schedule,100% of CMS fee schedule,43.67,100,,,fee schedule,100% of CMS fee schedule,40.61,450,
HIV 1 INTEGRASE GENOTYPING,300009276,CDM,306,RC,87906,HCPCS,outpatient,,,441,308.7,,348.39,79,,278.71,percent of total billed charges,79% of total billed charges,396.9,90,,317.52,percent of total billed charges,90% of total billed charges,128.73,100,,,fee schedule,100% of CMS fee schedule,205.97,160,,,fee schedule,160% of CMS fee schedule,167.35,130,,,fee schedule,130% of CMS fee schedule,49.09,100,,,fee schedule,100% of GA fee schedule,340.54,77.22,,272.43,percent of total billed charges,77.22% of total billed charges,51.54,105,,,fee schedule,105% of GA fee schedule,366.03,83,,292.82,percent of total billed charges,83% of total,418.95,95,,335.16,percent of total billed charges ,95% of total billed charges,352.8,80,,282.24,percent of total billed charges,78% of total billed charges,343.98,78,,275.184,percent of total billed charges,78% of total billed charges,128.73,100,,,fee schedule,100% of CMS fee schedule,49.09,100,,,fee schedule,100% of GA fee schedule,128.73,100,,,fee schedule,100% of CMS fee schedule,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,49.09,100,,,fee schedule,100% of GA fee schedule,374.85,85,,299.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,119.72,93,,,fee schedule,93% of CMS fee schedule,348.39,79,,278.71,percent of total billed charges,79% of total billed charges,128.73,100,,,fee schedule,100% of CMS fee schedule,128.73,100,,,fee schedule,100% of CMS fee schedule,49.09,450,
PARVOVIRUS B19 QUANT PCR,300009902,CDM,306,RC,87799,HCPCS,outpatient,,,480,336,,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,432,90,,345.6,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,370.66,77.22,,296.53,percent of total billed charges,77.22% of total billed charges,317.28,66.1,,253.82,percent of total billed charges,66.1% of total billed charges,398.4,83,,318.72,percent of total billed charges,83% of total,456,95,,364.8,percent of total billed charges ,95% of total billed charges,384,80,,307.2,percent of total billed charges,78% of total billed charges,374.4,78,,299.52,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,42.84,100,,,fee schedule,100% of CMS 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,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,408,85,,326.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,456,
SHIGA TOXIN,300084727,CDM,306,RC,87427,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
ORGANISM ID,300087106,CDM,306,RC,87106,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,16.51,160,,,fee schedule,160% of CMS fee schedule,13.42,130,,,fee schedule,130% of CMS fee schedule,12.98,100,,,fee schedule,100% of GA fee schedule,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,13.63,105,,,fee schedule,105% of GA fee schedule,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,12.98,100,,,fee schedule,100% of GA fee schedule,10.32,100,,,fee schedule,100% of CMS 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,12.98,100,,,fee schedule,100% of GA fee schedule,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.6,93,,,fee schedule,93% of CMS fee schedule,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,10.32,100,,,fee schedule,100% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,9.6,450,
ENTERIC BACTERIAL PANEL,300087150,CDM,306,RC,87505,HCPCS,outpatient,,,400,280,,316,79,,252.8,percent of total billed charges,79% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,128.29,100,,,fee schedule,100% of CMS fee schedule,205.26,160,,,fee schedule,160% of CMS fee schedule,166.78,130,,,fee schedule,130% of CMS fee schedule,102.63,100,,,fee schedule,100% of GA fee schedule,308.88,77.22,,247.1,percent of total billed charges,77.22% of total billed charges,107.76,105,,,fee schedule,105% of GA fee schedule,332,83,,265.6,percent of total billed charges,83% of total,380,95,,304,percent of total billed charges ,95% of total billed charges,320,80,,256,percent of total billed charges,78% of total billed charges,312,78,,249.6,percent of total billed charges,78% of total billed charges,128.29,100,,,fee schedule,100% of CMS fee schedule,102.63,100,,,fee schedule,100% of GA fee schedule,128.29,100,,,fee schedule,100% of CMS 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,102.63,100,,,fee schedule,100% of GA fee schedule,340,85,,272,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,119.31,93,,,fee schedule,93% of CMS fee schedule,316,79,,252.8,percent of total billed charges,79% of total billed charges,128.29,100,,,fee schedule,100% of CMS fee schedule,128.29,100,,,fee schedule,100% of CMS fee schedule,102.63,450,
FUNGUS,300087186,CDM,306,RC,87186,HCPCS,outpatient,,,1500,1050,,1185,79,,948,percent of total billed charges,79% of total billed charges,1350,90,,1080,percent of total billed charges,90% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,13.84,160,,,fee schedule,160% of CMS fee schedule,11.25,130,,,fee schedule,130% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,1158.3,77.22,,926.64,percent of total billed charges,77.22% of total billed charges,11.41,105,,,fee schedule,105% of GA fee schedule,1245,83,,996,percent of total billed charges,83% of total,1425,95,,1140,percent of total billed charges ,95% of total billed charges,1200,80,,960,percent of total billed charges,78% of total billed charges,1170,78,,936,percent of total billed charges,78% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,10.87,100,,,fee schedule,100% of GA fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,1350,90,,1080,percent of total billed charges,90% of total billed charges,1200,80,,960,percent of total billed charges,80% of total billed charges,10.87,100,,,fee schedule,100% of GA fee schedule,1275,85,,1020,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.04,93,,,fee schedule,93% of CMS fee schedule,1185,79,,948,percent of total billed charges,79% of total billed charges,8.65,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,8.04,1425,
SHIGA TOXIN,300087427,CDM,306,RC,87427,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
CAMPYLOBACTER ANTIGEN,300087449,CDM,306,RC,87046,HCPCS,outpatient,,,75,52.5,,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,67.5,90,,54,percent of total billed charges,90% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,15.1,160,,,fee schedule,160% of CMS fee schedule,12.27,130,,,fee schedule,130% of CMS fee schedule,2.97,100,,,fee schedule,100% of GA fee schedule,57.92,77.22,,46.34,percent of total billed charges,77.22% of total billed charges,3.12,105,,,fee schedule,105% of GA fee schedule,62.25,83,,49.8,percent of total billed charges,83% of total,71.25,95,,57,percent of total billed charges ,95% of total billed charges,60,80,,48,percent of total billed charges,78% of total billed charges,58.5,78,,46.8,percent of total billed charges,78% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,2.97,100,,,fee schedule,100% of GA fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,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,2.97,100,,,fee schedule,100% of GA fee schedule,63.75,85,,51,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.78,93,,,fee schedule,93% of CMS fee schedule,59.25,79,,47.4,percent of total billed charges,79% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,2.97,450,
STOOL CULTURE VIBRIO,300087450,CDM,306,RC,87046,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,15.1,160,,,fee schedule,160% of CMS fee schedule,12.27,130,,,fee schedule,130% of CMS fee schedule,2.97,100,,,fee schedule,100% of GA fee schedule,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,3.12,105,,,fee schedule,105% of GA fee schedule,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,2.97,100,,,fee schedule,100% of GA fee schedule,9.44,100,,,fee schedule,100% of CMS 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,2.97,100,,,fee schedule,100% of GA fee schedule,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.78,93,,,fee schedule,93% of CMS fee schedule,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,9.44,100,,,fee schedule,100% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,2.97,450,
HBVABT-HBV QUANT DNA ABBOTT,300087517,CDM,306,RC,87517,HCPCS,outpatient,,,435,304.5,,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,335.91,77.22,,268.73,percent of total billed charges,77.22% of total billed charges,56.56,105,,,fee schedule,105% of GA fee schedule,361.05,83,,288.84,percent of total billed charges,83% of total,413.25,95,,330.6,percent of total billed charges ,95% of total billed charges,348,80,,278.4,percent of total billed charges,78% of total billed charges,339.3,78,,271.44,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,53.87,100,,,fee schedule,100% of GA fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,391.5,90,,313.2,percent of total billed charges,90% of total billed charges,348,80,,278.4,percent of total billed charges,80% of total billed charges,53.87,100,,,fee schedule,100% of GA fee schedule,369.75,85,,295.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,343.65,79,,274.92,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,450,
TRICHOMONAS VAG,300087661,CDM,306,RC,87661,HCPCS,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,22.49,105,,,fee schedule,105% of GA fee schedule,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,21.42,100,,,fee schedule,100% of GA fee schedule,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,21.42,450,
JC POLYOMA DNA,300087799,CDM,306,RC,87799,HCPCS,outpatient,,,480,336,,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,432,90,,345.6,percent of total billed charges,90% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,68.54,160,,,fee schedule,160% of CMS fee schedule,55.69,130,,,fee schedule,130% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,370.66,77.22,,296.53,percent of total billed charges,77.22% of total billed charges,317.28,66.1,,253.82,percent of total billed charges,66.1% of total billed charges,398.4,83,,318.72,percent of total billed charges,83% of total,456,95,,364.8,percent of total billed charges ,95% of total billed charges,384,80,,307.2,percent of total billed charges,78% of total billed charges,374.4,78,,299.52,percent of total billed charges,78% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,42.84,100,,,fee schedule,100% of CMS 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,302.4,63,,241.92,percent of total billed charges,63% of total billed charges,408,85,,326.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,39.84,93,,,fee schedule,93% of CMS fee schedule,379.2,79,,303.36,percent of total billed charges,79% of total billed charges,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,39.84,456,
CHLAM GONOC MYCOP GEN PANEL CP,300180049,CDM,306,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CAMPY ANTIGEN,300474492,CDM,306,RC,87449,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,19.17,160,,,fee schedule,160% of CMS fee schedule,15.57,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,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,15.08,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,11.14,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.14,450,
RESPIRATORY PATHOGEN PANEL CP,306004567,CDM,306,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
N MENINGITIDIS TYPE AYWC CP,306086741,CDM,306,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ANAEROBIC BACTERIA ID,306087076,CDM,306,RC,87076,HCPCS,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,12.93,160,,,fee schedule,160% of CMS fee schedule,10.5,130,,,fee schedule,130% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,10.67,105,,,fee schedule,105% of GA fee schedule,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,10.16,100,,,fee schedule,100% of GA fee schedule,8.08,100,,,fee schedule,100% of CMS 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,10.16,100,,,fee schedule,100% of GA fee schedule,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.51,93,,,fee schedule,93% of CMS fee schedule,79,79,,63.2,percent of total billed charges,79% of total billed charges,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,7.51,450,
SARS COV 2 ANTIGEN,306087426,CDM,306,RC,87426,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,56.53,160,,,fee schedule,160% of CMS fee schedule,45.93,130,,,fee schedule,130% of CMS fee schedule,36.18,100,,,fee schedule,100% of GA fee schedule,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,37.99,105,,,fee schedule,105% of GA fee schedule,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,36.18,100,,,fee schedule,100% of GA fee schedule,35.33,100,,,fee schedule,100% of CMS 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,36.18,100,,,fee schedule,100% of GA fee schedule,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.86,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,35.33,100,,,fee schedule,100% of CMS fee schedule,32.86,450,
SARS ANTIGEN & FLU,306087428,CDM,306,RC,87428,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,70.29,100,,,fee schedule,100% of CMS fee schedule,112.46,160,,,fee schedule,160% of CMS fee schedule,91.38,130,,,fee schedule,130% of CMS fee schedule,67.08,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,70.43,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,70.29,100,,,fee schedule,100% of CMS fee schedule,67.08,100,,,fee schedule,100% of GA fee schedule,70.29,100,,,fee schedule,100% of CMS 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,67.08,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,65.37,93,,,fee schedule,93% of CMS fee schedule,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,70.29,100,,,fee schedule,100% of CMS fee schedule,70.29,100,,,fee schedule,100% of CMS fee schedule,65.37,450,
M GENITALIUM AMP PROBE,306087563,CDM,306,RC,87563,HCPCS,outpatient,,,43,30.1,,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,38.7,90,,30.96,percent of total billed charges,90% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,56.14,160,,,fee schedule,160% of CMS fee schedule,45.62,130,,,fee schedule,130% of CMS fee schedule,28.07,100,,,fee schedule,100% of GA fee schedule,33.2,77.22,,26.56,percent of total billed charges,77.22% of total billed charges,29.47,105,,,fee schedule,105% of GA fee schedule,35.69,83,,28.55,percent of total billed charges,83% of total,40.85,95,,32.68,percent of total billed charges ,95% of total billed charges,34.4,80,,27.52,percent of total billed charges,78% of total billed charges,33.54,78,,26.832,percent of total billed charges,78% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,28.07,100,,,fee schedule,100% of GA fee schedule,35.09,100,,,fee schedule,100% of CMS 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,28.07,100,,,fee schedule,100% of GA fee schedule,36.55,85,,29.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.63,93,,,fee schedule,93% of CMS fee schedule,33.97,79,,27.18,percent of total billed charges,79% of total billed charges,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,28.07,450,
MONKEYPOX ORTHOPOXVIRUS,306087593,CDM,306,RC,87593,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,100,,,fee schedule,100% of GA fee schedule,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,45.36,105,,,fee schedule,105% of GA fee schedule,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,43.2,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,43.2,100,,,fee schedule,100% of GA fee schedule,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43.2,450,
COVID 19,306087635,CDM,306,RC,U0003,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.93,450,
COVID 19 PCR,306287635,CDM,306,RC,87635,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,51.31,100,,,fee schedule,100% of CMS fee schedule,82.1,160,,,fee schedule,160% of CMS fee schedule,66.7,130,,,fee schedule,130% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,53.88,105,,,fee schedule,105% of GA fee schedule,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,51.31,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of GA fee schedule,51.31,100,,,fee schedule,100% of CMS 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,51.31,100,,,fee schedule,100% of GA fee schedule,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.72,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,51.31,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of CMS fee schedule,47.72,450,
N MENINGITIDIS TYPE-C IgG,306686741,CDM,306,RC,86741,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule ,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
N MENINGITIDIS TYPE W-135 IgG,306786741,CDM,306,RC,86741,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule ,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
N MENINGITIDIS TYPE-Y IgG,306886741,CDM,306,RC,86741,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule ,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
N MENINGITIDIS TYPE-A IgG,306986741,CDM,306,RC,86741,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,17.42,105,,,fee schedule,105% of GA fee schedule,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of GA fee schedule,13.19,100,,,fee schedule ,100% of CMS 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,16.59,100,,,fee schedule,100% of GA fee schedule,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
GI BACTERIA STOOL PCR,310087506,CDM,306,RC,87506,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,262.99,100,,,fee schedule,100% of CMS fee schedule,420.78,160,,,fee schedule,160% of CMS fee schedule,341.89,130,,,fee schedule,130% of CMS fee schedule,210.39,100,,,fee schedule,100% of GA fee schedule,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,220.91,105,,,fee schedule,105% of GA fee schedule,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,262.99,100,,,fee schedule,100% of CMS fee schedule,210.39,100,,,fee schedule,100% of GA fee schedule,262.99,100,,,fee schedule ,100% of CMS fee schedule,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,210.39,100,,,fee schedule,100% of GA fee schedule,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.58,93,,,fee schedule,93% of CMS fee schedule,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,262.99,100,,,fee schedule,100% of CMS fee schedule,262.99,100,,,fee schedule,100% of CMS fee schedule,210.39,450,
GI BACTERIA & PARASITE PCR,310087507,CDM,306,RC,87507,HCPCS,outpatient,,,1467,1026.9,,1158.93,79,,927.14,percent of total billed charges,79% of total billed charges,1320.3,90,,1056.24,percent of total billed charges,90% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,666.85,160,,,fee schedule,160% of CMS fee schedule,541.81,130,,,fee schedule,130% of CMS fee schedule,333.42,100,,,fee schedule,100% of GA fee schedule,1132.82,77.22,,906.26,percent of total billed charges,77.22% of total billed charges,350.09,105,,,fee schedule,105% of GA fee schedule,1217.61,83,,974.09,percent of total billed charges,83% of total,1393.65,95,,1114.92,percent of total billed charges ,95% of total billed charges,1173.6,80,,938.88,percent of total billed charges,78% of total billed charges,1144.26,78,,915.408,percent of total billed charges,78% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,333.42,100,,,fee schedule,100% of GA fee schedule,416.78,100,,,fee schedule ,100% of CMS fee schedule,1320.3,90,,1056.24,percent of total billed charges,90% of total billed charges,1173.6,80,,938.88,percent of total billed charges,80% of total billed charges,333.42,100,,,fee schedule,100% of GA fee schedule,1246.95,85,,997.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,387.61,93,,,fee schedule,93% of CMS fee schedule,1158.93,79,,927.14,percent of total billed charges,79% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,333.42,1393.65,
RHOGAM STUDIES,390000096,CDM,306,RC,,,outpatient,,,324,226.8,,255.96,79,,204.77,percent of total billed charges,79% of total billed charges,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.12,63,,163.3,percent of total billed charges,63% of total billed charges,250.19,77.22,,200.15,percent of total billed charges,77.22% of total billed charges,214.16,66.1,,171.33,percent of total billed charges,66.1% of total billed charges,268.92,83,,215.14,percent of total billed charges,83% of total,307.8,95,,246.24,percent of total billed charges ,95% of total billed charges,259.2,80,,207.36,percent of total billed charges,78% of total billed charges,252.72,78,,202.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,204.12,63,,163.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,204.12,63,,163.3,percent of total billed charges,63% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,255.96,79,,204.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.12,450,
SARS 2 ANTIGEN,87426,CDM,306,RC,87426,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,56.53,160,,,fee schedule,160% of CMS fee schedule,45.93,130,,,fee schedule,130% of CMS fee schedule,36.18,100,,,fee schedule,100% of GA fee schedule,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,37.99,105,,,fee schedule,105% of GA fee schedule,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,36.18,100,,,fee schedule,100% of GA fee schedule,35.33,100,,,fee schedule ,100% of CMS 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,36.18,100,,,fee schedule,100% of GA fee schedule,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.86,93,,,fee schedule,93% of CMS fee schedule,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,35.33,100,,,fee schedule,100% of CMS fee schedule,35.33,100,,,fee schedule,100% of CMS fee schedule,32.86,450,
SARS ANTIGEN & FLU,87428,CDM,306,RC,87428,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,70.29,100,,,fee schedule,100% of CMS fee schedule,112.46,160,,,fee schedule,160% of CMS fee schedule,91.38,130,,,fee schedule,130% of CMS fee schedule,67.08,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,70.43,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,70.29,100,,,fee schedule,100% of CMS fee schedule,67.08,100,,,fee schedule,100% of GA fee schedule,70.29,100,,,fee schedule ,100% of CMS 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,67.08,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,65.37,93,,,fee schedule,93% of CMS fee schedule,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,70.29,100,,,fee schedule,100% of CMS fee schedule,70.29,100,,,fee schedule,100% of CMS fee schedule,65.37,450,
INFLUENZA A SCREEN RAPID,87804,CDM,306,RC,87804,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,26.48,160,,,fee schedule,160% of CMS fee schedule,21.52,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16.55,100,,,fee schedule ,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.39,93,,,fee schedule,93% of CMS fee schedule,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,16.55,100,,,fee schedule,100% of CMS fee schedule,16.55,100,,,fee schedule,100% of CMS fee schedule,15.08,450,
STREP SCREEN RAPID,87880,CDM,306,RC,87880,HCPCS,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,26.45,160,,,fee schedule,160% of CMS fee schedule,21.49,130,,,fee schedule,130% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,15.83,105,,,fee schedule,105% of GA fee schedule,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of GA fee schedule,16.53,100,,,fee schedule ,100% of CMS 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,15.08,100,,,fee schedule,100% of GA fee schedule,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.37,93,,,fee schedule,93% of CMS fee schedule,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,16.53,100,,,fee schedule,100% of CMS fee schedule,16.53,100,,,fee schedule,100% of CMS fee schedule,15.08,450,
PREGNANCY TEST URINE,300000003,CDM,307,RC,81025,HCPCS,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,13.78,160,,,fee schedule,160% of CMS fee schedule,11.19,130,,,fee schedule,130% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,8.36,105,,,fee schedule,105% of GA fee schedule,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,8.61,100,,,fee schedule,100% of CMS 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,7.96,100,,,fee schedule,100% of GA fee schedule,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.01,93,,,fee schedule,93% of CMS fee schedule,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,450,
URINALYSIS,300000004,CDM,307,RC,81001,HCPCS,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,5.07,160,,,fee schedule,160% of CMS fee schedule,4.12,130,,,fee schedule,130% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,4.19,105,,,fee schedule,105% of GA fee schedule,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,3.17,100,,,fee schedule,100% of CMS 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,3.99,100,,,fee schedule,100% of GA fee schedule,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.95,93,,,fee schedule,93% of CMS fee schedule,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,3.17,100,,,fee schedule,100% of CMS fee schedule,2.95,450,
ACETONE,300000122,CDM,307,RC,82009,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,4.52,100,,,fee schedule,100% of CMS fee schedule,7.23,160,,,fee schedule,160% of CMS fee schedule,5.88,130,,,fee schedule,130% of CMS fee schedule,4.13,100,,,fee schedule,100% of GA fee schedule,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,4.34,105,,,fee schedule,105% of GA fee schedule,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,4.52,100,,,fee schedule,100% of CMS fee schedule,4.13,100,,,fee schedule,100% of GA fee schedule,4.52,100,,,fee schedule,100% of CMS 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,4.13,100,,,fee schedule,100% of GA fee schedule,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.2,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,4.52,100,,,fee schedule,100% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,4.13,450,
ALDOSTERONE SERUM,300000146,CDM,307,RC,82088,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,65.2,160,,,fee schedule,160% of CMS fee schedule,52.98,130,,,fee schedule,130% of CMS fee schedule,51.25,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,53.81,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,51.25,100,,,fee schedule,100% of GA fee schedule,40.75,100,,,fee schedule,100% of CMS 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,51.25,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,37.9,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,37.9,450,
ALBUMIN URINE,300000153,CDM,307,RC,82042,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,12.45,160,,,fee schedule,160% of CMS fee schedule,10.11,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,7.78,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.24,93,,,fee schedule,93% of CMS fee schedule,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,7.78,100,,,fee schedule,100% of CMS fee schedule,6.51,450,
MICROALBUMIN URINE,300000174,CDM,307,RC,82043,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,9.25,160,,,fee schedule,160% of CMS fee schedule,7.51,130,,,fee schedule,130% of CMS fee schedule,7.28,100,,,fee schedule,100% of GA fee schedule,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,7.64,105,,,fee schedule,105% of GA fee schedule,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,7.28,100,,,fee schedule,100% of GA fee schedule,5.78,100,,,fee schedule,100% of CMS 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,7.28,100,,,fee schedule,100% of GA fee schedule,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.38,93,,,fee schedule,93% of CMS fee schedule,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,5.38,450,
ALDOLASE,300000202,CDM,307,RC,82085,HCPCS,outpatient,,,21,14.7,,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,18.9,90,,15.12,percent of total billed charges,90% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,15.54,160,,,fee schedule,160% of CMS fee schedule,12.62,130,,,fee schedule,130% of CMS fee schedule,12.2,100,,,fee schedule,100% of GA fee schedule,16.22,77.22,,12.98,percent of total billed charges,77.22% of total billed charges,12.81,105,,,fee schedule,105% of GA fee schedule,17.43,83,,13.94,percent of total billed charges,83% of total,19.95,95,,15.96,percent of total billed charges ,95% of total billed charges,16.8,80,,13.44,percent of total billed charges,78% of total billed charges,16.38,78,,13.104,percent of total billed charges,78% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,12.2,100,,,fee schedule,100% of GA fee schedule,9.71,100,,,fee schedule,100% of CMS 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,12.2,100,,,fee schedule,100% of GA fee schedule,17.85,85,,14.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.03,93,,,fee schedule,93% of CMS fee schedule,16.59,79,,13.27,percent of total billed charges,79% of total billed charges,9.71,100,,,fee schedule,100% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,9.03,450,
SPECIFIC GRAVITY,300000358,CDM,307,RC,81000,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,4.02,100,,,fee schedule,100% of CMS fee schedule,6.43,160,,,fee schedule,160% of CMS fee schedule,5.23,130,,,fee schedule,130% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,4.19,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,4.02,100,,,fee schedule,100% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,4.02,100,,,fee schedule,100% of CMS 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,3.99,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.74,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,4.02,100,,,fee schedule,100% of CMS fee schedule,4.02,100,,,fee schedule,100% of CMS fee schedule,3.74,450,
TOLERANCE URINE #1,300000431,CDM,307,RC,81003,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
TOLERANCE URINE #2,300000432,CDM,307,RC,81003,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
TOLERANCE URINE #3,300000433,CDM,307,RC,81003,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
TOLERANCE URINE #4,300000434,CDM,307,RC,81003,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
TOLERANCE URINE #5,300000435,CDM,307,RC,81003,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
TOLERANCE URINE #6,300000436,CDM,307,RC,81003,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
TOLERANCE URINE #7,300000437,CDM,307,RC,81003,HCPCS,outpatient,,,9,6.3,,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,8.1,90,,6.48,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,6.95,77.22,,5.56,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,7.47,83,,5.98,percent of total billed charges,83% of total,8.55,95,,6.84,percent of total billed charges ,95% of total billed charges,7.2,80,,5.76,percent of total billed charges,78% of total billed charges,7.02,78,,5.616,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,7.65,85,,6.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,7.11,79,,5.69,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
PH/REDUCING SUB,300000495,CDM,307,RC,81000,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,4.02,100,,,fee schedule,100% of CMS fee schedule,6.43,160,,,fee schedule,160% of CMS fee schedule,5.23,130,,,fee schedule,130% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,4.19,105,,,fee schedule,105% of GA fee schedule,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,4.02,100,,,fee schedule,100% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,4.02,100,,,fee schedule,100% of CMS 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,3.99,100,,,fee schedule,100% of GA fee schedule,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.74,93,,,fee schedule,93% of CMS fee schedule,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,4.02,100,,,fee schedule,100% of CMS fee schedule,4.02,100,,,fee schedule,100% of CMS fee schedule,3.74,450,
UA DIP STICK,300000555,CDM,307,RC,81003,HCPCS,outpatient,,,10,7,,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,9,90,,7.2,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,7.72,77.22,,6.18,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,8.3,83,,6.64,percent of total billed charges,83% of total,9.5,95,,7.6,percent of total billed charges ,95% of total billed charges,8,80,,6.4,percent of total billed charges,78% of total billed charges,7.8,78,,6.24,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,8.5,85,,6.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,7.9,79,,6.32,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
"ALDOSTERONE,URINE",300008205,CDM,307,RC,82088,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,65.2,160,,,fee schedule,160% of CMS fee schedule,52.98,130,,,fee schedule,130% of CMS fee schedule,51.25,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,53.81,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,51.25,100,,,fee schedule,100% of GA fee schedule,40.75,100,,,fee schedule,100% of CMS 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,51.25,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,37.9,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,37.9,450,
"CYCLIC,BLOOD OR URINE",300008223,CDM,307,RC,82030,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,25.8,100,,,fee schedule,100% of CMS fee schedule,41.28,160,,,fee schedule,160% of CMS fee schedule,33.54,130,,,fee schedule,130% of CMS fee schedule,32.45,100,,,fee schedule,100% of GA fee schedule,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,34.07,105,,,fee schedule,105% of GA fee schedule,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,25.8,100,,,fee schedule,100% of CMS fee schedule,32.45,100,,,fee schedule,100% of GA fee schedule,25.8,100,,,fee schedule,100% of CMS 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,32.45,100,,,fee schedule,100% of GA fee schedule,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.99,93,,,fee schedule,93% of CMS fee schedule,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,25.8,100,,,fee schedule,100% of CMS fee schedule,25.8,100,,,fee schedule,100% of CMS fee schedule,23.99,450,
STOOL REDUCING SUBSTANCES,300008291,CDM,307,RC,81001,HCPCS,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,5.07,160,,,fee schedule,160% of CMS fee schedule,4.12,130,,,fee schedule,130% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,4.19,105,,,fee schedule,105% of GA fee schedule,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,3.99,100,,,fee schedule,100% of GA fee schedule,3.17,100,,,fee schedule,100% of CMS 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,3.99,100,,,fee schedule,100% of GA fee schedule,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.95,93,,,fee schedule,93% of CMS fee schedule,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,3.17,100,,,fee schedule,100% of CMS fee schedule,3.17,100,,,fee schedule,100% of CMS fee schedule,2.95,450,
ACTH,300008313,CDM,307,RC,82024,HCPCS,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,38.62,100,,,fee schedule,100% of CMS fee schedule,61.79,160,,,fee schedule,160% of CMS fee schedule,50.21,130,,,fee schedule,130% of CMS fee schedule,48.57,100,,,fee schedule,100% of GA fee schedule,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,51,105,,,fee schedule,105% of GA fee schedule,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,38.62,100,,,fee schedule,100% of CMS fee schedule,48.57,100,,,fee schedule,100% of GA fee schedule,38.62,100,,,fee schedule,100% of CMS 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,48.57,100,,,fee schedule,100% of GA fee schedule,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.92,93,,,fee schedule,93% of CMS fee schedule,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,38.62,100,,,fee schedule,100% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,35.92,450,
BETA HYDROXYBUTYRIC,300008472,CDM,307,RC,82010,HCPCS,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,13.07,160,,,fee schedule,160% of CMS fee schedule,10.62,130,,,fee schedule,130% of CMS fee schedule,10.28,100,,,fee schedule,100% of GA fee schedule,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,10.79,105,,,fee schedule,105% of GA fee schedule,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,10.28,100,,,fee schedule,100% of GA fee schedule,8.17,100,,,fee schedule,100% of CMS 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,10.28,100,,,fee schedule,100% of GA fee schedule,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.6,93,,,fee schedule,93% of CMS fee schedule,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,8.17,100,,,fee schedule,100% of CMS fee schedule,8.17,100,,,fee schedule,100% of CMS fee schedule,7.6,450,
ALBUMIN CSF,300008537,CDM,307,RC,82042,HCPCS,outpatient,,,67,46.9,,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,60.3,90,,48.24,percent of total billed charges,90% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,12.45,160,,,fee schedule,160% of CMS fee schedule,10.11,130,,,fee schedule,130% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,51.74,77.22,,41.39,percent of total billed charges,77.22% of total billed charges,6.84,105,,,fee schedule,105% of GA fee schedule,55.61,83,,44.49,percent of total billed charges,83% of total,63.65,95,,50.92,percent of total billed charges ,95% of total billed charges,53.6,80,,42.88,percent of total billed charges,78% of total billed charges,52.26,78,,41.808,percent of total billed charges,78% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of GA fee schedule,7.78,100,,,fee schedule,100% of CMS 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,6.51,100,,,fee schedule,100% of GA fee schedule,56.95,85,,45.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.24,93,,,fee schedule,93% of CMS fee schedule,52.93,79,,42.34,percent of total billed charges,79% of total billed charges,7.78,100,,,fee schedule,100% of CMS fee schedule,7.78,100,,,fee schedule,100% of CMS fee schedule,6.51,450,
BETA HCG URINE,300008600,CDM,307,RC,81025,HCPCS,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,13.78,160,,,fee schedule,160% of CMS fee schedule,11.19,130,,,fee schedule,130% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,8.36,105,,,fee schedule,105% of GA fee schedule,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,8.61,100,,,fee schedule,100% of CMS 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,7.96,100,,,fee schedule,100% of GA fee schedule,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.01,93,,,fee schedule,93% of CMS fee schedule,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,450,
URINE DIPSTICK W/O MICROSCOPE,300008703,CDM,307,RC,81002,HCPCS,outpatient,,,34,23.8,,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,30.6,90,,24.48,percent of total billed charges,90% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,5.57,160,,,fee schedule,160% of CMS fee schedule,4.52,130,,,fee schedule,130% of CMS fee schedule,3.21,100,,,fee schedule,100% of GA fee schedule,26.25,77.22,,21,percent of total billed charges,77.22% of total billed charges,3.37,105,,,fee schedule,105% of GA fee schedule,28.22,83,,22.58,percent of total billed charges,83% of total,32.3,95,,25.84,percent of total billed charges ,95% of total billed charges,27.2,80,,21.76,percent of total billed charges,78% of total billed charges,26.52,78,,21.216,percent of total billed charges,78% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,3.21,100,,,fee schedule,100% of GA fee schedule,3.48,100,,,fee schedule,100% of CMS 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,3.21,100,,,fee schedule,100% of GA fee schedule,28.9,85,,23.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.24,93,,,fee schedule,93% of CMS fee schedule,26.86,79,,21.49,percent of total billed charges,79% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,3.48,100,,,fee schedule,100% of CMS fee schedule,3.21,450,
ACYLCARNITINE,300008758,CDM,307,RC,82017,HCPCS,outpatient,,,198,138.6,,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,178.2,90,,142.56,percent of total billed charges,90% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,26.99,160,,,fee schedule,160% of CMS fee schedule,21.93,130,,,fee schedule,130% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,152.9,77.22,,122.32,percent of total billed charges,77.22% of total billed charges,22.27,105,,,fee schedule,105% of GA fee schedule,164.34,83,,131.47,percent of total billed charges,83% of total,188.1,95,,150.48,percent of total billed charges ,95% of total billed charges,158.4,80,,126.72,percent of total billed charges,78% of total billed charges,154.44,78,,123.552,percent of total billed charges,78% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of GA fee schedule,16.87,100,,,fee schedule,100% of CMS 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,21.21,100,,,fee schedule,100% of GA fee schedule,168.3,85,,134.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.69,93,,,fee schedule,93% of CMS fee schedule,156.42,79,,125.14,percent of total billed charges,79% of total billed charges,16.87,100,,,fee schedule,100% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,15.69,450,
ALDOSTERONE,300009077,CDM,307,RC,82088,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,65.2,160,,,fee schedule,160% of CMS fee schedule,52.98,130,,,fee schedule,130% of CMS fee schedule,51.25,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,53.81,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,51.25,100,,,fee schedule,100% of GA fee schedule,40.75,100,,,fee schedule,100% of CMS 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,51.25,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,37.9,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,40.75,100,,,fee schedule,100% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,37.9,450,
KEYTONE,300009278,CDM,307,RC,81003,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
URINE PREG TEST BY VISUAL COLL,300081025,CDM,307,RC,81025,HCPCS,outpatient,,,74,51.8,,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,66.6,90,,53.28,percent of total billed charges,90% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,13.78,160,,,fee schedule,160% of CMS fee schedule,11.19,130,,,fee schedule,130% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,57.14,77.22,,45.71,percent of total billed charges,77.22% of total billed charges,8.36,105,,,fee schedule,105% of GA fee schedule,61.42,83,,49.14,percent of total billed charges,83% of total,70.3,95,,56.24,percent of total billed charges ,95% of total billed charges,59.2,80,,47.36,percent of total billed charges,78% of total billed charges,57.72,78,,46.176,percent of total billed charges,78% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,8.61,100,,,fee schedule,100% of CMS 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,7.96,100,,,fee schedule,100% of GA fee schedule,62.9,85,,50.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.01,93,,,fee schedule,93% of CMS fee schedule,58.46,79,,46.77,percent of total billed charges,79% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,450,
ALBUMIN,300900101,CDM,307,RC,82040,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,7.92,160,,,fee schedule,160% of CMS fee schedule,6.44,130,,,fee schedule,130% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,3.8,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,3.62,100,,,fee schedule,100% of GA fee schedule,4.95,100,,,fee schedule,100% of CMS 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,3.62,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.6,93,,,fee schedule,93% of CMS fee schedule,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,4.95,100,,,fee schedule,100% of CMS fee schedule,3.62,450,
24HR UR ALBUMIN,307082043,CDM,307,RC,82043,HCPCS,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,9.25,160,,,fee schedule,160% of CMS fee schedule,7.51,130,,,fee schedule,130% of CMS fee schedule,7.28,100,,,fee schedule,100% of GA fee schedule,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,7.64,105,,,fee schedule,105% of GA fee schedule,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,7.28,100,,,fee schedule,100% of GA fee schedule,5.78,100,,,fee schedule ,100% of CMS 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,7.28,100,,,fee schedule,100% of GA fee schedule,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.38,93,,,fee schedule,93% of CMS fee schedule,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,5.78,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,5.38,450,
URINALYSIS NONAUTO W/O SCOPE,762081002,CDM,307,RC,81002,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,5.57,160,,,fee schedule,160% of CMS fee schedule,4.52,130,,,fee schedule,130% of CMS fee schedule,3.21,100,,,fee schedule,100% of GA fee schedule,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,3.37,105,,,fee schedule,105% of GA fee schedule,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,3.21,100,,,fee schedule,100% of GA fee schedule,3.48,100,,,fee schedule ,100% of CMS 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,3.21,100,,,fee schedule,100% of GA fee schedule,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.24,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,3.48,100,,,fee schedule,100% of CMS fee schedule,3.48,100,,,fee schedule,100% of CMS fee schedule,3.21,450,
URINALYSIS AUTOMATED W/O MICRO,81003,CDM,307,RC,81003,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,3.6,160,,,fee schedule,160% of CMS fee schedule,2.93,130,,,fee schedule,130% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,2.97,105,,,fee schedule,105% of GA fee schedule,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.83,100,,,fee schedule,100% of GA fee schedule,2.25,100,,,fee schedule ,100% of CMS 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,2.83,100,,,fee schedule,100% of GA fee schedule,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.09,93,,,fee schedule,93% of CMS fee schedule,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.09,450,
URINE PREGNANCY TEST,81025,CDM,307,RC,81025,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,13.78,160,,,fee schedule,160% of CMS fee schedule,11.19,130,,,fee schedule,130% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,8.36,105,,,fee schedule,105% of GA fee schedule,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,100,,,fee schedule,100% of GA fee schedule,8.61,100,,,fee schedule ,100% of CMS fee schedule,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,7.96,100,,,fee schedule,100% of GA fee schedule,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.01,93,,,fee schedule,93% of CMS fee schedule,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,8.61,100,,,fee schedule,100% of CMS fee schedule,8.61,100,,,fee schedule,100% of CMS fee schedule,7.96,450,
PANCREATITIS 3 - GENE PROF CP,300001222,CDM,310,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
GENETIC ANALYSIS,300001223,CDM,310,RC,81223,HCPCS,outpatient,,,1218,852.6,,962.22,79,,769.78,percent of total billed charges,79% of total billed charges,1096.2,90,,876.96,percent of total billed charges,90% of total billed charges,499,100,,,fee schedule,100% of CMS fee schedule,798.4,160,,,fee schedule,160% of CMS fee schedule,648.7,130,,,fee schedule,130% of CMS fee schedule,960,100,,,fee schedule,100% of GA fee schedule,940.54,77.22,,752.43,percent of total billed charges,77.22% of total billed charges,1008,105,,,fee schedule,105% of GA fee schedule,1010.94,83,,808.75,percent of total billed charges,83% of total,1157.1,95,,925.68,percent of total billed charges ,95% of total billed charges,974.4,80,,779.52,percent of total billed charges,78% of total billed charges,950.04,78,,760.032,percent of total billed charges,78% of total billed charges,499,100,,,fee schedule,100% of CMS fee schedule,960,100,,,fee schedule,100% of GA fee schedule,499,100,,,fee schedule,100% of CMS fee schedule,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,960,100,,,fee schedule,100% of GA fee schedule,1035.3,85,,828.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,464.07,93,,,fee schedule,93% of CMS fee schedule,962.22,79,,769.78,percent of total billed charges,79% of total billed charges,499,100,,,fee schedule,100% of CMS fee schedule,499,100,,,fee schedule,100% of CMS fee schedule,450,1157.1,
PRSS1 SEQUENCING,300001404,CDM,310,RC,81404,HCPCS,outpatient,,,1219,853.3,,963.01,79,,770.41,percent of total billed charges,79% of total billed charges,1097.1,90,,877.68,percent of total billed charges,90% of total billed charges,274.83,100,,,fee schedule,100% of CMS fee schedule,439.73,160,,,fee schedule,160% of CMS fee schedule,357.28,130,,,fee schedule,130% of CMS fee schedule,244,100,,,fee schedule,100% of GA fee schedule,941.31,77.22,,753.05,percent of total billed charges,77.22% of total billed charges,256.2,105,,,fee schedule,105% of GA fee schedule,1011.77,83,,809.42,percent of total billed charges,83% of total,1158.05,95,,926.44,percent of total billed charges ,95% of total billed charges,975.2,80,,780.16,percent of total billed charges,78% of total billed charges,950.82,78,,760.656,percent of total billed charges,78% of total billed charges,274.83,100,,,fee schedule,100% of CMS fee schedule,244,100,,,fee schedule,100% of GA fee schedule,274.83,100,,,fee schedule,100% of CMS fee schedule,1097.1,90,,877.68,percent of total billed charges,90% of total billed charges,975.2,80,,780.16,percent of total billed charges,80% of total billed charges,244,100,,,fee schedule,100% of GA fee schedule,1036.15,85,,828.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,255.59,93,,,fee schedule,93% of CMS fee schedule,963.01,79,,770.41,percent of total billed charges,79% of total billed charges,274.83,100,,,fee schedule,100% of CMS fee schedule,274.83,100,,,fee schedule,100% of CMS fee schedule,244,1158.05,
SPINK SEQUENCING,300001405,CDM,310,RC,81404,HCPCS,outpatient,,,1219,853.3,,963.01,79,,770.41,percent of total billed charges,79% of total billed charges,1097.1,90,,877.68,percent of total billed charges,90% of total billed charges,274.83,100,,,fee schedule,100% of CMS fee schedule,439.73,160,,,fee schedule,160% of CMS fee schedule,357.28,130,,,fee schedule,130% of CMS fee schedule,244,100,,,fee schedule,100% of GA fee schedule,941.31,77.22,,753.05,percent of total billed charges,77.22% of total billed charges,256.2,105,,,fee schedule,105% of GA fee schedule,1011.77,83,,809.42,percent of total billed charges,83% of total,1158.05,95,,926.44,percent of total billed charges ,95% of total billed charges,975.2,80,,780.16,percent of total billed charges,78% of total billed charges,950.82,78,,760.656,percent of total billed charges,78% of total billed charges,274.83,100,,,fee schedule,100% of CMS fee schedule,244,100,,,fee schedule,100% of GA fee schedule,274.83,100,,,fee schedule,100% of CMS fee schedule,1097.1,90,,877.68,percent of total billed charges,90% of total billed charges,975.2,80,,780.16,percent of total billed charges,80% of total billed charges,244,100,,,fee schedule,100% of GA fee schedule,1036.15,85,,828.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,255.59,93,,,fee schedule,93% of CMS fee schedule,963.01,79,,770.41,percent of total billed charges,79% of total billed charges,274.83,100,,,fee schedule,100% of CMS fee schedule,274.83,100,,,fee schedule,100% of CMS fee schedule,244,1158.05,
HLA DQ CP,300008137,CDM,310,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FACTOR V LEIDEN BY PCR,300008419,CDM,310,RC,81241,HCPCS,outpatient,,,169,118.3,,133.51,79,,106.81,percent of total billed charges,79% of total billed charges,152.1,90,,121.68,percent of total billed charges,90% of total billed charges,73.37,100,,,fee schedule,100% of CMS fee schedule,117.39,160,,,fee schedule,160% of CMS fee schedule,95.38,130,,,fee schedule,130% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,130.5,77.22,,104.4,percent of total billed charges,77.22% of total billed charges,42,105,,,fee schedule,105% of GA fee schedule,140.27,83,,112.22,percent of total billed charges,83% of total,160.55,95,,128.44,percent of total billed charges ,95% of total billed charges,135.2,80,,108.16,percent of total billed charges,78% of total billed charges,131.82,78,,105.456,percent of total billed charges,78% of total billed charges,73.37,100,,,fee schedule,100% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,73.37,100,,,fee schedule,100% of CMS 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,40,100,,,fee schedule,100% of GA fee schedule,143.65,85,,114.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,68.23,93,,,fee schedule,93% of CMS fee schedule,133.51,79,,106.81,percent of total billed charges,79% of total billed charges,73.37,100,,,fee schedule,100% of CMS fee schedule,73.37,100,,,fee schedule,100% of CMS fee schedule,40,450,
HEMOCHROMATOSIS MUTATION,300008462,CDM,310,RC,81256,HCPCS,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,65.36,100,,,fee schedule,100% of CMS fee schedule,104.58,160,,,fee schedule,160% of CMS fee schedule,84.97,130,,,fee schedule,130% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,307.34,77.22,,245.87,percent of total billed charges,77.22% of total billed charges,42,105,,,fee schedule,105% of GA fee schedule,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,65.36,100,,,fee schedule,100% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,65.36,100,,,fee schedule,100% of CMS 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,40,100,,,fee schedule,100% of GA fee schedule,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,60.78,93,,,fee schedule,93% of CMS fee schedule,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,65.36,100,,,fee schedule,100% of CMS fee schedule,65.36,100,,,fee schedule,100% of CMS fee schedule,40,450,
EXTRACTION,300008466,CDM,310,RC,83890,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
DIGESTION,300008467,CDM,310,RC,83892,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
GEL,300008468,CDM,310,RC,83894,HCPCS,outpatient,,,622,435.4,,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,480.31,77.22,,384.25,percent of total billed charges,77.22% of total billed charges,411.14,66.1,,328.91,percent of total billed charges,66.1% of total billed charges,516.26,83,,413.01,percent of total billed charges,83% of total,590.9,95,,472.72,percent of total billed charges ,95% of total billed charges,497.6,80,,398.08,percent of total billed charges,78% of total billed charges,485.16,78,,388.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,528.7,85,,422.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,391.86,590.9,
AMPLIFICATION,300008469,CDM,310,RC,83898,HCPCS,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,113.69,66.1,,90.95,percent of total billed charges,66.1% of total billed charges,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.36,450,
INTERPRETATION,300008470,CDM,310,RC,83912,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.99,450,
CYSTIC FIBROSIS,300008471,CDM,310,RC,81220,HCPCS,outpatient,,,1003,702.1,,792.37,79,,633.9,percent of total billed charges,79% of total billed charges,902.7,90,,722.16,percent of total billed charges,90% of total billed charges,556.6,100,,,fee schedule,100% of CMS fee schedule,890.56,160,,,fee schedule,160% of CMS fee schedule,723.58,130,,,fee schedule,130% of CMS fee schedule,960,100,,,fee schedule,100% of GA fee schedule,774.52,77.22,,619.62,percent of total billed charges,77.22% of total billed charges,1008,105,,,fee schedule,105% of GA fee schedule,832.49,83,,665.99,percent of total billed charges,83% of total,952.85,95,,762.28,percent of total billed charges ,95% of total billed charges,802.4,80,,641.92,percent of total billed charges,78% of total billed charges,782.34,78,,625.872,percent of total billed charges,78% of total billed charges,556.6,100,,,fee schedule,100% of CMS fee schedule,960,100,,,fee schedule,100% of GA fee schedule,556.6,100,,,fee schedule,100% of CMS fee schedule,902.7,90,,722.16,percent of total billed charges,90% of total billed charges,802.4,80,,641.92,percent of total billed charges,80% of total billed charges,960,100,,,fee schedule,100% of GA fee schedule,852.55,85,,682.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,517.64,93,,,fee schedule,93% of CMS fee schedule,792.37,79,,633.9,percent of total billed charges,79% of total billed charges,556.6,100,,,fee schedule,100% of CMS fee schedule,556.6,100,,,fee schedule,100% of CMS fee schedule,450,1008,
PROTHROMBIN GENE MUTATION,300008481,CDM,310,RC,81240,HCPCS,outpatient,,,274,191.8,,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,246.6,90,,197.28,percent of total billed charges,90% of total billed charges,65.69,100,,,fee schedule,100% of CMS fee schedule,105.1,160,,,fee schedule,160% of CMS fee schedule,85.4,130,,,fee schedule,130% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,211.58,77.22,,169.26,percent of total billed charges,77.22% of total billed charges,42,105,,,fee schedule,105% of GA fee schedule,227.42,83,,181.94,percent of total billed charges,83% of total,260.3,95,,208.24,percent of total billed charges ,95% of total billed charges,219.2,80,,175.36,percent of total billed charges,78% of total billed charges,213.72,78,,170.976,percent of total billed charges,78% of total billed charges,65.69,100,,,fee schedule,100% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,65.69,100,,,fee schedule,100% of CMS 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,40,100,,,fee schedule,100% of GA fee schedule,232.9,85,,186.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,61.09,93,,,fee schedule,93% of CMS fee schedule,216.46,79,,173.17,percent of total billed charges,79% of total billed charges,65.69,100,,,fee schedule,100% of CMS fee schedule,65.69,100,,,fee schedule,100% of CMS fee schedule,40,450,
FRAGILE X SYNDROME CARRIER,300008741,CDM,310,RC,81244,HCPCS,outpatient,,,820,574,,647.8,79,,518.24,percent of total billed charges,79% of total billed charges,738,90,,590.4,percent of total billed charges,90% of total billed charges,44.89,100,,,fee schedule,100% of CMS fee schedule,71.82,160,,,fee schedule,160% of CMS fee schedule,58.36,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,633.2,77.22,,506.56,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,680.6,83,,544.48,percent of total billed charges,83% of total,779,95,,623.2,percent of total billed charges ,95% of total billed charges,656,80,,524.8,percent of total billed charges,78% of total billed charges,639.6,78,,511.68,percent of total billed charges,78% of total billed charges,44.89,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,44.89,100,,,fee schedule,100% of CMS fee schedule,738,90,,590.4,percent of total billed charges,90% of total billed charges,656,80,,524.8,percent of total billed charges,80% of total billed charges,98.4,100,,,fee schedule,100% of GA fee schedule,697,85,,557.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,41.75,93,,,fee schedule,93% of CMS fee schedule,647.8,79,,518.24,percent of total billed charges,79% of total billed charges,44.89,100,,,fee schedule,100% of CMS fee schedule,44.89,100,,,fee schedule,100% of CMS fee schedule,41.75,779,
CONGO RED,300008821,CDM,310,RC,P2029,HCPCS,outpatient,,,193,135.1,,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,173.7,90,,138.96,percent of total billed charges,90% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,7.92,160,,,fee schedule,160% of CMS fee schedule,6.44,130,,,fee schedule,130% of CMS fee schedule,121.59,63,,97.27,percent of total billed charges,63% of total billed charges,149.03,77.22,,119.22,percent of total billed charges,77.22% of total billed charges,127.57,66.1,,102.06,percent of total billed charges,66.1% of total billed charges,160.19,83,,128.15,percent of total billed charges,83% of total,183.35,95,,146.68,percent of total billed charges ,95% of total billed charges,154.4,80,,123.52,percent of total billed charges,78% of total billed charges,150.54,78,,120.432,percent of total billed charges,78% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,121.59,63,,97.27,percent of total billed charges,63% of total billed charges,4.95,100,,,fee schedule,100% of CMS 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,121.59,63,,97.27,percent of total billed charges,63% of total billed charges,164.05,85,,131.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.6,93,,,fee schedule,93% of CMS fee schedule,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,4.95,100,,,fee schedule,100% of CMS fee schedule,4.95,100,,,fee schedule,100% of CMS fee schedule,4.6,450,
MICROSAT INSTA HNPCC STAIN CP,300008898,CDM,310,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MOLECULAR PATHOLOGY PROC LEV 6,300009248,CDM,310,RC,81405,HCPCS,outpatient,,,1379,965.3,,1089.41,79,,871.53,percent of total billed charges,79% of total billed charges,1241.1,90,,992.88,percent of total billed charges,90% of total billed charges,301.35,100,,,fee schedule,100% of CMS fee schedule,482.16,160,,,fee schedule,160% of CMS fee schedule,391.76,130,,,fee schedule,130% of CMS fee schedule,360,100,,,fee schedule,100% of GA fee schedule,1064.86,77.22,,851.89,percent of total billed charges,77.22% of total billed charges,378,105,,,fee schedule,105% of GA fee schedule,1144.57,83,,915.66,percent of total billed charges,83% of total,1310.05,95,,1048.04,percent of total billed charges ,95% of total billed charges,1103.2,80,,882.56,percent of total billed charges,78% of total billed charges,1075.62,78,,860.496,percent of total billed charges,78% of total billed charges,301.35,100,,,fee schedule,100% of CMS fee schedule,360,100,,,fee schedule,100% of GA fee schedule,301.35,100,,,fee schedule,100% of CMS fee schedule,1241.1,90,,992.88,percent of total billed charges,90% of total billed charges,1103.2,80,,882.56,percent of total billed charges,80% of total billed charges,360,100,,,fee schedule,100% of GA fee schedule,1172.15,85,,937.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,280.26,93,,,fee schedule,93% of CMS fee schedule,1089.41,79,,871.53,percent of total billed charges,79% of total billed charges,301.35,100,,,fee schedule,100% of CMS fee schedule,301.35,100,,,fee schedule,100% of CMS fee schedule,280.26,1310.05,
CHROMIC LYMPHOCYTIC LEUKEMIA,300009257,CDM,310,RC,81263,HCPCS,outpatient,,,557,389.9,,440.03,79,,352.02,percent of total billed charges,79% of total billed charges,501.3,90,,401.04,percent of total billed charges,90% of total billed charges,294.52,100,,,fee schedule,100% of CMS fee schedule,471.23,160,,,fee schedule,160% of CMS fee schedule,382.88,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,430.12,77.22,,344.1,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,462.31,83,,369.85,percent of total billed charges,83% of total,529.15,95,,423.32,percent of total billed charges ,95% of total billed charges,445.6,80,,356.48,percent of total billed charges,78% of total billed charges,434.46,78,,347.568,percent of total billed charges,78% of total billed charges,294.52,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,294.52,100,,,fee schedule,100% of CMS fee schedule,501.3,90,,401.04,percent of total billed charges,90% of total billed charges,445.6,80,,356.48,percent of total billed charges,80% of total billed charges,98.4,100,,,fee schedule,100% of GA fee schedule,473.45,85,,378.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,273.9,93,,,fee schedule,93% of CMS fee schedule,440.03,79,,352.02,percent of total billed charges,79% of total billed charges,294.52,100,,,fee schedule,100% of CMS fee schedule,294.52,100,,,fee schedule,100% of CMS fee schedule,98.4,529.15,
JAK2 MUTATION QUANT,300009267,CDM,310,RC,81270,HCPCS,outpatient,,,903,632.1,,713.37,79,,570.7,percent of total billed charges,79% of total billed charges,812.7,90,,650.16,percent of total billed charges,90% of total billed charges,91.66,100,,,fee schedule,100% of CMS fee schedule,146.66,160,,,fee schedule,160% of CMS fee schedule,119.16,130,,,fee schedule,130% of CMS fee schedule,72,100,,,fee schedule,100% of GA fee schedule,697.3,77.22,,557.84,percent of total billed charges,77.22% of total billed charges,75.6,105,,,fee schedule,105% of GA fee schedule,749.49,83,,599.59,percent of total billed charges,83% of total,857.85,95,,686.28,percent of total billed charges ,95% of total billed charges,722.4,80,,577.92,percent of total billed charges,78% of total billed charges,704.34,78,,563.472,percent of total billed charges,78% of total billed charges,91.66,100,,,fee schedule,100% of CMS fee schedule,72,100,,,fee schedule,100% of GA fee schedule,91.66,100,,,fee schedule,100% of CMS 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,72,100,,,fee schedule,100% of GA fee schedule,767.55,85,,614.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.24,93,,,fee schedule,93% of CMS fee schedule,713.37,79,,570.7,percent of total billed charges,79% of total billed charges,91.66,100,,,fee schedule,100% of CMS fee schedule,91.66,100,,,fee schedule,100% of CMS fee schedule,72,857.85,
P190 BCR,300009273,CDM,310,RC,81207,HCPCS,outpatient,,,321,224.7,,253.59,79,,202.87,percent of total billed charges,79% of total billed charges,288.9,90,,231.12,percent of total billed charges,90% of total billed charges,144.84,100,,,fee schedule,100% of CMS fee schedule,231.74,160,,,fee schedule,160% of CMS fee schedule,188.29,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,247.88,77.22,,198.3,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,266.43,83,,213.14,percent of total billed charges,83% of total,304.95,95,,243.96,percent of total billed charges ,95% of total billed charges,256.8,80,,205.44,percent of total billed charges,78% of total billed charges,250.38,78,,200.304,percent of total billed charges,78% of total billed charges,144.84,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,144.84,100,,,fee schedule,100% of CMS 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,98.4,100,,,fee schedule,100% of GA fee schedule,272.85,85,,218.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,134.7,93,,,fee schedule,93% of CMS fee schedule,253.59,79,,202.87,percent of total billed charges,79% of total billed charges,144.84,100,,,fee schedule,100% of CMS fee schedule,144.84,100,,,fee schedule,100% of CMS fee schedule,98.4,450,
BCR ABL REARRANGE,300009274,CDM,310,RC,81206,HCPCS,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,163.96,100,,,fee schedule,100% of CMS fee schedule,262.34,160,,,fee schedule,160% of CMS fee schedule,213.15,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,163.96,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,163.96,100,,,fee schedule,100% of CMS fee schedule,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,98.4,100,,,fee schedule,100% of GA fee schedule,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,152.48,93,,,fee schedule,93% of CMS fee schedule,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,163.96,100,,,fee schedule,100% of CMS fee schedule,163.96,100,,,fee schedule,100% of CMS fee schedule,98.4,450,
MOLECULAR PATHOLOGY PROC LEV 4,300009275,CDM,310,RC,81403,HCPCS,outpatient,,,497,347.9,,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,296.32,160,,,fee schedule,160% of CMS fee schedule,240.76,130,,,fee schedule,130% of CMS fee schedule,188,100,,,fee schedule,100% of GA fee schedule,383.78,77.22,,307.02,percent of total billed charges,77.22% of total billed charges,197.4,105,,,fee schedule,105% of GA fee schedule,412.51,83,,330.01,percent of total billed charges,83% of total,472.15,95,,377.72,percent of total billed charges ,95% of total billed charges,397.6,80,,318.08,percent of total billed charges,78% of total billed charges,387.66,78,,310.128,percent of total billed charges,78% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,188,100,,,fee schedule,100% of GA fee schedule,185.2,100,,,fee schedule,100% of CMS fee schedule,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,397.6,80,,318.08,percent of total billed charges,80% of total billed charges,188,100,,,fee schedule,100% of GA fee schedule,422.45,85,,337.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,172.24,93,,,fee schedule,93% of CMS fee schedule,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,185.2,100,,,fee schedule,100% of CMS fee schedule,172.24,472.15,
ALPHA GLOBULIN COMMON MUTATION,300009277,CDM,310,RC,81257,HCPCS,outpatient,,,781,546.7,,616.99,79,,493.59,percent of total billed charges,79% of total billed charges,702.9,90,,562.32,percent of total billed charges,90% of total billed charges,102.26,100,,,fee schedule,100% of CMS fee schedule,163.62,160,,,fee schedule,160% of CMS fee schedule,132.94,130,,,fee schedule,130% of CMS fee schedule,188,100,,,fee schedule,100% of GA fee schedule,603.09,77.22,,482.47,percent of total billed charges,77.22% of total billed charges,197.4,105,,,fee schedule,105% of GA fee schedule,648.23,83,,518.58,percent of total billed charges,83% of total,741.95,95,,593.56,percent of total billed charges ,95% of total billed charges,624.8,80,,499.84,percent of total billed charges,78% of total billed charges,609.18,78,,487.344,percent of total billed charges,78% of total billed charges,102.26,100,,,fee schedule,100% of CMS fee schedule,188,100,,,fee schedule,100% of GA fee schedule,102.26,100,,,fee schedule,100% of CMS fee schedule,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,188,100,,,fee schedule,100% of GA fee schedule,663.85,85,,531.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,95.1,93,,,fee schedule,93% of CMS fee schedule,616.99,79,,493.59,percent of total billed charges,79% of total billed charges,102.26,100,,,fee schedule,100% of CMS fee schedule,102.26,100,,,fee schedule,100% of CMS fee schedule,95.1,741.95,
CHRONIC LYMPHOCYTIC,300009284,CDM,310,RC,81263,HCPCS,outpatient,,,557,389.9,,440.03,79,,352.02,percent of total billed charges,79% of total billed charges,501.3,90,,401.04,percent of total billed charges,90% of total billed charges,294.52,100,,,fee schedule,100% of CMS fee schedule,471.23,160,,,fee schedule,160% of CMS fee schedule,382.88,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,430.12,77.22,,344.1,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,462.31,83,,369.85,percent of total billed charges,83% of total,529.15,95,,423.32,percent of total billed charges ,95% of total billed charges,445.6,80,,356.48,percent of total billed charges,78% of total billed charges,434.46,78,,347.568,percent of total billed charges,78% of total billed charges,294.52,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,294.52,100,,,fee schedule,100% of CMS fee schedule,501.3,90,,401.04,percent of total billed charges,90% of total billed charges,445.6,80,,356.48,percent of total billed charges,80% of total billed charges,98.4,100,,,fee schedule,100% of GA fee schedule,473.45,85,,378.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,273.9,93,,,fee schedule,93% of CMS fee schedule,440.03,79,,352.02,percent of total billed charges,79% of total billed charges,294.52,100,,,fee schedule,100% of CMS fee schedule,294.52,100,,,fee schedule,100% of CMS fee schedule,98.4,529.15,
CAH 21 HYDROXYLASE (CYP21),300009300,CDM,310,RC,81402,HCPCS,outpatient,,,525,367.5,,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,472.5,90,,378,percent of total billed charges,90% of total billed charges,150.33,100,,,fee schedule,100% of CMS fee schedule,240.53,160,,,fee schedule,160% of CMS fee schedule,195.43,130,,,fee schedule,130% of CMS fee schedule,164,100,,,fee schedule,100% of GA fee schedule,405.41,77.22,,324.33,percent of total billed charges,77.22% of total billed charges,172.2,105,,,fee schedule,105% of GA fee schedule,435.75,83,,348.6,percent of total billed charges,83% of total,498.75,95,,399,percent of total billed charges ,95% of total billed charges,420,80,,336,percent of total billed charges,78% of total billed charges,409.5,78,,327.6,percent of total billed charges,78% of total billed charges,150.33,100,,,fee schedule,100% of CMS fee schedule,164,100,,,fee schedule,100% of GA fee schedule,150.33,100,,,fee schedule,100% of CMS fee schedule,472.5,90,,378,percent of total billed charges,90% of total billed charges,420,80,,336,percent of total billed charges,80% of total billed charges,164,100,,,fee schedule,100% of GA fee schedule,446.25,85,,357,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,139.81,93,,,fee schedule,93% of CMS fee schedule,414.75,79,,331.8,percent of total billed charges,79% of total billed charges,150.33,100,,,fee schedule,100% of CMS fee schedule,150.33,100,,,fee schedule,100% of CMS fee schedule,139.81,498.75,
HEMOPHILIA B GENETIC,300081238,CDM,310,RC,81238,HCPCS,outpatient,,,2700,1890,,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,2430,90,,1944,percent of total billed charges,90% of total billed charges,600,100,,,fee schedule,100% of CMS fee schedule,960,160,,,fee schedule,160% of CMS fee schedule,780,130,,,fee schedule,130% of CMS fee schedule,480,100,,,fee schedule,100% of GA fee schedule,2084.94,77.22,,1667.95,percent of total billed charges,77.22% of total billed charges,504,105,,,fee schedule,105% of GA fee schedule,2241,83,,1792.8,percent of total billed charges,83% of total,2565,95,,2052,percent of total billed charges ,95% of total billed charges,2160,80,,1728,percent of total billed charges,78% of total billed charges,2106,78,,1684.8,percent of total billed charges,78% of total billed charges,600,100,,,fee schedule,100% of CMS fee schedule,480,100,,,fee schedule,100% of GA fee schedule,600,100,,,fee schedule,100% of CMS fee schedule,2430,90,,1944,percent of total billed charges,90% of total billed charges,2160,80,,1728,percent of total billed charges,80% of total billed charges,480,100,,,fee schedule,100% of GA fee schedule,2295,85,,1836,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,558,93,,,fee schedule,93% of CMS fee schedule,2133,79,,1706.4,percent of total billed charges,79% of total billed charges,600,100,,,fee schedule,100% of CMS fee schedule,600,100,,,fee schedule,100% of CMS fee schedule,450,2565,
PML RARA QUANT/RT-PCR,300081315,CDM,310,RC,81315,HCPCS,outpatient,,,419,293.3,,331.01,79,,264.81,percent of total billed charges,79% of total billed charges,377.1,90,,301.68,percent of total billed charges,90% of total billed charges,207.31,100,,,fee schedule,100% of CMS fee schedule,331.7,160,,,fee schedule,160% of CMS fee schedule,269.5,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,323.55,77.22,,258.84,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,347.77,83,,278.22,percent of total billed charges,83% of total,398.05,95,,318.44,percent of total billed charges ,95% of total billed charges,335.2,80,,268.16,percent of total billed charges,78% of total billed charges,326.82,78,,261.456,percent of total billed charges,78% of total billed charges,207.31,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,207.31,100,,,fee schedule,100% of CMS 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,98.4,100,,,fee schedule,100% of GA fee schedule,356.15,85,,284.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.8,93,,,fee schedule,93% of CMS fee schedule,331.01,79,,264.81,percent of total billed charges,79% of total billed charges,207.31,100,,,fee schedule,100% of CMS fee schedule,207.31,100,,,fee schedule,100% of CMS fee schedule,98.4,450,
SPINAL MUSCULAR ATROPHY,300081329,CDM,310,RC,81329,HCPCS,outpatient,,,1000,700,,790,79,,632,percent of total billed charges,79% of total billed charges,900,90,,720,percent of total billed charges,90% of total billed charges,137,100,,,fee schedule,100% of CMS fee schedule,219.2,160,,,fee schedule,160% of CMS fee schedule,178.1,130,,,fee schedule,130% of CMS fee schedule,109.6,100,,,fee schedule,100% of GA fee schedule,772.2,77.22,,617.76,percent of total billed charges,77.22% of total billed charges,115.08,105,,,fee schedule,105% of GA fee schedule,830,83,,664,percent of total billed charges,83% of total,950,95,,760,percent of total billed charges ,95% of total billed charges,800,80,,640,percent of total billed charges,78% of total billed charges,780,78,,624,percent of total billed charges,78% of total billed charges,137,100,,,fee schedule,100% of CMS fee schedule,109.6,100,,,fee schedule,100% of GA fee schedule,137,100,,,fee schedule,100% of CMS fee schedule,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,109.6,100,,,fee schedule,100% of GA fee schedule,850,85,,680,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,127.41,93,,,fee schedule,93% of CMS fee schedule,790,79,,632,percent of total billed charges,79% of total billed charges,137,100,,,fee schedule,100% of CMS fee schedule,137,100,,,fee schedule,100% of CMS fee schedule,109.6,950,
HLA DQ 2,300081377,CDM,310,RC,81377,HCPCS,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,94.74,100,,,fee schedule,100% of CMS fee schedule,151.58,160,,,fee schedule,160% of CMS fee schedule,123.16,130,,,fee schedule,130% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,42,105,,,fee schedule,105% of GA fee schedule,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,94.74,100,,,fee schedule,100% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,94.74,100,,,fee schedule,100% of CMS 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,40,100,,,fee schedule,100% of GA fee schedule,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,88.11,93,,,fee schedule,93% of CMS fee schedule,296.25,79,,237,percent of total billed charges,79% of total billed charges,94.74,100,,,fee schedule,100% of CMS fee schedule,94.74,100,,,fee schedule,100% of CMS fee schedule,40,450,
HEMOPHILIA A,300081403,CDM,310,RC,81403,HCPCS,outpatient,,,497,347.9,,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,296.32,160,,,fee schedule,160% of CMS fee schedule,240.76,130,,,fee schedule,130% of CMS fee schedule,188,100,,,fee schedule,100% of GA fee schedule,383.78,77.22,,307.02,percent of total billed charges,77.22% of total billed charges,197.4,105,,,fee schedule,105% of GA fee schedule,412.51,83,,330.01,percent of total billed charges,83% of total,472.15,95,,377.72,percent of total billed charges ,95% of total billed charges,397.6,80,,318.08,percent of total billed charges,78% of total billed charges,387.66,78,,310.128,percent of total billed charges,78% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,188,100,,,fee schedule,100% of GA fee schedule,185.2,100,,,fee schedule,100% of CMS fee schedule,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,397.6,80,,318.08,percent of total billed charges,80% of total billed charges,188,100,,,fee schedule,100% of GA fee schedule,422.45,85,,337.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,172.24,93,,,fee schedule,93% of CMS fee schedule,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,185.2,100,,,fee schedule,100% of CMS fee schedule,185.2,100,,,fee schedule,100% of CMS fee schedule,172.24,472.15,
LONG CHAIN 3 OH,300081479,CDM,310,RC,81479,HCPCS,outpatient,,,550,385,,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,495,90,,396,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,890.08,100,,,fee schedule,100% of GA fee schedule,424.71,77.22,,339.77,percent of total billed charges,77.22% of total billed charges,934.58,105,,,fee schedule,105% of GA fee schedule,456.5,83,,365.2,percent of total billed charges,83% of total,522.5,95,,418,percent of total billed charges ,95% of total billed charges,440,80,,352,percent of total billed charges,78% of total billed charges,429,78,,343.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,890.08,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,495,90,,396,percent of total billed charges,90% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,890.08,100,,,fee schedule,100% of GA fee schedule,467.5,85,,374,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,424.71,934.58,
HLA DQ 8,308137759,CDM,310,RC,81377,HCPCS,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,94.74,100,,,fee schedule,100% of CMS fee schedule,151.58,160,,,fee schedule,160% of CMS fee schedule,123.16,130,,,fee schedule,130% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,42,105,,,fee schedule,105% of GA fee schedule,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,94.74,100,,,fee schedule,100% of CMS fee schedule,40,100,,,fee schedule,100% of GA fee schedule,94.74,100,,,fee schedule ,100% of CMS 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,40,100,,,fee schedule,100% of GA fee schedule,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,88.11,93,,,fee schedule,93% of CMS fee schedule,296.25,79,,237,percent of total billed charges,79% of total billed charges,94.74,100,,,fee schedule,100% of CMS fee schedule,94.74,100,,,fee schedule,100% of CMS fee schedule,40,450,
GI PATHOGEN 22 TARGETS,310000097,CDM,310,RC,87507,HCPCS,outpatient,,,1467,1026.9,,1158.93,79,,927.14,percent of total billed charges,79% of total billed charges,1320.3,90,,1056.24,percent of total billed charges,90% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,666.85,160,,,fee schedule,160% of CMS fee schedule,541.81,130,,,fee schedule,130% of CMS fee schedule,333.42,100,,,fee schedule,100% of GA fee schedule,1132.82,77.22,,906.26,percent of total billed charges,77.22% of total billed charges,350.09,105,,,fee schedule,105% of GA fee schedule,1217.61,83,,974.09,percent of total billed charges,83% of total,1393.65,95,,1114.92,percent of total billed charges ,95% of total billed charges,1173.6,80,,938.88,percent of total billed charges,78% of total billed charges,1144.26,78,,915.408,percent of total billed charges,78% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,333.42,100,,,fee schedule,100% of GA fee schedule,416.78,100,,,fee schedule ,100% of CMS fee schedule,1320.3,90,,1056.24,percent of total billed charges,90% of total billed charges,1173.6,80,,938.88,percent of total billed charges,80% of total billed charges,333.42,100,,,fee schedule,100% of GA fee schedule,1246.95,85,,997.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,387.61,93,,,fee schedule,93% of CMS fee schedule,1158.93,79,,927.14,percent of total billed charges,79% of total billed charges,416.78,100,,,fee schedule,100% of CMS fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,333.42,1393.65,
PAPSMEAR,310000393,CDM,310,RC,,,outpatient,,,23,16.1,,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,20.7,90,,16.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,17.76,77.22,,14.21,percent of total billed charges,77.22% of total billed charges,15.2,66.1,,12.16,percent of total billed charges,66.1% of total billed charges,19.09,83,,15.27,percent of total billed charges,83% of total,21.85,95,,17.48,percent of total billed charges ,95% of total billed charges,18.4,80,,14.72,percent of total billed charges,78% of total billed charges,17.94,78,,14.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,14.49,63,,11.59,percent of total billed charges,63% of total billed charges,19.55,85,,15.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,18.17,79,,14.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.49,450,
PATHOLOGY NON BILLABLE CHG,310040902,CDM,310,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PMP22 DELETION/DUPLICATION,310081324,CDM,310,RC,81324,HCPCS,outpatient,,,742,519.4,,586.18,79,,468.94,percent of total billed charges,79% of total billed charges,667.8,90,,534.24,percent of total billed charges,90% of total billed charges,758.36,100,,,fee schedule,100% of CMS fee schedule,1213.38,160,,,fee schedule,160% of CMS fee schedule,985.87,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,572.97,77.22,,458.38,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,615.86,83,,492.69,percent of total billed charges,83% of total,704.9,95,,563.92,percent of total billed charges ,95% of total billed charges,593.6,80,,474.88,percent of total billed charges,78% of total billed charges,578.76,78,,463.008,percent of total billed charges,78% of total billed charges,758.36,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,758.36,100,,,fee schedule ,100% of CMS fee schedule,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,98.4,100,,,fee schedule,100% of GA fee schedule,630.7,85,,504.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,705.27,93,,,fee schedule,93% of CMS fee schedule,586.18,79,,468.94,percent of total billed charges,79% of total billed charges,758.36,100,,,fee schedule,100% of CMS fee schedule,758.36,100,,,fee schedule,100% of CMS fee schedule,98.4,1213.38,
THIOPURINE TPMT GENOTYPE,310081335,CDM,310,RC,81335,HCPCS,outpatient,,,500,350,,395,79,,316,percent of total billed charges,79% of total billed charges,450,90,,360,percent of total billed charges,90% of total billed charges,174.81,100,,,fee schedule,100% of CMS fee schedule,279.7,160,,,fee schedule,160% of CMS fee schedule,227.25,130,,,fee schedule,130% of CMS fee schedule,139.85,100,,,fee schedule,100% of GA fee schedule,386.1,77.22,,308.88,percent of total billed charges,77.22% of total billed charges,146.84,105,,,fee schedule,105% of GA fee schedule,415,83,,332,percent of total billed charges,83% of total,475,95,,380,percent of total billed charges ,95% of total billed charges,400,80,,320,percent of total billed charges,78% of total billed charges,390,78,,312,percent of total billed charges,78% of total billed charges,174.81,100,,,fee schedule,100% of CMS fee schedule,139.85,100,,,fee schedule,100% of GA fee schedule,174.81,100,,,fee schedule ,100% of CMS 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,139.85,100,,,fee schedule,100% of GA fee schedule,425,85,,340,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,162.57,93,,,fee schedule,93% of CMS fee schedule,395,79,,316,percent of total billed charges,79% of total billed charges,174.81,100,,,fee schedule,100% of CMS fee schedule,174.81,100,,,fee schedule,100% of CMS fee schedule,139.85,475,
ACADVL GENESEQ PLUS,310081406,CDM,310,RC,81406,HCPCS,outpatient,,,1500,1050,,1185,79,,948,percent of total billed charges,79% of total billed charges,1350,90,,1080,percent of total billed charges,90% of total billed charges,282.88,100,,,fee schedule,100% of CMS fee schedule,452.61,160,,,fee schedule,160% of CMS fee schedule,367.74,130,,,fee schedule,130% of CMS fee schedule,520,100,,,fee schedule,100% of GA fee schedule,1158.3,77.22,,926.64,percent of total billed charges,77.22% of total billed charges,546,105,,,fee schedule,105% of GA fee schedule,1245,83,,996,percent of total billed charges,83% of total,1425,95,,1140,percent of total billed charges ,95% of total billed charges,1200,80,,960,percent of total billed charges,78% of total billed charges,1170,78,,936,percent of total billed charges,78% of total billed charges,282.88,100,,,fee schedule,100% of CMS fee schedule,520,100,,,fee schedule,100% of GA fee schedule,282.88,100,,,fee schedule ,100% of CMS fee schedule,1350,90,,1080,percent of total billed charges,90% of total billed charges,1200,80,,960,percent of total billed charges,80% of total billed charges,520,100,,,fee schedule,100% of GA fee schedule,1275,85,,1020,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,263.08,93,,,fee schedule,93% of CMS fee schedule,1185,79,,948,percent of total billed charges,79% of total billed charges,282.88,100,,,fee schedule,100% of CMS fee schedule,282.88,100,,,fee schedule,100% of CMS fee schedule,263.08,1425,
MATERNI T21 PLUS CORE,310081420,CDM,310,RC,81420,HCPCS,outpatient,,,1789,1252.3,,1413.31,79,,1130.65,percent of total billed charges,79% of total billed charges,1610.1,90,,1288.08,percent of total billed charges,90% of total billed charges,759.05,100,,,fee schedule,100% of CMS fee schedule,1214.48,160,,,fee schedule,160% of CMS fee schedule,986.77,130,,,fee schedule,130% of CMS fee schedule,641.86,100,,,fee schedule,100% of GA fee schedule,1381.47,77.22,,1105.18,percent of total billed charges,77.22% of total billed charges,673.95,105,,,fee schedule,105% of GA fee schedule,1484.87,83,,1187.9,percent of total billed charges,83% of total,1699.55,95,,1359.64,percent of total billed charges ,95% of total billed charges,1431.2,80,,1144.96,percent of total billed charges,78% of total billed charges,1395.42,78,,1116.336,percent of total billed charges,78% of total billed charges,759.05,100,,,fee schedule,100% of CMS fee schedule,641.86,100,,,fee schedule,100% of GA fee schedule,759.05,100,,,fee schedule ,100% of CMS fee schedule,1610.1,90,,1288.08,percent of total billed charges,90% of total billed charges,1431.2,80,,1144.96,percent of total billed charges,80% of total billed charges,641.86,100,,,fee schedule,100% of GA fee schedule,1520.65,85,,1216.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,705.92,93,,,fee schedule,93% of CMS fee schedule,1413.31,79,,1130.65,percent of total billed charges,79% of total billed charges,759.05,100,,,fee schedule,100% of CMS fee schedule,759.05,100,,,fee schedule,100% of CMS fee schedule,450,1699.55,
BRAF GENE,310088109,CDM,310,RC,81210,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,175.4,100,,,fee schedule,100% of CMS fee schedule,280.64,160,,,fee schedule,160% of CMS fee schedule,228.02,130,,,fee schedule,130% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,103.32,105,,,fee schedule,105% of GA fee schedule,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,175.4,100,,,fee schedule,100% of CMS fee schedule,98.4,100,,,fee schedule,100% of GA fee schedule,175.4,100,,,fee schedule ,100% of CMS 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,98.4,100,,,fee schedule,100% of GA fee schedule,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,163.12,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,175.4,100,,,fee schedule,100% of CMS fee schedule,175.4,100,,,fee schedule,100% of CMS fee schedule,64.86,450,
CORD BLOOD WORKUP,390000249,CDM,310,RC,,,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,450,
CHROMOSONE,300008065,CDM,311,RC,88237,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,230,160,,,fee schedule,160% of CMS fee schedule,186.88,130,,,fee schedule,130% of CMS fee schedule,111.02,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,116.57,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,111.02,100,,,fee schedule,100% of GA fee schedule,143.75,100,,,fee schedule,100% of CMS 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,111.02,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,133.69,93,,,fee schedule,93% of CMS fee schedule,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,143.75,100,,,fee schedule,100% of CMS fee schedule,37.07,450,
COUNT 15-20 CELLS KARYOTYPES,300008374,CDM,311,RC,88262,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,200.78,160,,,fee schedule,160% of CMS fee schedule,163.14,130,,,fee schedule,130% of CMS fee schedule,156.73,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,164.57,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,156.73,100,,,fee schedule,100% of GA fee schedule,125.49,100,,,fee schedule,100% of CMS fee schedule,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,156.73,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,116.71,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,125.49,100,,,fee schedule,100% of CMS fee schedule,116.71,450,
TISSUE CULTURE NEOPLASTIC DISO,300008375,CDM,311,RC,88230,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,116.49,100,,,fee schedule,100% of CMS fee schedule,186.38,160,,,fee schedule,160% of CMS fee schedule,151.44,130,,,fee schedule,130% of CMS fee schedule,146.49,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,153.81,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,116.49,100,,,fee schedule,100% of CMS fee schedule,146.49,100,,,fee schedule,100% of GA fee schedule,116.49,100,,,fee schedule,100% of CMS fee schedule,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,146.49,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,108.34,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,116.49,100,,,fee schedule,100% of CMS fee schedule,116.49,100,,,fee schedule,100% of CMS fee schedule,108.34,450,
ADDITIONAL HIGH RESOLUTION,300008644,CDM,311,RC,88291,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,26.66,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,25.39,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.39,450,
TISSUE CULTURE NEOPLASTIC,300008749,CDM,311,RC,88239,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,147.52,100,,,fee schedule,100% of CMS fee schedule,236.03,160,,,fee schedule,160% of CMS fee schedule,191.78,130,,,fee schedule,130% of CMS fee schedule,185.51,100,,,fee schedule,100% of GA fee schedule,207.72,77.22,,166.18,percent of total billed charges,77.22% of total billed charges,194.79,105,,,fee schedule,105% of GA fee schedule,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,147.52,100,,,fee schedule,100% of CMS fee schedule,185.51,100,,,fee schedule,100% of GA fee schedule,147.52,100,,,fee schedule,100% of CMS fee schedule,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,185.51,100,,,fee schedule,100% of GA fee schedule,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,137.19,93,,,fee schedule,93% of CMS fee schedule,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,147.52,100,,,fee schedule,100% of CMS fee schedule,147.52,100,,,fee schedule,100% of CMS fee schedule,137.19,450,
COUNT 15-20 CELLS,300008750,CDM,311,RC,88262,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,200.78,160,,,fee schedule,160% of CMS fee schedule,163.14,130,,,fee schedule,130% of CMS fee schedule,156.73,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,164.57,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,156.73,100,,,fee schedule,100% of GA fee schedule,125.49,100,,,fee schedule,100% of CMS fee schedule,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,156.73,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,116.71,93,,,fee schedule,93% of CMS fee schedule,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,125.49,100,,,fee schedule,100% of CMS fee schedule,125.49,100,,,fee schedule,100% of CMS fee schedule,116.71,450,
CHROMOSOME ANALYSIS ADDITIONAL,300008751,CDM,311,RC,88280,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,33.47,100,,,fee schedule,100% of CMS fee schedule,53.55,160,,,fee schedule,160% of CMS fee schedule,43.51,130,,,fee schedule,130% of CMS fee schedule,31.56,100,,,fee schedule,100% of GA fee schedule,207.72,77.22,,166.18,percent of total billed charges,77.22% of total billed charges,33.14,105,,,fee schedule,105% of GA fee schedule,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,33.47,100,,,fee schedule,100% of CMS fee schedule,31.56,100,,,fee schedule,100% of GA fee schedule,33.47,100,,,fee schedule,100% of CMS fee schedule,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,31.56,100,,,fee schedule,100% of GA fee schedule,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.13,93,,,fee schedule,93% of CMS fee schedule,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,33.47,100,,,fee schedule,100% of CMS fee schedule,33.47,100,,,fee schedule,100% of CMS fee schedule,31.13,450,
CYTO/MOLECULAR REPORT,300008752,CDM,311,RC,88291,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,26.66,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,25.39,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.39,450,
MOLECULAR CYTO,300008754,CDM,311,RC,88271,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,34.27,160,,,fee schedule,160% of CMS fee schedule,27.85,130,,,fee schedule,130% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,28.29,105,,,fee schedule,105% of GA fee schedule,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,21.42,100,,,fee schedule,100% of CMS 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,26.94,100,,,fee schedule,100% of GA fee schedule,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.92,93,,,fee schedule,93% of CMS fee schedule,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of CMS fee schedule,19.92,613.7,
CYTOGENETICS 10-30 CELLS,300008755,CDM,311,RC,88273,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,34.81,100,,,fee schedule,100% of CMS fee schedule,55.7,160,,,fee schedule,160% of CMS fee schedule,45.25,130,,,fee schedule,130% of CMS fee schedule,40.4,100,,,fee schedule,100% of GA fee schedule,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,42.42,105,,,fee schedule,105% of GA fee schedule,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,34.81,100,,,fee schedule,100% of CMS fee schedule,40.4,100,,,fee schedule,100% of GA fee schedule,34.81,100,,,fee schedule,100% of CMS 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,40.4,100,,,fee schedule,100% of GA fee schedule,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,32.37,93,,,fee schedule,93% of CMS fee schedule,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,34.81,100,,,fee schedule,100% of CMS fee schedule,34.81,100,,,fee schedule,100% of CMS fee schedule,32.37,613.7,
CYTOGENETICS GENZYME REPORT,300008782,CDM,311,RC,88291,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,26.66,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,25.39,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.39,450,
BONE MARROW CULTURE;NEOPLASTIC,300008929,CDM,311,RC,88237,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,230,160,,,fee schedule,160% of CMS fee schedule,186.88,130,,,fee schedule,130% of CMS fee schedule,111.02,100,,,fee schedule,100% of GA fee schedule,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,116.57,105,,,fee schedule,105% of GA fee schedule,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,111.02,100,,,fee schedule,100% of GA fee schedule,143.75,100,,,fee schedule,100% of CMS 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,111.02,100,,,fee schedule,100% of GA fee schedule,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,133.69,93,,,fee schedule,93% of CMS fee schedule,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,143.75,100,,,fee schedule,100% of CMS fee schedule,143.75,100,,,fee schedule,100% of CMS fee schedule,37.07,450,
NEUTROPHIL RECEPTOR,300008984,CDM,311,RC,88184,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,48.41,105,,,fee schedule,105% of GA fee schedule,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,46.1,100,,,fee schedule,100% of GA fee schedule,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,480.89,
PNH PROFILE,300008986,CDM,311,RC,88184,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,48.41,105,,,fee schedule,105% of GA fee schedule,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,46.1,100,,,fee schedule,100% of GA fee schedule,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,480.89,
FLOW CYTOMETRY,300008992,CDM,311,RC,88184,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,48.41,105,,,fee schedule,105% of GA fee schedule,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,46.1,100,,,fee schedule,100% of GA fee schedule,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,480.89,
FLOW CYTOMETRY EA ADD MARKER,300008993,CDM,311,RC,88185,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,23.8,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.67,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.67,450,
FLOW CYTOMETRY EA ADD MARKER,300008994,CDM,311,RC,88185,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,23.8,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.67,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.67,450,
DNA PROBE EA FISH #1,300009082,CDM,311,RC,88271,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,34.27,160,,,fee schedule,160% of CMS fee schedule,27.85,130,,,fee schedule,130% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,28.29,105,,,fee schedule,105% of GA fee schedule,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,21.42,100,,,fee schedule,100% of CMS 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,26.94,100,,,fee schedule,100% of GA fee schedule,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.92,93,,,fee schedule,93% of CMS fee schedule,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of CMS fee schedule,19.92,613.7,
DNA PROBE EA FISH #2,300009083,CDM,311,RC,88271,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,34.27,160,,,fee schedule,160% of CMS fee schedule,27.85,130,,,fee schedule,130% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,28.29,105,,,fee schedule,105% of GA fee schedule,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,21.42,100,,,fee schedule,100% of CMS 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,26.94,100,,,fee schedule,100% of GA fee schedule,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.92,93,,,fee schedule,93% of CMS fee schedule,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of CMS fee schedule,19.92,613.7,
CYTOGENTIC & MOLECULAR INTERPR,300009085,CDM,311,RC,88291,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,26.66,105,,,fee schedule,105% of GA fee schedule,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,25.39,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,25.39,100,,,fee schedule,100% of GA fee schedule,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.39,450,
IMMUNODEFFICIENCY PANEL,300009097,CDM,311,RC,88182,HCPCS,outpatient,,,470,329,,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,72.49,160,,,Fee Schedule,160% of CMS OPPS rate,58.9,130,,,Fee Schedule,130% of CMS OPPS rate,66.96,100,,,fee schedule,100% of GA fee schedule,362.93,77.22,,290.34,percent of total billed charges,77.22% of total billed charges,70.31,105,,,fee schedule,105% of GA fee schedule,390.1,83,,312.08,percent of total billed charges,83% of total,446.5,95,,357.2,percent of total billed charges ,95% of total billed charges,376,80,,300.8,percent of total billed charges,78% of total billed charges,366.6,78,,293.28,percent of total billed charges,78% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,66.96,100,,,fee schedule,100% of GA fee schedule,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,66.96,100,,,fee schedule,100% of GA fee schedule,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,42.13,93,,,fee schedule,93% of CMS OPPS rate,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,42.13,450,
CYTOGENETICS DNA,300009252,CDM,311,RC,88271,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,34.27,160,,,fee schedule,160% of CMS fee schedule,27.85,130,,,fee schedule,130% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,28.29,105,,,fee schedule,105% of GA fee schedule,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,21.42,100,,,fee schedule,100% of CMS 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,26.94,100,,,fee schedule,100% of GA fee schedule,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.92,93,,,fee schedule,93% of CMS fee schedule,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of CMS fee schedule,19.92,613.7,
CYTOGENETICS #2,300009253,CDM,311,RC,88271,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,34.27,160,,,fee schedule,160% of CMS fee schedule,27.85,130,,,fee schedule,130% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,28.29,105,,,fee schedule,105% of GA fee schedule,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,26.94,100,,,fee schedule,100% of GA fee schedule,21.42,100,,,fee schedule,100% of CMS 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,26.94,100,,,fee schedule,100% of GA fee schedule,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.92,93,,,fee schedule,93% of CMS fee schedule,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,21.42,100,,,fee schedule,100% of CMS fee schedule,21.42,100,,,fee schedule,100% of CMS fee schedule,19.92,613.7,
CYTOGENETICS #3,300009254,CDM,311,RC,88275,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,81.9,160,,,fee schedule,160% of CMS fee schedule,66.55,130,,,fee schedule,130% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,53.03,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,51.19,100,,,fee schedule,100% of CMS 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,50.5,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.61,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,51.19,100,,,fee schedule,100% of CMS fee schedule,47.61,450,
CYTOGENETICS #4,300009255,CDM,311,RC,88275,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,81.9,160,,,fee schedule,160% of CMS fee schedule,66.55,130,,,fee schedule,130% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,53.03,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,51.19,100,,,fee schedule,100% of CMS 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,50.5,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.61,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,51.19,100,,,fee schedule,100% of CMS fee schedule,47.61,450,
CYTOGENETICS #5,300009256,CDM,311,RC,88275,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,81.9,160,,,fee schedule,160% of CMS fee schedule,66.55,130,,,fee schedule,130% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,53.03,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,51.19,100,,,fee schedule,100% of CMS 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,50.5,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.61,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,51.19,100,,,fee schedule,100% of CMS fee schedule,47.61,450,
CYTOGENETICS 100-300,300009269,CDM,311,RC,88275,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,81.9,160,,,fee schedule,160% of CMS fee schedule,66.55,130,,,fee schedule,130% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,53.03,105,,,fee schedule,105% of GA fee schedule,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,50.5,100,,,fee schedule,100% of GA fee schedule,51.19,100,,,fee schedule,100% of CMS 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,50.5,100,,,fee schedule,100% of GA fee schedule,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.61,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,51.19,100,,,fee schedule,100% of CMS fee schedule,51.19,100,,,fee schedule,100% of CMS fee schedule,47.61,450,
FLOW CYTOMETRY#3 EA ADD'L MARK,300040935,CDM,311,RC,88185,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,23.8,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.67,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.67,450,
FLOW CYTOMETRY #4 EA ADD'L MAR,300040936,CDM,311,RC,88185,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,23.8,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.67,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.67,450,
FLOW CYTOMETRY #5 EA ADDL MARK,300040937,CDM,311,RC,88185,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,23.8,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.67,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.67,450,
FLOW CYTOMETRY #6 FIRST MARKER,300040938,CDM,311,RC,88184,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,48.41,105,,,fee schedule,105% of GA fee schedule,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,46.1,100,,,fee schedule,100% of GA fee schedule,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,46.1,480.89,
FLOW CYTOMETRY #7 EA ADDL MARK,300040939,CDM,311,RC,88185,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,23.8,105,,,fee schedule,105% of GA fee schedule,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.67,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,22.67,100,,,fee schedule,100% of GA fee schedule,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.67,450,
RHC PAP SMEAR,300800350,CDM,311,RC,88150,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,17.76,100,,,fee schedule,100% of CMS fee schedule,28.42,160,,,fee schedule,160% of CMS fee schedule,23.09,130,,,fee schedule,130% of CMS fee schedule,13.28,100,,,fee schedule,100% of GA fee schedule,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,13.94,105,,,fee schedule,105% of GA fee schedule,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,17.76,100,,,fee schedule,100% of CMS fee schedule,13.28,100,,,fee schedule,100% of GA fee schedule,17.76,100,,,fee schedule,100% of CMS 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,13.28,100,,,fee schedule,100% of GA fee schedule,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.52,93,,,fee schedule,93% of CMS fee schedule,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,17.76,100,,,fee schedule,100% of CMS fee schedule,17.76,100,,,fee schedule,100% of CMS fee schedule,13.28,450,
CYTOPATH OTHER SOURCE,3100088161,CDM,311,RC,88161,HCPCS,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,34.89,100,,,fee schedule,100% of GA fee schedule,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.63,105,,,fee schedule,105% of GA fee schedule,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,34.89,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,34.89,100,,,fee schedule,100% of GA fee schedule,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,23.15,450,
CYTOPATH FLUIDS CONCENTRATION,310088108,CDM,311,RC,88108,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,53.65,160,,,Fee Schedule,160% of CMS OPPS rate,43.59,130,,,Fee Schedule,130% of CMS OPPS rate,45.74,100,,,fee schedule,100% of GA fee schedule,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,48.03,105,,,fee schedule,105% of GA fee schedule,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,45.74,100,,,fee schedule,100% of GA fee schedule,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,45.74,100,,,fee schedule,100% of GA fee schedule,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.18,93,,,fee schedule,93% of CMS OPPS rate,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.18,450,
PATHOLOGY,300008820,CDM,312,RC,88305,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,72.49,160,,,Fee Schedule,160% of CMS OPPS rate,58.9,130,,,Fee Schedule,130% of CMS OPPS rate,65.88,100,,,fee schedule,100% of GA fee schedule,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,69.17,105,,,fee schedule,105% of GA fee schedule,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,65.88,100,,,fee schedule,100% of GA fee schedule,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,65.88,100,,,fee schedule,100% of GA fee schedule,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,42.13,93,,,fee schedule,93% of CMS OPPS rate,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,42.13,450,
TRICHROME,300008822,CDM,312,RC,88314,HCPCS,outpatient,,,179,125.3,,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.62,100,,,fee schedule,100% of GA fee schedule,138.22,77.22,,110.58,percent of total billed charges,77.22% of total billed charges,93.05,105,,,fee schedule,105% of GA fee schedule,148.57,83,,118.86,percent of total billed charges,83% of total,170.05,95,,136.04,percent of total billed charges ,95% of total billed charges,143.2,80,,114.56,percent of total billed charges,78% of total billed charges,139.62,78,,111.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.62,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,88.62,100,,,fee schedule,100% of GA fee schedule,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.62,450,
OIL RED O,300008823,CDM,312,RC,88314,HCPCS,outpatient,,,179,125.3,,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.62,100,,,fee schedule,100% of GA fee schedule,138.22,77.22,,110.58,percent of total billed charges,77.22% of total billed charges,93.05,105,,,fee schedule,105% of GA fee schedule,148.57,83,,118.86,percent of total billed charges,83% of total,170.05,95,,136.04,percent of total billed charges ,95% of total billed charges,143.2,80,,114.56,percent of total billed charges,78% of total billed charges,139.62,78,,111.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.62,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,88.62,100,,,fee schedule,100% of GA fee schedule,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.62,450,
PAS (PERIODIC ACID-SCHIFF),300008824,CDM,312,RC,88314,HCPCS,outpatient,,,179,125.3,,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.62,100,,,fee schedule,100% of GA fee schedule,138.22,77.22,,110.58,percent of total billed charges,77.22% of total billed charges,93.05,105,,,fee schedule,105% of GA fee schedule,148.57,83,,118.86,percent of total billed charges,83% of total,170.05,95,,136.04,percent of total billed charges ,95% of total billed charges,143.2,80,,114.56,percent of total billed charges,78% of total billed charges,139.62,78,,111.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,88.62,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,88.62,100,,,fee schedule,100% of GA fee schedule,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.62,450,
ATPase pH 4.2,300008825,CDM,312,RC,88319,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,1150.41,
ATPase pH 10.4,300008826,CDM,312,RC,88319,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,1150.41,
NADH (TETRAZOLIUM REDUCTASE),300008827,CDM,312,RC,88319,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,1150.41,
SDH (SUCCINATE DEHYDROGENASE),300008828,CDM,312,RC,88319,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,1150.41,
CYTOCHROME C OXIDASE,300008829,CDM,312,RC,88319,HCPCS,outpatient,,,513,359.1,,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,461.7,90,,369.36,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,396.14,77.22,,316.91,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,425.79,83,,340.63,percent of total billed charges,83% of total,487.35,95,,389.88,percent of total billed charges ,95% of total billed charges,410.4,80,,328.32,percent of total billed charges,78% of total billed charges,400.14,78,,320.112,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,1150.41,
COX/SDH,300008830,CDM,312,RC,88319,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,1150.41,
ACID PHOSPHATASE,300008831,CDM,312,RC,88319,HCPCS,outpatient,,,209,146.3,,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,188.1,90,,150.48,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,161.39,77.22,,129.11,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,173.47,83,,138.78,percent of total billed charges,83% of total,198.55,95,,158.84,percent of total billed charges ,95% of total billed charges,167.2,80,,133.76,percent of total billed charges,78% of total billed charges,163.02,78,,130.416,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,177.65,85,,142.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,165.11,79,,132.09,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,1150.41,
PERIODIC ACID SCHIFF STAIN,300008887,CDM,312,RC,88313,HCPCS,outpatient,,,193,135.1,,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,173.7,90,,138.96,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,44.91,100,,,fee schedule,100% of GA fee schedule,149.03,77.22,,119.22,percent of total billed charges,77.22% of total billed charges,47.16,105,,,fee schedule,105% of GA fee schedule,160.19,83,,128.15,percent of total billed charges,83% of total,183.35,95,,146.68,percent of total billed charges ,95% of total billed charges,154.4,80,,123.52,percent of total billed charges,78% of total billed charges,150.54,78,,120.432,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,44.91,100,,,fee schedule,100% of GA fee schedule,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,44.91,100,,,fee schedule,100% of GA fee schedule,164.05,85,,131.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,44.91,450,
IMMUNOHISTOCHEMISTRY #1,300008894,CDM,312,RC,88342,HCPCS,outpatient,,,526,368.2,,415.54,79,,332.43,percent of total billed charges,79% of total billed charges,473.4,90,,378.72,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,71.58,100,,,fee schedule,100% of GA fee schedule,406.18,77.22,,324.94,percent of total billed charges,77.22% of total billed charges,75.16,105,,,fee schedule,105% of GA fee schedule,436.58,83,,349.26,percent of total billed charges,83% of total,499.7,95,,399.76,percent of total billed charges ,95% of total billed charges,420.8,80,,336.64,percent of total billed charges,78% of total billed charges,410.28,78,,328.224,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,71.58,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,71.58,100,,,fee schedule,100% of GA fee schedule,447.1,85,,357.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,415.54,79,,332.43,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,71.58,499.7,
IMMUNOHISTOCHEMISTRY #2,300008895,CDM,312,RC,88341,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.38,100,,,fee schedule,100% of GA fee schedule,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,60.25,105,,,fee schedule,105% of GA fee schedule,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.38,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,57.38,100,,,fee schedule,100% of GA fee schedule,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.38,450,
IMMUNOHISTOCHEMISTRY #3,300008896,CDM,312,RC,88341,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.38,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,60.25,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.38,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,57.38,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.38,450,
IMMUNOHISTOCHEMISTRY #4,300008897,CDM,312,RC,88341,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.38,100,,,fee schedule,100% of GA fee schedule,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,60.25,105,,,fee schedule,105% of GA fee schedule,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.38,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,57.38,100,,,fee schedule,100% of GA fee schedule,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.38,450,
DETERMINATATIVE HISTOCHEMISTRY,300009080,CDM,312,RC,88319,HCPCS,outpatient,,,81,56.7,,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,72.9,90,,58.32,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,62.55,77.22,,50.04,percent of total billed charges,77.22% of total billed charges,90.96,105,,,fee schedule,105% of GA fee schedule,67.23,83,,53.78,percent of total billed charges,83% of total,76.95,95,,61.56,percent of total billed charges ,95% of total billed charges,64.8,80,,51.84,percent of total billed charges,78% of total billed charges,63.18,78,,50.544,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,86.63,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,86.63,100,,,fee schedule,100% of GA fee schedule,68.85,85,,55.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,63.99,79,,51.19,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,62.55,1150.41,
"ERA, SINGLE, COMPUTER-ASSISTED",310000306,CDM,312,RC,88361,HCPCS,outpatient,,,1053,737.1,,831.87,79,,665.5,percent of total billed charges,79% of total billed charges,947.7,90,,758.16,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,122.28,100,,,fee schedule,100% of GA fee schedule,813.13,77.22,,650.5,percent of total billed charges,77.22% of total billed charges,128.39,105,,,fee schedule,105% of GA fee schedule,873.99,83,,699.19,percent of total billed charges,83% of total,1000.35,95,,800.28,percent of total billed charges ,95% of total billed charges,842.4,80,,673.92,percent of total billed charges,78% of total billed charges,821.34,78,,657.072,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,122.28,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,122.28,100,,,fee schedule,100% of GA fee schedule,895.05,85,,716.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,831.87,79,,665.5,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,122.28,1000.35,
ESTROGEN RECEPTOR ANALYSIS MAN,310000307,CDM,312,RC,88360,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,102.53,105,,,fee schedule,105% of GA fee schedule,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,97.65,100,,,fee schedule,100% of GA fee schedule,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,450,
PROGESTERONE RECEPTOR MANUAL,310000308,CDM,312,RC,88360,HCPCS,outpatient,,,396,277.2,,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,305.79,77.22,,244.63,percent of total billed charges,77.22% of total billed charges,102.53,105,,,fee schedule,105% of GA fee schedule,328.68,83,,262.94,percent of total billed charges,83% of total,376.2,95,,300.96,percent of total billed charges ,95% of total billed charges,316.8,80,,253.44,percent of total billed charges,78% of total billed charges,308.88,78,,247.104,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,97.65,100,,,fee schedule,100% of GA fee schedule,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,450,
HER2/NEU,310000309,CDM,312,RC,88360,HCPCS,outpatient,,,396,277.2,,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,356.4,90,,285.12,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,305.79,77.22,,244.63,percent of total billed charges,77.22% of total billed charges,102.53,105,,,fee schedule,105% of GA fee schedule,328.68,83,,262.94,percent of total billed charges,83% of total,376.2,95,,300.96,percent of total billed charges ,95% of total billed charges,316.8,80,,253.44,percent of total billed charges,78% of total billed charges,308.88,78,,247.104,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,97.65,100,,,fee schedule,100% of GA fee schedule,336.6,85,,269.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,312.84,79,,250.27,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,450,
HE2/NEU FISH,310000311,CDM,312,RC,88368,HCPCS,outpatient,,,507,354.9,,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,169.57,100,,,fee schedule,100% of GA fee schedule,391.51,77.22,,313.21,percent of total billed charges,77.22% of total billed charges,178.05,105,,,fee schedule,105% of GA fee schedule,420.81,83,,336.65,percent of total billed charges,83% of total,481.65,95,,385.32,percent of total billed charges ,95% of total billed charges,405.6,80,,324.48,percent of total billed charges,78% of total billed charges,395.46,78,,316.368,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,169.57,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,405.6,80,,324.48,percent of total billed charges,80% of total billed charges,169.57,100,,,fee schedule,100% of GA fee schedule,430.95,85,,344.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,169.57,481.65,
HE2/NEU FISHM,310000312,CDM,312,RC,88368,HCPCS,outpatient,,,507,354.9,,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,169.57,100,,,fee schedule,100% of GA fee schedule,391.51,77.22,,313.21,percent of total billed charges,77.22% of total billed charges,178.05,105,,,fee schedule,105% of GA fee schedule,420.81,83,,336.65,percent of total billed charges,83% of total,481.65,95,,385.32,percent of total billed charges ,95% of total billed charges,405.6,80,,324.48,percent of total billed charges,78% of total billed charges,395.46,78,,316.368,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,169.57,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,405.6,80,,324.48,percent of total billed charges,80% of total billed charges,169.57,100,,,fee schedule,100% of GA fee schedule,430.95,85,,344.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,169.57,481.65,
TUMOR IHC COMPUTER ASSISTED,310000320,CDM,312,RC,88361,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,122.28,100,,,fee schedule,100% of GA fee schedule,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,128.39,105,,,fee schedule,105% of GA fee schedule,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,122.28,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,122.28,100,,,fee schedule,100% of GA fee schedule,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,122.28,480.89,
TUMOR IHC MANUAL,310000321,CDM,312,RC,88360,HCPCS,outpatient,,,229,160.3,,180.91,79,,144.73,percent of total billed charges,79% of total billed charges,206.1,90,,164.88,percent of total billed charges,90% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,228.51,160,,,Fee Schedule,160% of CMS OPPS rate,185.66,130,,,Fee Schedule,130% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,176.83,77.22,,141.46,percent of total billed charges,77.22% of total billed charges,102.53,105,,,fee schedule,105% of GA fee schedule,190.07,83,,152.06,percent of total billed charges,83% of total,217.55,95,,174.04,percent of total billed charges ,95% of total billed charges,183.2,80,,146.56,percent of total billed charges,78% of total billed charges,178.62,78,,142.896,percent of total billed charges,78% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,100,,,fee schedule,100% of GA fee schedule,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,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,97.65,100,,,fee schedule,100% of GA fee schedule,194.65,85,,155.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,132.82,93,,,fee schedule,93% of CMS OPPS rate,180.91,79,,144.73,percent of total billed charges,79% of total billed charges,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,142.82,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,450,
LIMITED BONE MARROW,310000792,CDM,312,RC,U0792,HCPCS,outpatient,,,497,347.9,,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.11,63,,250.49,percent of total billed charges,63% of total billed charges,383.78,77.22,,307.02,percent of total billed charges,77.22% of total billed charges,328.52,66.1,,262.82,percent of total billed charges,66.1% of total billed charges,412.51,83,,330.01,percent of total billed charges,83% of total,472.15,95,,377.72,percent of total billed charges ,95% of total billed charges,397.6,80,,318.08,percent of total billed charges,78% of total billed charges,387.66,78,,310.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,313.11,63,,250.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,397.6,80,,318.08,percent of total billed charges,80% of total billed charges,313.11,63,,250.49,percent of total billed charges,63% of total billed charges,422.45,85,,337.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,313.11,472.15,
PATH TISSUE PROC LEVEL III,310040100,CDM,312,RC,88304,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,72.49,160,,,Fee Schedule,160% of CMS OPPS rate,58.9,130,,,Fee Schedule,130% of CMS OPPS rate,30.18,100,,,fee schedule,100% of GA fee schedule,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,31.69,105,,,fee schedule,105% of GA fee schedule,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,30.18,100,,,fee schedule,100% of GA fee schedule,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,30.18,100,,,fee schedule,100% of GA fee schedule,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,42.13,93,,,fee schedule,93% of CMS OPPS rate,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,30.18,450,
PATH TISSUE PROC LEVEL IV,310040200,CDM,312,RC,88305,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,72.49,160,,,Fee Schedule,160% of CMS OPPS rate,58.9,130,,,Fee Schedule,130% of CMS OPPS rate,65.88,100,,,fee schedule,100% of GA fee schedule,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,69.17,105,,,fee schedule,105% of GA fee schedule,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,65.88,100,,,fee schedule,100% of GA fee schedule,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,65.88,100,,,fee schedule,100% of GA fee schedule,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,42.13,93,,,fee schedule,93% of CMS OPPS rate,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,42.13,450,
PATH TISSUE PROC LEVEL V,310040300,CDM,312,RC,88307,HCPCS,outpatient,,,676,473.2,,534.04,79,,427.23,percent of total billed charges,79% of total billed charges,608.4,90,,486.72,percent of total billed charges,90% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,480.89,160,,,Fee Schedule,160% of CMS OPPS rate,390.72,130,,,Fee Schedule,130% of CMS OPPS rate,133.3,100,,,fee schedule,100% of GA fee schedule,522.01,77.22,,417.61,percent of total billed charges,77.22% of total billed charges,139.97,105,,,fee schedule,105% of GA fee schedule,561.08,83,,448.86,percent of total billed charges,83% of total,642.2,95,,513.76,percent of total billed charges ,95% of total billed charges,540.8,80,,432.64,percent of total billed charges,78% of total billed charges,527.28,78,,421.824,percent of total billed charges,78% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,133.3,100,,,fee schedule,100% of GA fee schedule,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,608.4,90,,486.72,percent of total billed charges,90% of total billed charges,540.8,80,,432.64,percent of total billed charges,80% of total billed charges,133.3,100,,,fee schedule,100% of GA fee schedule,574.6,85,,459.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,279.52,93,,,fee schedule,93% of CMS OPPS rate,534.04,79,,427.23,percent of total billed charges,79% of total billed charges,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,300.56,100,,,Fee Schedule,100% of CMS OPPS rate,133.3,642.2,
PATH TISSUE PROC COMPLEX ORGAN,310040400,CDM,312,RC,88309,HCPCS,outpatient,,,513,359.1,,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,461.7,90,,369.36,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,187.78,100,,,fee schedule,100% of GA fee schedule,396.14,77.22,,316.91,percent of total billed charges,77.22% of total billed charges,197.17,105,,,fee schedule,105% of GA fee schedule,425.79,83,,340.63,percent of total billed charges,83% of total,487.35,95,,389.88,percent of total billed charges ,95% of total billed charges,410.4,80,,328.32,percent of total billed charges,78% of total billed charges,400.14,78,,320.112,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,187.78,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,187.78,100,,,fee schedule,100% of GA fee schedule,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,187.78,1150.41,
PATH TIS SPEC STAIN GR1 MICRO,310040401,CDM,312,RC,88312,HCPCS,outpatient,,,137,95.9,,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,123.3,90,,98.64,percent of total billed charges,90% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,72.49,160,,,Fee Schedule,160% of CMS OPPS rate,58.9,130,,,Fee Schedule,130% of CMS OPPS rate,43.39,100,,,fee schedule,100% of GA fee schedule,105.79,77.22,,84.63,percent of total billed charges,77.22% of total billed charges,45.56,105,,,fee schedule,105% of GA fee schedule,113.71,83,,90.97,percent of total billed charges,83% of total,130.15,95,,104.12,percent of total billed charges ,95% of total billed charges,109.6,80,,87.68,percent of total billed charges,78% of total billed charges,106.86,78,,85.488,percent of total billed charges,78% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,43.39,100,,,fee schedule,100% of GA fee schedule,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,43.39,100,,,fee schedule,100% of GA fee schedule,116.45,85,,93.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,42.13,93,,,fee schedule,93% of CMS OPPS rate,108.23,79,,86.58,percent of total billed charges,79% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,42.13,450,
PATH TISSUE PROC LEVEL I,310040500,CDM,312,RC,88300,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,14.3,100,,,fee schedule,100% of GA fee schedule,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,15.02,105,,,fee schedule,105% of GA fee schedule,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,14.3,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,14.3,100,,,fee schedule,100% of GA fee schedule,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,14.3,450,
PATH TISSUE PROC LEVEL II,310040600,CDM,312,RC,88302,HCPCS,outpatient,,,179,125.3,,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,161.1,90,,128.88,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,35.06,100,,,fee schedule,100% of GA fee schedule,138.22,77.22,,110.58,percent of total billed charges,77.22% of total billed charges,36.81,105,,,fee schedule,105% of GA fee schedule,148.57,83,,118.86,percent of total billed charges,83% of total,170.05,95,,136.04,percent of total billed charges ,95% of total billed charges,143.2,80,,114.56,percent of total billed charges,78% of total billed charges,139.62,78,,111.696,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,35.06,100,,,fee schedule,100% of GA fee schedule,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,35.06,100,,,fee schedule,100% of GA fee schedule,152.15,85,,121.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,141.41,79,,113.13,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,23.15,450,
PATH TISSUE PROC IRON STAIN,310040700,CDM,312,RC,88313,HCPCS,outpatient,,,193,135.1,,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,173.7,90,,138.96,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,44.91,100,,,fee schedule,100% of GA fee schedule,149.03,77.22,,119.22,percent of total billed charges,77.22% of total billed charges,47.16,105,,,fee schedule,105% of GA fee schedule,160.19,83,,128.15,percent of total billed charges,83% of total,183.35,95,,146.68,percent of total billed charges ,95% of total billed charges,154.4,80,,123.52,percent of total billed charges,78% of total billed charges,150.54,78,,120.432,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,44.91,100,,,fee schedule,100% of GA fee schedule,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,44.91,100,,,fee schedule,100% of GA fee schedule,164.05,85,,131.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,44.91,450,
"FLOWCYTOMETRY,READ 16 OR >",310040900,CDM,312,RC,88189,HCPCS,outpatient,,,1662,1163.4,,1312.98,79,,1050.38,percent of total billed charges,79% of total billed charges,1495.8,90,,1196.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.26,100,,,fee schedule,100% of GA fee schedule,1283.4,77.22,,1026.72,percent of total billed charges,77.22% of total billed charges,103.17,105,,,fee schedule,105% of GA fee schedule,1379.46,83,,1103.57,percent of total billed charges,83% of total,1578.9,95,,1263.12,percent of total billed charges ,95% of total billed charges,1329.6,80,,1063.68,percent of total billed charges,78% of total billed charges,1296.36,78,,1037.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,98.26,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1495.8,90,,1196.64,percent of total billed charges,90% of total billed charges,1329.6,80,,1063.68,percent of total billed charges,80% of total billed charges,98.26,100,,,fee schedule,100% of GA fee schedule,1412.7,85,,1130.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1312.98,79,,1050.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.26,1578.9,
PATHOLOGY CONSULTATION,310040901,CDM,312,RC,88323,HCPCS,outpatient,,,427,298.9,,337.33,79,,269.86,percent of total billed charges,79% of total billed charges,384.3,90,,307.44,percent of total billed charges,90% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,72.49,160,,,Fee Schedule,160% of CMS OPPS rate,58.9,130,,,Fee Schedule,130% of CMS OPPS rate,93.21,100,,,fee schedule,100% of GA fee schedule,329.73,77.22,,263.78,percent of total billed charges,77.22% of total billed charges,97.87,105,,,fee schedule,105% of GA fee schedule,354.41,83,,283.53,percent of total billed charges,83% of total,405.65,95,,324.52,percent of total billed charges ,95% of total billed charges,341.6,80,,273.28,percent of total billed charges,78% of total billed charges,333.06,78,,266.448,percent of total billed charges,78% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,93.21,100,,,fee schedule,100% of GA fee schedule,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,93.21,100,,,fee schedule,100% of GA fee schedule,362.95,85,,290.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,42.13,93,,,fee schedule,93% of CMS OPPS rate,337.33,79,,269.86,percent of total billed charges,79% of total billed charges,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,45.31,100,,,Fee Schedule,100% of CMS OPPS rate,42.13,450,
"FLOWCYTOMETRY, READ 2-8 MARKER",31004902,CDM,312,RC,88187,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.78,100,,,fee schedule,100% of GA fee schedule,884.17,77.22,,707.34,percent of total billed charges,77.22% of total billed charges,62.77,105,,,fee schedule,105% of GA fee schedule,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,59.78,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,59.78,100,,,fee schedule,100% of GA fee schedule,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59.78,1087.75,
FLOW CYTOMETRY PANEL,31004903,CDM,312,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MICRODISSECTION,310088110,CDM,312,RC,88381,HCPCS,outpatient,,,204,142.8,,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,183.6,90,,146.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.91,100,,,fee schedule,100% of GA fee schedule,157.53,77.22,,126.02,percent of total billed charges,77.22% of total billed charges,176.31,105,,,fee schedule,105% of GA fee schedule,169.32,83,,135.46,percent of total billed charges,83% of total,193.8,95,,155.04,percent of total billed charges ,95% of total billed charges,163.2,80,,130.56,percent of total billed charges,78% of total billed charges,159.12,78,,127.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,167.91,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,167.91,100,,,fee schedule,100% of GA fee schedule,173.4,85,,138.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,161.16,79,,128.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.53,450,
"PATH CONSULT,SURG CYTOLOGIC",310088331,CDM,312,RC,88333,HCPCS,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,1150.41,160,,,Fee Schedule,160% of CMS OPPS rate,934.71,130,,,Fee Schedule,130% of CMS OPPS rate,75.49,100,,,fee schedule,100% of GA fee schedule,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,79.26,105,,,fee schedule,105% of GA fee schedule,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,75.49,100,,,fee schedule,100% of GA fee schedule,719,100,,,Fee Schedule,100% of CMS OPPS rate,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,75.49,100,,,fee schedule,100% of GA fee schedule,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,668.67,93,,,fee schedule,93% of CMS OPPS rate,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,719,100,,,Fee Schedule,100% of CMS OPPS rate,719,100,,,Fee Schedule,100% of CMS OPPS rate,47.88,1150.41,
SITU HYBRIDIZATION,310088364,CDM,312,RC,88364,HCPCS,outpatient,,,180,126,,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,162,90,,129.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.61,100,,,fee schedule,100% of GA fee schedule,139,77.22,,111.2,percent of total billed charges,77.22% of total billed charges,86.74,105,,,fee schedule,105% of GA fee schedule,149.4,83,,119.52,percent of total billed charges,83% of total,171,95,,136.8,percent of total billed charges ,95% of total billed charges,144,80,,115.2,percent of total billed charges,78% of total billed charges,140.4,78,,112.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,82.61,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,82.61,100,,,fee schedule,100% of GA fee schedule,153,85,,122.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,142.2,79,,113.76,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,82.61,450,
WRIST BILATERAL MIN 3 VIEWS,310001712,CDM,320,RC,73110,HCPCS,outpatient,,,244,170.8,,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,219.6,90,,175.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,188.42,77.22,,150.74,percent of total billed charges,77.22% of total billed charges,161.28,66.1,,129.02,percent of total billed charges,66.1% of total billed charges,202.52,83,,162.02,percent of total billed charges,83% of total,231.8,95,,185.44,percent of total billed charges ,95% of total billed charges,195.2,80,,156.16,percent of total billed charges,78% of total billed charges,190.32,78,,152.256,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,153.72,63,,122.98,percent of total billed charges,63% of total billed charges,207.4,85,,165.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,192.76,79,,154.21,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
DEXA BMI SP,320001174,CDM,320,RC,,,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,91.88,66.1,,73.5,percent of total billed charges,66.1% of total billed charges,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87.57,450,
DEXA-BMI FOLLOW-UP NONBILL,320001175,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
L KNEE COMPLETE 3 VIEWS,320001307,CDM,320,RC,73562,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
IVP UROGRAPHY W/WO KUB OR TOMO,320001402,CDM,320,RC,74400,HCPCS,outpatient,,,760,532,,600.4,79,,480.32,percent of total billed charges,79% of total billed charges,684,90,,547.2,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,478.8,63,,383.04,percent of total billed charges,63% of total billed charges,586.87,77.22,,469.5,percent of total billed charges,77.22% of total billed charges,502.36,66.1,,401.89,percent of total billed charges,66.1% of total billed charges,630.8,83,,504.64,percent of total billed charges,83% of total,722,95,,577.6,percent of total billed charges ,95% of total billed charges,608,80,,486.4,percent of total billed charges,78% of total billed charges,592.8,78,,474.24,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,478.8,63,,383.04,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,684,90,,547.2,percent of total billed charges,90% of total billed charges,608,80,,486.4,percent of total billed charges,80% of total billed charges,478.8,63,,383.04,percent of total billed charges,63% of total billed charges,646,85,,516.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,600.4,79,,480.32,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,722,
R KNEE COMPLETE 3 VIEWS,320001407,CDM,320,RC,73562,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SPINE SCOLIOSIS COMPL 2-3 VIEW,320001414,CDM,320,RC,72082,HCPCS,outpatient,,,333,233.1,,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,299.7,90,,239.76,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,257.14,77.22,,205.71,percent of total billed charges,77.22% of total billed charges,220.11,66.1,,176.09,percent of total billed charges,66.1% of total billed charges,276.39,83,,221.11,percent of total billed charges,83% of total,316.35,95,,253.08,percent of total billed charges ,95% of total billed charges,266.4,80,,213.12,percent of total billed charges,78% of total billed charges,259.74,78,,207.792,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
CERVICAL SPINE CMPL 4/5 VIEWS,320001415,CDM,320,RC,72050,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
THORACIC SPINE CMPL 3 VIEWS,320001416,CDM,320,RC,72072,HCPCS,outpatient,,,442,309.4,,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,341.31,77.22,,273.05,percent of total billed charges,77.22% of total billed charges,292.16,66.1,,233.73,percent of total billed charges,66.1% of total billed charges,366.86,83,,293.49,percent of total billed charges,83% of total,419.9,95,,335.92,percent of total billed charges ,95% of total billed charges,353.6,80,,282.88,percent of total billed charges,78% of total billed charges,344.76,78,,275.808,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
LUMBAR SPINE CMPL MIN 4 VIEWS,320001418,CDM,320,RC,72110,HCPCS,outpatient,,,618,432.6,,488.22,79,,390.58,percent of total billed charges,79% of total billed charges,556.2,90,,444.96,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,389.34,63,,311.47,percent of total billed charges,63% of total billed charges,477.22,77.22,,381.78,percent of total billed charges,77.22% of total billed charges,408.5,66.1,,326.8,percent of total billed charges,66.1% of total billed charges,512.94,83,,410.35,percent of total billed charges,83% of total,587.1,95,,469.68,percent of total billed charges ,95% of total billed charges,494.4,80,,395.52,percent of total billed charges,78% of total billed charges,482.04,78,,385.632,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,389.34,63,,311.47,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,389.34,63,,311.47,percent of total billed charges,63% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,488.22,79,,390.58,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,587.1,
LUMB SPINE LTD/AP LAT 2/3 VIE,320001419,CDM,320,RC,72100,HCPCS,outpatient,,,442,309.4,,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,341.31,77.22,,273.05,percent of total billed charges,77.22% of total billed charges,292.16,66.1,,233.73,percent of total billed charges,66.1% of total billed charges,366.86,83,,293.49,percent of total billed charges,83% of total,419.9,95,,335.92,percent of total billed charges ,95% of total billed charges,353.6,80,,282.88,percent of total billed charges,78% of total billed charges,344.76,78,,275.808,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
PELVIS 1 OR 2 VIEWS,320001420,CDM,320,RC,72170,HCPCS,outpatient,,,442,309.4,,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,341.31,77.22,,273.05,percent of total billed charges,77.22% of total billed charges,292.16,66.1,,233.73,percent of total billed charges,66.1% of total billed charges,366.86,83,,293.49,percent of total billed charges,83% of total,419.9,95,,335.92,percent of total billed charges ,95% of total billed charges,353.6,80,,282.88,percent of total billed charges,78% of total billed charges,344.76,78,,275.808,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
CERVI SPINE LTD/AP LAT 2/3 VIE,320001421,CDM,320,RC,72040,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
STERNUM MIN 2 VIEWS,320001422,CDM,320,RC,71120,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIBS BILATERAL MIN 4 VIEWS,320001427,CDM,320,RC,71111,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SHOULDER LT WGT BEAR MIN 2 VI,320001432,CDM,320,RC,73030,HCPCS,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
UPPER EXTREMITY INFANT 2 VIEWS,320001437,CDM,320,RC,73092,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
WRIST LIMITED BILATERAL 2 VIEW,320001439,CDM,320,RC,73100,HCPCS,outpatient,,,371,259.7,,293.09,79,,234.47,percent of total billed charges,79% of total billed charges,333.9,90,,267.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,233.73,63,,186.98,percent of total billed charges,63% of total billed charges,286.49,77.22,,229.19,percent of total billed charges,77.22% of total billed charges,245.23,66.1,,196.18,percent of total billed charges,66.1% of total billed charges,307.93,83,,246.34,percent of total billed charges,83% of total,352.45,95,,281.96,percent of total billed charges ,95% of total billed charges,296.8,80,,237.44,percent of total billed charges,78% of total billed charges,289.38,78,,231.504,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,233.73,63,,186.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.73,63,,186.98,percent of total billed charges,63% of total billed charges,315.35,85,,252.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,293.09,79,,234.47,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SKULL COMPLETE MIN 4 VIEWS,320001443,CDM,320,RC,70260,HCPCS,outpatient,,,455,318.5,,359.45,79,,287.56,percent of total billed charges,79% of total billed charges,409.5,90,,327.6,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,286.65,63,,229.32,percent of total billed charges,63% of total billed charges,351.35,77.22,,281.08,percent of total billed charges,77.22% of total billed charges,300.76,66.1,,240.61,percent of total billed charges,66.1% of total billed charges,377.65,83,,302.12,percent of total billed charges,83% of total,432.25,95,,345.8,percent of total billed charges ,95% of total billed charges,364,80,,291.2,percent of total billed charges,78% of total billed charges,354.9,78,,283.92,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,286.65,63,,229.32,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,286.65,63,,229.32,percent of total billed charges,63% of total billed charges,386.75,85,,309.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,359.45,79,,287.56,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
X-RAY OF SKULL < 4 VIEWS,320001444,CDM,320,RC,70250,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SINUSES COMPLETE MIN 3 VIEWS,320001445,CDM,320,RC,70220,HCPCS,outpatient,,,414,289.8,,327.06,79,,261.65,percent of total billed charges,79% of total billed charges,372.6,90,,298.08,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,260.82,63,,208.66,percent of total billed charges,63% of total billed charges,319.69,77.22,,255.75,percent of total billed charges,77.22% of total billed charges,273.65,66.1,,218.92,percent of total billed charges,66.1% of total billed charges,343.62,83,,274.9,percent of total billed charges,83% of total,393.3,95,,314.64,percent of total billed charges ,95% of total billed charges,331.2,80,,264.96,percent of total billed charges,78% of total billed charges,322.92,78,,258.336,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,260.82,63,,208.66,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,260.82,63,,208.66,percent of total billed charges,63% of total billed charges,351.9,85,,281.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,327.06,79,,261.65,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FACIAL BONES COMPL MIN 3 VIEWS,320001447,CDM,320,RC,70150,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
MANDIBLE COMPLETE MINIMUN 4 VI,320001448,CDM,320,RC,70110,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
NASAL BONES COMPL MIN 3 VIEWS,320001450,CDM,320,RC,70160,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FLAT AND UPRIGHT ABD 2 VIEWS,320001454,CDM,320,RC,74019,HCPCS,outpatient,,,227,158.9,,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,175.29,77.22,,140.23,percent of total billed charges,77.22% of total billed charges,150.05,66.1,,120.04,percent of total billed charges,66.1% of total billed charges,188.41,83,,150.73,percent of total billed charges,83% of total,215.65,95,,172.52,percent of total billed charges ,95% of total billed charges,181.6,80,,145.28,percent of total billed charges,78% of total billed charges,177.06,78,,141.648,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
VOIDING CYSTOGRAPHY,320001465,CDM,320,RC,74455,HCPCS,outpatient,,,622,435.4,,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,559.8,90,,447.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,480.31,77.22,,384.25,percent of total billed charges,77.22% of total billed charges,411.14,66.1,,328.91,percent of total billed charges,66.1% of total billed charges,516.26,83,,413.01,percent of total billed charges,83% of total,590.9,95,,472.72,percent of total billed charges ,95% of total billed charges,497.6,80,,398.08,percent of total billed charges,78% of total billed charges,485.16,78,,388.128,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,391.86,63,,313.49,percent of total billed charges,63% of total billed charges,528.7,85,,422.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.55,93,,,fee schedule,93% of CMS OPPS rate,491.38,79,,393.1,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.55,590.9,
ABDOMEN SINGLE VIEW,320001468,CDM,320,RC,74018,HCPCS,outpatient,,,295,206.5,,233.05,79,,186.44,percent of total billed charges,79% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,227.8,77.22,,182.24,percent of total billed charges,77.22% of total billed charges,195,66.1,,156,percent of total billed charges,66.1% of total billed charges,244.85,83,,195.88,percent of total billed charges,83% of total,280.25,95,,224.2,percent of total billed charges ,95% of total billed charges,236,80,,188.8,percent of total billed charges,78% of total billed charges,230.1,78,,184.08,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,233.05,79,,186.44,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
COMP ACU ABD 2>VWS  CHEST 1 VW,320001469,CDM,320,RC,74022,HCPCS,outpatient,,,556,389.2,,439.24,79,,351.39,percent of total billed charges,79% of total billed charges,500.4,90,,400.32,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,350.28,63,,280.22,percent of total billed charges,63% of total billed charges,429.34,77.22,,343.47,percent of total billed charges,77.22% of total billed charges,367.52,66.1,,294.02,percent of total billed charges,66.1% of total billed charges,461.48,83,,369.18,percent of total billed charges,83% of total,528.2,95,,422.56,percent of total billed charges ,95% of total billed charges,444.8,80,,355.84,percent of total billed charges,78% of total billed charges,433.68,78,,346.944,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,350.28,63,,280.22,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,350.28,63,,280.22,percent of total billed charges,63% of total billed charges,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,439.24,79,,351.39,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,528.2,
SACROILIAC JOINTS 3 > VIEWS,320001471,CDM,320,RC,72202,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SACRUM AND COCCYX MIN 2 VIEWS,320001472,CDM,320,RC,72220,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,191.03,66.1,,152.82,percent of total billed charges,66.1% of total billed charges,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
XRAY XM SMALL INTEST 1 CNTRST,320001473,CDM,320,RC,74250,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,450,
ESOPHAGUS BAR SWALLOW 1 CNTRST,320001476,CDM,320,RC,74220,HCPCS,outpatient,,,366,256.2,,289.14,79,,231.31,percent of total billed charges,79% of total billed charges,329.4,90,,263.52,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,230.58,63,,184.46,percent of total billed charges,63% of total billed charges,282.63,77.22,,226.1,percent of total billed charges,77.22% of total billed charges,241.93,66.1,,193.54,percent of total billed charges,66.1% of total billed charges,303.78,83,,243.02,percent of total billed charges,83% of total,347.7,95,,278.16,percent of total billed charges ,95% of total billed charges,292.8,80,,234.24,percent of total billed charges,78% of total billed charges,285.48,78,,228.384,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,230.58,63,,184.46,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,230.58,63,,184.46,percent of total billed charges,63% of total billed charges,311.1,85,,248.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,289.14,79,,231.31,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,450,
XRAY XM COLON SGL CONTRAST,320001478,CDM,320,RC,74270,HCPCS,outpatient,,,417,291.9,,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,262.71,63,,210.17,percent of total billed charges,63% of total billed charges,322.01,77.22,,257.61,percent of total billed charges,77.22% of total billed charges,275.64,66.1,,220.51,percent of total billed charges,66.1% of total billed charges,346.11,83,,276.89,percent of total billed charges,83% of total,396.15,95,,316.92,percent of total billed charges ,95% of total billed charges,333.6,80,,266.88,percent of total billed charges,78% of total billed charges,325.26,78,,260.208,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,262.71,63,,210.17,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,262.71,63,,210.17,percent of total billed charges,63% of total billed charges,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,450,
XRAY XM COLON DBL CONTRAST STD,320001479,CDM,320,RC,74280,HCPCS,outpatient,,,649,454.3,,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,501.16,77.22,,400.93,percent of total billed charges,77.22% of total billed charges,428.99,66.1,,343.19,percent of total billed charges,66.1% of total billed charges,538.67,83,,430.94,percent of total billed charges,83% of total,616.55,95,,493.24,percent of total billed charges ,95% of total billed charges,519.2,80,,415.36,percent of total billed charges,78% of total billed charges,506.22,78,,404.976,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,616.55,
"CHOLANGIOGRAPHY, OPERATIVE",320001480,CDM,320,RC,74300,HCPCS,outpatient,,,753,527.1,,594.87,79,,475.9,percent of total billed charges,79% of total billed charges,677.7,90,,542.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,474.39,63,,379.51,percent of total billed charges,63% of total billed charges,581.47,77.22,,465.18,percent of total billed charges,77.22% of total billed charges,497.73,66.1,,398.18,percent of total billed charges,66.1% of total billed charges,624.99,83,,499.99,percent of total billed charges,83% of total,715.35,95,,572.28,percent of total billed charges ,95% of total billed charges,602.4,80,,481.92,percent of total billed charges,78% of total billed charges,587.34,78,,469.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,474.39,63,,379.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,474.39,63,,379.51,percent of total billed charges,63% of total billed charges,640.05,85,,512.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,594.87,79,,475.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,715.35,
"CHOLANGIOGRAPHY, POST OP",320001481,CDM,320,RC,47531,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,4628.58,160,,,Fee Schedule,160% of CMS OPPS rate,3760.72,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2690.36,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,4628.58,
METASTATIC BONE SURVEY LIMITED,320001491,CDM,320,RC,77074,HCPCS,outpatient,,,1029,720.3,,812.91,79,,650.33,percent of total billed charges,79% of total billed charges,926.1,90,,740.88,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,648.27,63,,518.62,percent of total billed charges,63% of total billed charges,794.59,77.22,,635.67,percent of total billed charges,77.22% of total billed charges,680.17,66.1,,544.14,percent of total billed charges,66.1% of total billed charges,854.07,83,,683.26,percent of total billed charges,83% of total,977.55,95,,782.04,percent of total billed charges ,95% of total billed charges,823.2,80,,658.56,percent of total billed charges,78% of total billed charges,802.62,78,,642.096,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,648.27,63,,518.62,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,926.1,90,,740.88,percent of total billed charges,90% of total billed charges,823.2,80,,658.56,percent of total billed charges,80% of total billed charges,648.27,63,,518.62,percent of total billed charges,63% of total billed charges,874.65,85,,699.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,812.91,79,,650.33,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,977.55,
HYSTEROSALPINGOGRAM (DP),320001492,CDM,320,RC,74740,HCPCS,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.55,93,,,fee schedule,93% of CMS OPPS rate,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.55,1129.55,
"FLUOROSCOPY GUIDANCE,1 HOUR",320001497,CDM,320,RC,76000,HCPCS,outpatient,,,649,454.3,,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,501.16,77.22,,400.93,percent of total billed charges,77.22% of total billed charges,428.99,66.1,,343.19,percent of total billed charges,66.1% of total billed charges,538.67,83,,430.94,percent of total billed charges,83% of total,616.55,95,,493.24,percent of total billed charges ,95% of total billed charges,519.2,80,,415.36,percent of total billed charges,78% of total billed charges,506.22,78,,404.976,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,616.55,
SOFT TISSUE NECK,320001501,CDM,320,RC,70360,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FLUROSCO GUID & LOCALIZATION,320001502,CDM,320,RC,77003,HCPCS,outpatient,,,771,539.7,,609.09,79,,487.27,percent of total billed charges,79% of total billed charges,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,485.73,63,,388.58,percent of total billed charges,63% of total billed charges,595.37,77.22,,476.3,percent of total billed charges,77.22% of total billed charges,509.63,66.1,,407.7,percent of total billed charges,66.1% of total billed charges,639.93,83,,511.94,percent of total billed charges,83% of total,732.45,95,,585.96,percent of total billed charges ,95% of total billed charges,616.8,80,,493.44,percent of total billed charges,78% of total billed charges,601.38,78,,481.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,485.73,63,,388.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,485.73,63,,388.58,percent of total billed charges,63% of total billed charges,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,609.09,79,,487.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,732.45,
ACROMINOCLAVICULAR JOINTS,320001504,CDM,320,RC,73050,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BONE AGE,320001506,CDM,320,RC,77072,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
INJECTION PROCEDURE/SHOULDER,320001511,CDM,320,RC,23350,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,149.39,66.1,,119.51,percent of total billed charges,66.1% of total billed charges,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,142.38,450,
INJECTION PROC KNEE ARTHROSCOP,320001512,CDM,320,RC,27369,HCPCS,outpatient,,,202,141.4,,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,155.98,77.22,,124.78,percent of total billed charges,77.22% of total billed charges,133.52,66.1,,106.82,percent of total billed charges,66.1% of total billed charges,167.66,83,,134.13,percent of total billed charges,83% of total,191.9,95,,153.52,percent of total billed charges ,95% of total billed charges,161.6,80,,129.28,percent of total billed charges,78% of total billed charges,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.26,450,
BILATERAL ELBOW COMP 3 VIEWS,320001515,CDM,320,RC,73080,HCPCS,outpatient,,,386,270.2,,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,298.07,77.22,,238.46,percent of total billed charges,77.22% of total billed charges,255.15,66.1,,204.12,percent of total billed charges,66.1% of total billed charges,320.38,83,,256.3,percent of total billed charges,83% of total,366.7,95,,293.36,percent of total billed charges ,95% of total billed charges,308.8,80,,247.04,percent of total billed charges,78% of total billed charges,301.08,78,,240.864,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
UGI AIR CONTRAST W/ KUB,320001516,CDM,320,RC,74246,HCPCS,outpatient,,,394,275.8,,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,304.25,77.22,,243.4,percent of total billed charges,77.22% of total billed charges,260.43,66.1,,208.34,percent of total billed charges,66.1% of total billed charges,327.02,83,,261.62,percent of total billed charges,83% of total,374.3,95,,299.44,percent of total billed charges ,95% of total billed charges,315.2,80,,252.16,percent of total billed charges,78% of total billed charges,307.32,78,,245.856,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,450,
UGI & SM BOWEL AIR CONTRAST CP,320001517,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ABDOMEN/PORTABLE SINGLE VIEW,320001518,CDM,320,RC,74018,HCPCS,outpatient,,,295,206.5,,233.05,79,,186.44,percent of total billed charges,79% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,227.8,77.22,,182.24,percent of total billed charges,77.22% of total billed charges,195,66.1,,156,percent of total billed charges,66.1% of total billed charges,244.85,83,,195.88,percent of total billed charges,83% of total,280.25,95,,224.2,percent of total billed charges ,95% of total billed charges,236,80,,188.8,percent of total billed charges,78% of total billed charges,230.1,78,,184.08,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,233.05,79,,186.44,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIBS BILATERAL/THREE VIEWS,320001520,CDM,320,RC,71110,HCPCS,outpatient,,,288,201.6,,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,222.39,77.22,,177.91,percent of total billed charges,77.22% of total billed charges,190.37,66.1,,152.3,percent of total billed charges,66.1% of total billed charges,239.04,83,,191.23,percent of total billed charges,83% of total,273.6,95,,218.88,percent of total billed charges ,95% of total billed charges,230.4,80,,184.32,percent of total billed charges,78% of total billed charges,224.64,78,,179.712,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
XRAY XM SWLNG FUNCJ CINER VIDE,320001526,CDM,320,RC,74230,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,450,
CYSTOGRAM MIN 3 VIEWS,320001527,CDM,320,RC,74430,HCPCS,outpatient,,,649,454.3,,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,501.16,77.22,,400.93,percent of total billed charges,77.22% of total billed charges,428.99,66.1,,343.19,percent of total billed charges,66.1% of total billed charges,538.67,83,,430.94,percent of total billed charges,83% of total,616.55,95,,493.24,percent of total billed charges ,95% of total billed charges,519.2,80,,415.36,percent of total billed charges,78% of total billed charges,506.22,78,,404.976,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,616.55,
ANKLE LIMITED/TWO VIEWS RIGHT,320001546,CDM,320,RC,73600,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
CLAVICLE RIGHT,320001547,CDM,320,RC,73000,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,197.5,79,,158,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW LIMITED/TWO VIEWS RIGHT,320001548,CDM,320,RC,73070,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW COMPLETE RIGHT MIN 3 VIE,320001549,CDM,320,RC,73080,HCPCS,outpatient,,,386,270.2,,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,298.07,77.22,,238.46,percent of total billed charges,77.22% of total billed charges,255.15,66.1,,204.12,percent of total billed charges,66.1% of total billed charges,320.38,83,,256.3,percent of total billed charges,83% of total,366.7,95,,293.36,percent of total billed charges ,95% of total billed charges,308.8,80,,247.04,percent of total billed charges,78% of total billed charges,301.08,78,,240.864,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FEMUR RIGHT MIN 2 VIEWS,320001550,CDM,320,RC,73552,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOREARM RIGHT 2 VIEWS,320001551,CDM,320,RC,73090,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,204.25,66.1,,163.4,percent of total billed charges,66.1% of total billed charges,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 3 VIEWS RIGHT,320001552,CDM,320,RC,73630,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HAND COMPLETE 3 VIEWS RIGHT,320001553,CDM,320,RC,73130,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,608,
OS CALCIS R HEEL MIN 2 VIEWS,320001554,CDM,320,RC,73650,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,149.39,66.1,,119.51,percent of total billed charges,66.1% of total billed charges,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R HIP CMPL/UNILATERAL 2-3VIEWS,320001556,CDM,320,RC,73502,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HUMERUS RIGHT MIN 2 VIEWS,320001557,CDM,320,RC,73060,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R KNEE COMPLETE 4 > VIEWS,320001558,CDM,320,RC,73564,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
R KNEE LMTD 1/2 VIEWS,320001559,CDM,320,RC,73560,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
PATELLA RIGHT 1/2 VIEWS,320001561,CDM,320,RC,73560,HCPCS,outpatient,,,296,207.2,,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,228.57,77.22,,182.86,percent of total billed charges,77.22% of total billed charges,195.66,66.1,,156.53,percent of total billed charges,66.1% of total billed charges,245.68,83,,196.54,percent of total billed charges,83% of total,281.2,95,,224.96,percent of total billed charges ,95% of total billed charges,236.8,80,,189.44,percent of total billed charges,78% of total billed charges,230.88,78,,184.704,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
DUAL ENERGY XRAY ABSORPTIOMETR,320001562,CDM,320,RC,77080,HCPCS,outpatient,,,350,245,,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,315,90,,252,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,270.27,77.22,,216.22,percent of total billed charges,77.22% of total billed charges,231.35,66.1,,185.08,percent of total billed charges,66.1% of total billed charges,290.5,83,,232.4,percent of total billed charges,83% of total,332.5,95,,266,percent of total billed charges ,95% of total billed charges,280,80,,224,percent of total billed charges,78% of total billed charges,273,78,,218.4,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,220.5,63,,176.4,percent of total billed charges,63% of total billed charges,297.5,85,,238,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,276.5,79,,221.2,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
SCAPULA RIGHT,320001564,CDM,320,RC,73010,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SHOULDER RIGHT MIN 3 VIEWS,320001566,CDM,320,RC,73030,HCPCS,outpatient,,,546,382.2,,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,421.62,77.22,,337.3,percent of total billed charges,77.22% of total billed charges,360.91,66.1,,288.73,percent of total billed charges,66.1% of total billed charges,453.18,83,,362.54,percent of total billed charges,83% of total,518.7,95,,414.96,percent of total billed charges ,95% of total billed charges,436.8,80,,349.44,percent of total billed charges,78% of total billed charges,425.88,78,,340.704,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,464.1,85,,371.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,518.7,
R TIBIA & FIBULA 2 VIEWS,320001567,CDM,320,RC,73590,HCPCS,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST RIGHT MIN 3 VIEWS,320001569,CDM,320,RC,73110,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST LIMITED 2 VIEWS RIGHT,320001570,CDM,320,RC,73100,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIGHT HAND THUMB MIN 2 VIEWS,320001571,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"RIGHT HAND,SECOND DIGIT MIN 2V",320001572,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"RIGHT HAND, THIRD DIGIT MIN 2V",320001573,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"R HAND,4TH DIGIT MIN 2 VIEWS",320001574,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"R HAND, 5TH DIGIT MIN 2 VIEWS",320001575,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"L HAND, SECOND DIGIT MIN 2 VIE",320001576,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"LEFT HAND, THIRD DIGIT MIN 2 V",320001577,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"LHAND, FOURTH DIGIT MIN 2 VIEW",320001578,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"LEFT HAND, FIFTH DIGIT MIN 2 V",320001579,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"L FOOT, 2ND DIGIT MIN 2 VIEWS",320001580,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"L FOOT, THIRD DIGIT MIN 2 VIEW",320001581,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FOOT 4TH DIGIT MIN 2 VIEWS,320001582,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"L FOOT, 5TH DIGIT MIN 2 VIEWS",320001583,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"R FOOT, GREAT TOE MIN 2 VIEWS",320001584,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"R FOOT, SECOND DIGIT MIN 2 VIE",320001585,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"R FOOT,THIRD DIGIT MIN 2 VIEWS",320001586,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT 4TH DIGIT MIN 2 VIEWS,320001587,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT FIFTH DIGIT MIN 2 VIEWS,320001588,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R ANKLE COMPLETE MIN 3 VIEWS,320001589,CDM,320,RC,73610,HCPCS,outpatient,,,342,239.4,,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,264.09,77.22,,211.27,percent of total billed charges,77.22% of total billed charges,226.06,66.1,,180.85,percent of total billed charges,66.1% of total billed charges,283.86,83,,227.09,percent of total billed charges,83% of total,324.9,95,,259.92,percent of total billed charges ,95% of total billed charges,273.6,80,,218.88,percent of total billed charges,78% of total billed charges,266.76,78,,213.408,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L ANKLE COMPLETE MIN 3 VIEWS,320001590,CDM,320,RC,73610,HCPCS,outpatient,,,342,239.4,,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,264.09,77.22,,211.27,percent of total billed charges,77.22% of total billed charges,226.06,66.1,,180.85,percent of total billed charges,66.1% of total billed charges,283.86,83,,227.09,percent of total billed charges,83% of total,324.9,95,,259.92,percent of total billed charges ,95% of total billed charges,273.6,80,,218.88,percent of total billed charges,78% of total billed charges,266.76,78,,213.408,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ANKLE LEFT LIMITED 2 VIEWS,320001591,CDM,320,RC,73600,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
CLAVICLE LEFT,320001592,CDM,320,RC,73000,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,197.5,79,,158,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW LIMITED LEFT 2 VIEWS,320001593,CDM,320,RC,73070,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW COMPL LEFT MIN 3 VIEWS,320001594,CDM,320,RC,73080,HCPCS,outpatient,,,386,270.2,,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,298.07,77.22,,238.46,percent of total billed charges,77.22% of total billed charges,255.15,66.1,,204.12,percent of total billed charges,66.1% of total billed charges,320.38,83,,256.3,percent of total billed charges,83% of total,366.7,95,,293.36,percent of total billed charges ,95% of total billed charges,308.8,80,,247.04,percent of total billed charges,78% of total billed charges,301.08,78,,240.864,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FEMUR LEFT MIN 2 VIEW,320001595,CDM,320,RC,73552,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOREARM LEFT 2 VIEWS,320001596,CDM,320,RC,73090,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,204.25,66.1,,163.4,percent of total billed charges,66.1% of total billed charges,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 3 VIEWS LEFT,320001597,CDM,320,RC,73630,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HAND COMPL LEFT MIN 3 VIEWS,320001598,CDM,320,RC,73130,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,608,
HEEL LEFT MIN 2 VIEWS,320001599,CDM,320,RC,73650,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,149.39,66.1,,119.51,percent of total billed charges,66.1% of total billed charges,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L HIP CMPL/UNILATERAL 2-3VIEWS,320001600,CDM,320,RC,73502,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HUMERUS LEFT MIN 2 VIEWS,320001601,CDM,320,RC,73060,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L KNEE FULL SERIES 4> VIEWS,320001602,CDM,320,RC,73564,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
L KNEE LIMITED VIEWS 1/2 VIEWS,320001603,CDM,320,RC,73560,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ORBITS LEFT MIN 4 VIEWS,320001604,CDM,320,RC,70200,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,158.13,63,,126.5,percent of total billed charges,63% of total billed charges,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,165.91,66.1,,132.73,percent of total billed charges,66.1% of total billed charges,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,158.13,63,,126.5,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,158.13,63,,126.5,percent of total billed charges,63% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
PATELLA LEFT 1/2 VIEWS,320001605,CDM,320,RC,73560,HCPCS,outpatient,,,296,207.2,,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,228.57,77.22,,182.86,percent of total billed charges,77.22% of total billed charges,195.66,66.1,,156.53,percent of total billed charges,66.1% of total billed charges,245.68,83,,196.54,percent of total billed charges,83% of total,281.2,95,,224.96,percent of total billed charges ,95% of total billed charges,236.8,80,,189.44,percent of total billed charges,78% of total billed charges,230.88,78,,184.704,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SCAPULA LEFT,320001606,CDM,320,RC,73010,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SHOULDER LEFT  MIN 3 VIEWS,320001607,CDM,320,RC,73030,HCPCS,outpatient,,,546,382.2,,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,421.62,77.22,,337.3,percent of total billed charges,77.22% of total billed charges,360.91,66.1,,288.73,percent of total billed charges,66.1% of total billed charges,453.18,83,,362.54,percent of total billed charges,83% of total,518.7,95,,414.96,percent of total billed charges ,95% of total billed charges,436.8,80,,349.44,percent of total billed charges,78% of total billed charges,425.88,78,,340.704,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,464.1,85,,371.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,518.7,
LEFT HAND THUMB MIN 2 VIEWS,320001608,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TIBIA AND FIBULA 2 VIEWS,320001609,CDM,320,RC,73590,HCPCS,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST LEFT MIN 3 VIEWS,320001611,CDM,320,RC,73110,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST LIMITED 2 VIEWS LEFT,320001612,CDM,320,RC,73100,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 1 VIEW RIGHT,320001632,CDM,320,RC,73620,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,70.73,66.1,,56.58,percent of total billed charges,66.1% of total billed charges,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,67.41,450,
FOOT 1 VIEW LEFT,320001633,CDM,320,RC,73620,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,70.73,66.1,,56.58,percent of total billed charges,66.1% of total billed charges,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,67.41,450,
LEFT HAND THUMB MIN 2 VIEWS,320001642,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
"L FOOT,GREAT TOE MIN 2 VIEWS",320001643,CDM,320,RC,73660,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIBS RIGHT MIN 3 VIEWS,320001644,CDM,320,RC,71101,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
RIBS LEFT MIN 3 VIEWS,320001645,CDM,320,RC,71101,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
PORTABLE FOREARM LEFT 2 VIEWS,320001646,CDM,320,RC,73090,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,204.25,66.1,,163.4,percent of total billed charges,66.1% of total billed charges,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
PORTABLE FOREARM RIGHT 2 VIEWS,320001647,CDM,320,RC,73090,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,204.25,66.1,,163.4,percent of total billed charges,66.1% of total billed charges,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST LMTD/2 VIEWS RIGHT,320001650,CDM,320,RC,73100,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 2 VIEWS RIGHT,320001654,CDM,320,RC,73620,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 2 VIEWS LEFT,320001655,CDM,320,RC,73620,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BONE (SKELETAL) SURVEY,320001656,CDM,320,RC,77075,HCPCS,outpatient,,,672,470.4,,530.88,79,,424.7,percent of total billed charges,79% of total billed charges,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,518.92,77.22,,415.14,percent of total billed charges,77.22% of total billed charges,444.19,66.1,,355.35,percent of total billed charges,66.1% of total billed charges,557.76,83,,446.21,percent of total billed charges,83% of total,638.4,95,,510.72,percent of total billed charges ,95% of total billed charges,537.6,80,,430.08,percent of total billed charges,78% of total billed charges,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,530.88,79,,424.7,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,638.4,
LOWER EXTREMITY INFANT 2 VIEWS,320001657,CDM,320,RC,73592,HCPCS,outpatient,,,470,329,,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,362.93,77.22,,290.34,percent of total billed charges,77.22% of total billed charges,310.67,66.1,,248.54,percent of total billed charges,66.1% of total billed charges,390.1,83,,312.08,percent of total billed charges,83% of total,446.5,95,,357.2,percent of total billed charges ,95% of total billed charges,376,80,,300.8,percent of total billed charges,78% of total billed charges,366.6,78,,293.28,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL HIP 3/4 VIEWS,320001658,CDM,320,RC,73522,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BONE SKETETAL SURVEY LIMITED,320001661,CDM,320,RC,77074,HCPCS,outpatient,,,1029,720.3,,812.91,79,,650.33,percent of total billed charges,79% of total billed charges,926.1,90,,740.88,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,648.27,63,,518.62,percent of total billed charges,63% of total billed charges,794.59,77.22,,635.67,percent of total billed charges,77.22% of total billed charges,680.17,66.1,,544.14,percent of total billed charges,66.1% of total billed charges,854.07,83,,683.26,percent of total billed charges,83% of total,977.55,95,,782.04,percent of total billed charges ,95% of total billed charges,823.2,80,,658.56,percent of total billed charges,78% of total billed charges,802.62,78,,642.096,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,648.27,63,,518.62,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,926.1,90,,740.88,percent of total billed charges,90% of total billed charges,823.2,80,,658.56,percent of total billed charges,80% of total billed charges,648.27,63,,518.62,percent of total billed charges,63% of total billed charges,874.65,85,,699.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,812.91,79,,650.33,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,977.55,
SHOULDER LT 2 VIEWS,320001662,CDM,320,RC,73030,HCPCS,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SHOULDER RT 2 VIEWS,320001663,CDM,320,RC,73030,HCPCS,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LUM SPINE COMP W/BEND MN 6VIEW,320001664,CDM,320,RC,72114,HCPCS,outpatient,,,389,272.3,,307.31,79,,245.85,percent of total billed charges,79% of total billed charges,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,245.07,63,,196.06,percent of total billed charges,63% of total billed charges,300.39,77.22,,240.31,percent of total billed charges,77.22% of total billed charges,257.13,66.1,,205.7,percent of total billed charges,66.1% of total billed charges,322.87,83,,258.3,percent of total billed charges,83% of total,369.55,95,,295.64,percent of total billed charges ,95% of total billed charges,311.2,80,,248.96,percent of total billed charges,78% of total billed charges,303.42,78,,242.736,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,245.07,63,,196.06,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,245.07,63,,196.06,percent of total billed charges,63% of total billed charges,330.65,85,,264.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,307.31,79,,245.85,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BILATERAL KNEE STANDING 2 VIEW,320001665,CDM,320,RC,73565,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SHOULDER LEFT 1 VIEW,320001670,CDM,320,RC,73020,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SHOULDER RIGHT 1 VIEW,320001689,CDM,320,RC,73020,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
VENOGRAM RT LEG,320001690,CDM,320,RC,75820,HCPCS,outpatient,,,771,539.7,,609.09,79,,487.27,percent of total billed charges,79% of total billed charges,693.9,90,,555.12,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.9,130,,,Fee Schedule,130% of CMS OPPS rate,485.73,63,,388.58,percent of total billed charges,63% of total billed charges,595.37,77.22,,476.3,percent of total billed charges,77.22% of total billed charges,509.63,66.1,,407.7,percent of total billed charges,66.1% of total billed charges,639.93,83,,511.94,percent of total billed charges,83% of total,732.45,95,,585.96,percent of total billed charges ,95% of total billed charges,616.8,80,,493.44,percent of total billed charges,78% of total billed charges,601.38,78,,481.104,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,485.73,63,,388.58,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,485.73,63,,388.58,percent of total billed charges,63% of total billed charges,655.35,85,,524.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,609.09,79,,487.27,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,2142.64,
ANKLES BILATERAL MIN 3 VIEWS,320001706,CDM,320,RC,73610,HCPCS,outpatient,,,523,366.1,,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,403.86,77.22,,323.09,percent of total billed charges,77.22% of total billed charges,345.7,66.1,,276.56,percent of total billed charges,66.1% of total billed charges,434.09,83,,347.27,percent of total billed charges,83% of total,496.85,95,,397.48,percent of total billed charges ,95% of total billed charges,418.4,80,,334.72,percent of total billed charges,78% of total billed charges,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,496.85,
HAND BILATER COMPLETE MIN 3 VI,320001710,CDM,320,RC,73130,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,608,
BILATERAL FT COMPLETE MIN 3 VI,320001711,CDM,320,RC,73630,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST BILATERAL CMPLTE MIN 3 V,320001712,CDM,320,RC,73110,HCPCS,outpatient,,,370.5,259.35,,292.7,79,,234.16,percent of total billed charges,79% of total billed charges,333.45,90,,266.76,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,233.42,63,,186.74,percent of total billed charges,63% of total billed charges,286.1,77.22,,228.88,percent of total billed charges,77.22% of total billed charges,244.9,66.1,,195.92,percent of total billed charges,66.1% of total billed charges,307.52,83,,246.02,percent of total billed charges,83% of total,351.98,95,,281.58,percent of total billed charges ,95% of total billed charges,296.4,80,,237.12,percent of total billed charges,78% of total billed charges,288.99,78,,231.192,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,233.42,63,,186.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,333.45,90,,266.76,percent of total billed charges,90% of total billed charges,296.4,80,,237.12,percent of total billed charges,80% of total billed charges,233.42,63,,186.74,percent of total billed charges,63% of total billed charges,314.93,85,,251.944,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,292.7,79,,234.16,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL SHOULDER MIN 2 VIEWS,320001713,CDM,320,RC,73030,HCPCS,outpatient,,,446,312.2,,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,344.4,77.22,,275.52,percent of total billed charges,77.22% of total billed charges,294.81,66.1,,235.85,percent of total billed charges,66.1% of total billed charges,370.18,83,,296.14,percent of total billed charges,83% of total,423.7,95,,338.96,percent of total billed charges ,95% of total billed charges,356.8,80,,285.44,percent of total billed charges,78% of total billed charges,347.88,78,,278.304,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL KNEES COMPLETE,320001715,CDM,320,RC,73565,HCPCS,outpatient,,,763,534.1,,602.77,79,,482.22,percent of total billed charges,79% of total billed charges,686.7,90,,549.36,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,480.69,63,,384.55,percent of total billed charges,63% of total billed charges,589.19,77.22,,471.35,percent of total billed charges,77.22% of total billed charges,504.34,66.1,,403.47,percent of total billed charges,66.1% of total billed charges,633.29,83,,506.63,percent of total billed charges,83% of total,724.85,95,,579.88,percent of total billed charges ,95% of total billed charges,610.4,80,,488.32,percent of total billed charges,78% of total billed charges,595.14,78,,476.112,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,480.69,63,,384.55,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,480.69,63,,384.55,percent of total billed charges,63% of total billed charges,648.55,85,,518.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,602.77,79,,482.22,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,724.85,
BILATERAL HEEL MIN 2 VIEWS,320001716,CDM,320,RC,73650,HCPCS,outpatient,,,447,312.9,,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,345.17,77.22,,276.14,percent of total billed charges,77.22% of total billed charges,295.47,66.1,,236.38,percent of total billed charges,66.1% of total billed charges,371.01,83,,296.81,percent of total billed charges,83% of total,424.65,95,,339.72,percent of total billed charges ,95% of total billed charges,357.6,80,,286.08,percent of total billed charges,78% of total billed charges,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL ORBIT MIN 4 VIEWS,320001718,CDM,320,RC,70200,HCPCS,outpatient,,,251,175.7,,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,225.9,90,,180.72,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,158.13,63,,126.5,percent of total billed charges,63% of total billed charges,193.82,77.22,,155.06,percent of total billed charges,77.22% of total billed charges,165.91,66.1,,132.73,percent of total billed charges,66.1% of total billed charges,208.33,83,,166.66,percent of total billed charges,83% of total,238.45,95,,190.76,percent of total billed charges ,95% of total billed charges,200.8,80,,160.64,percent of total billed charges,78% of total billed charges,195.78,78,,156.624,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,158.13,63,,126.5,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,158.13,63,,126.5,percent of total billed charges,63% of total billed charges,213.35,85,,170.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,198.29,79,,158.63,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
ARTHROGRAM RIGHT KNEE,320001722,CDM,320,RC,73580,HCPCS,outpatient,,,736,515.2,,581.44,79,,465.15,percent of total billed charges,79% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,568.34,77.22,,454.67,percent of total billed charges,77.22% of total billed charges,486.5,66.1,,389.2,percent of total billed charges,66.1% of total billed charges,610.88,83,,488.7,percent of total billed charges,83% of total,699.2,95,,559.36,percent of total billed charges ,95% of total billed charges,588.8,80,,471.04,percent of total billed charges,78% of total billed charges,574.08,78,,459.264,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,581.44,79,,465.15,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,699.2,
FEMUR BILATERAL MIN 2 VIEW,320001723,CDM,320,RC,73552,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
TIBIA & FIBULA BILATERAL 2VIEW,320001724,CDM,320,RC,73590,HCPCS,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HUMERUS BILATERAL MIN 2 VIEWS,320001725,CDM,320,RC,73060,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOREARM BILATERAL 2 VIEWS,320001726,CDM,320,RC,73090,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,204.25,66.1,,163.4,percent of total billed charges,66.1% of total billed charges,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL SHOULDERS 2 VIEWS,320001728,CDM,320,RC,73030,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL FOOT 2 VIEWS,320001729,CDM,320,RC,73620,HCPCS,outpatient,,,208,145.6,,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,160.62,77.22,,128.5,percent of total billed charges,77.22% of total billed charges,137.49,66.1,,109.99,percent of total billed charges,66.1% of total billed charges,172.64,83,,138.11,percent of total billed charges,83% of total,197.6,95,,158.08,percent of total billed charges ,95% of total billed charges,166.4,80,,133.12,percent of total billed charges,78% of total billed charges,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL ANKLE LIMIT MIN 3 V,320001730,CDM,320,RC,73610,HCPCS,outpatient,,,405,283.5,,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,312.74,77.22,,250.19,percent of total billed charges,77.22% of total billed charges,267.71,66.1,,214.17,percent of total billed charges,66.1% of total billed charges,336.15,83,,268.92,percent of total billed charges,83% of total,384.75,95,,307.8,percent of total billed charges ,95% of total billed charges,324,80,,259.2,percent of total billed charges,78% of total billed charges,315.9,78,,252.72,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,324,80,,259.2,percent of total billed charges,80% of total billed charges,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,344.25,85,,275.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL FEET AP LATERAL 2 VI,320001733,CDM,320,RC,73620,HCPCS,outpatient,,,292,204.4,,230.68,79,,184.54,percent of total billed charges,79% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,183.96,63,,147.17,percent of total billed charges,63% of total billed charges,225.48,77.22,,180.38,percent of total billed charges,77.22% of total billed charges,193.01,66.1,,154.41,percent of total billed charges,66.1% of total billed charges,242.36,83,,193.89,percent of total billed charges,83% of total,277.4,95,,221.92,percent of total billed charges ,95% of total billed charges,233.6,80,,186.88,percent of total billed charges,78% of total billed charges,227.76,78,,182.208,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,183.96,63,,147.17,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,183.96,63,,147.17,percent of total billed charges,63% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,230.68,79,,184.54,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LOWER EXT INFANT 2 VIEW BILAT,320001734,CDM,320,RC,73592,HCPCS,outpatient,,,470,329,,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,362.93,77.22,,290.34,percent of total billed charges,77.22% of total billed charges,310.67,66.1,,248.54,percent of total billed charges,66.1% of total billed charges,390.1,83,,312.08,percent of total billed charges,83% of total,446.5,95,,357.2,percent of total billed charges ,95% of total billed charges,376,80,,300.8,percent of total billed charges,78% of total billed charges,366.6,78,,293.28,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL ELBOW 2 VIEWS,320001739,CDM,320,RC,73070,HCPCS,outpatient,,,502,351.4,,396.58,79,,317.26,percent of total billed charges,79% of total billed charges,451.8,90,,361.44,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,387.64,77.22,,310.11,percent of total billed charges,77.22% of total billed charges,331.82,66.1,,265.46,percent of total billed charges,66.1% of total billed charges,416.66,83,,333.33,percent of total billed charges,83% of total,476.9,95,,381.52,percent of total billed charges ,95% of total billed charges,401.6,80,,321.28,percent of total billed charges,78% of total billed charges,391.56,78,,313.248,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,316.26,63,,253.01,percent of total billed charges,63% of total billed charges,426.7,85,,341.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,396.58,79,,317.26,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,476.9,
CERVICAL SPINE LAT SINGLE VIEW,320001740,CDM,320,RC,72020,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,144.76,66.1,,115.81,percent of total billed charges,66.1% of total billed charges,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL UPP EXT INF MIN 2 VI,320001741,CDM,320,RC,73092,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BILATERAL CLAVICLES,320001742,CDM,320,RC,73000,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,197.5,79,,158,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
NORGARD/PA HANDS & WRIST,320001753,CDM,320,RC,77072,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
ANKLE 2 VIEWS BILAT,320001754,CDM,320,RC,73600,HCPCS,outpatient,,,405,283.5,,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,312.74,77.22,,250.19,percent of total billed charges,77.22% of total billed charges,267.71,66.1,,214.17,percent of total billed charges,66.1% of total billed charges,336.15,83,,268.92,percent of total billed charges,83% of total,384.75,95,,307.8,percent of total billed charges ,95% of total billed charges,324,80,,259.2,percent of total billed charges,78% of total billed charges,315.9,78,,252.72,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,324,80,,259.2,percent of total billed charges,80% of total billed charges,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,344.25,85,,275.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
CERV SPINE W/FLEX & EXT 6/>VIE,320001755,CDM,320,RC,72052,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
WB KNEES LT WITH OBLIQ LAT 4 V,320001757,CDM,320,RC,73564,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
STANDING BILATERAL LT AP KNEES,320001758,CDM,320,RC,73565,HCPCS,outpatient,,,248,173.6,,195.92,79,,156.74,percent of total billed charges,79% of total billed charges,223.2,90,,178.56,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,191.51,77.22,,153.21,percent of total billed charges,77.22% of total billed charges,163.93,66.1,,131.14,percent of total billed charges,66.1% of total billed charges,205.84,83,,164.67,percent of total billed charges,83% of total,235.6,95,,188.48,percent of total billed charges ,95% of total billed charges,198.4,80,,158.72,percent of total billed charges,78% of total billed charges,193.44,78,,154.752,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,223.2,90,,178.56,percent of total billed charges,90% of total billed charges,198.4,80,,158.72,percent of total billed charges,80% of total billed charges,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,210.8,85,,168.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,195.92,79,,156.74,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WB KNEES RT WITH OBLIQ LAT 4 V,320001759,CDM,320,RC,73564,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
STANDING BILATERAL RT AP KNEES,320001760,CDM,320,RC,73565,HCPCS,outpatient,,,248,173.6,,195.92,79,,156.74,percent of total billed charges,79% of total billed charges,223.2,90,,178.56,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,191.51,77.22,,153.21,percent of total billed charges,77.22% of total billed charges,163.93,66.1,,131.14,percent of total billed charges,66.1% of total billed charges,205.84,83,,164.67,percent of total billed charges,83% of total,235.6,95,,188.48,percent of total billed charges ,95% of total billed charges,198.4,80,,158.72,percent of total billed charges,78% of total billed charges,193.44,78,,154.752,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,223.2,90,,178.56,percent of total billed charges,90% of total billed charges,198.4,80,,158.72,percent of total billed charges,80% of total billed charges,156.24,63,,124.99,percent of total billed charges,63% of total billed charges,210.8,85,,168.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,195.92,79,,156.74,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
C SPINE FLEXION/EXT 2/3 VIEWS,320001762,CDM,320,RC,72040,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL STANDING KNEES 3 VIE,320001764,CDM,320,RC,73565,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
KNEE 1/2 VIEWS RT,320001765,CDM,320,RC,73560,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FLURO GUIDANCE NEEDLE PLACEMEN,320001788,CDM,320,RC,77002,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
SOFT TISSUE FACE NECK HEAD,320001792,CDM,320,RC,70360,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FLOROSCOPIC GUID W POSTOP CHST,320001798,CDM,320,RC,77001,HCPCS,outpatient,,,840,588,,663.6,79,,530.88,percent of total billed charges,79% of total billed charges,756,90,,604.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,529.2,63,,423.36,percent of total billed charges,63% of total billed charges,648.65,77.22,,518.92,percent of total billed charges,77.22% of total billed charges,555.24,66.1,,444.19,percent of total billed charges,66.1% of total billed charges,697.2,83,,557.76,percent of total billed charges,83% of total,798,95,,638.4,percent of total billed charges ,95% of total billed charges,672,80,,537.6,percent of total billed charges,78% of total billed charges,655.2,78,,524.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,529.2,63,,423.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,756,90,,604.8,percent of total billed charges,90% of total billed charges,672,80,,537.6,percent of total billed charges,80% of total billed charges,529.2,63,,423.36,percent of total billed charges,63% of total billed charges,714,85,,571.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,663.6,79,,530.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,798,
NON-BILLABLE CHARGE RAD,320005555,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NON-BILLABLE CHARGE ORTHO,320008555,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NJX CONTRAST KNEE ARTHG CT MRI,320027369,CDM,320,RC,27369,HCPCS,outpatient,,,202,141.4,,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,155.98,77.22,,124.78,percent of total billed charges,77.22% of total billed charges,133.52,66.1,,106.82,percent of total billed charges,66.1% of total billed charges,167.66,83,,134.13,percent of total billed charges,83% of total,191.9,95,,153.52,percent of total billed charges ,95% of total billed charges,161.6,80,,129.28,percent of total billed charges,78% of total billed charges,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.26,450,
MYELOGRAPHY VIA LUMBAR INJECT,320062304,CDM,320,RC,62304,HCPCS,outpatient,,,1912,1338.4,,1510.48,79,,1208.38,percent of total billed charges,79% of total billed charges,1720.8,90,,1376.64,percent of total billed charges,90% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,1071.2,160,,,Fee Schedule,160% of CMS OPPS rate,870.35,130,,,Fee Schedule,130% of CMS OPPS rate,1204.56,63,,963.65,percent of total billed charges,63% of total billed charges,1476.45,77.22,,1181.16,percent of total billed charges,77.22% of total billed charges,1263.83,66.1,,1011.06,percent of total billed charges,66.1% of total billed charges,1586.96,83,,1269.57,percent of total billed charges,83% of total,1816.4,95,,1453.12,percent of total billed charges ,95% of total billed charges,1529.6,80,,1223.68,percent of total billed charges,78% of total billed charges,1491.36,78,,1193.088,percent of total billed charges,78% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,1204.56,63,,963.65,percent of total billed charges,63% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,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,1204.56,63,,963.65,percent of total billed charges,63% of total billed charges,1625.2,85,,1300.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,622.63,93,,,fee schedule,93% of CMS OPPS rate,1510.48,79,,1208.38,percent of total billed charges,79% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,450,1816.4,
RIBS XR LEFT,320071100,CDM,320,RC,71100,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,157.32,66.1,,125.86,percent of total billed charges,66.1% of total billed charges,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
KNEE BILATR COMPLETE 1/2 VIEWS,320073560,CDM,320,RC,73560,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL KNEES COMPL 3 VIEWS,320073562,CDM,320,RC,73562,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,171.86,66.1,,137.49,percent of total billed charges,66.1% of total billed charges,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
XRAY EXAM KNEE COMP 4 VIEWS >,320073564,CDM,320,RC,73564,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
ESOPHAGUS BARIUM SWALW 2CNTRST,320074221,CDM,320,RC,74221,HCPCS,outpatient,,,456,319.2,,360.24,79,,288.19,percent of total billed charges,79% of total billed charges,410.4,90,,328.32,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,287.28,63,,229.82,percent of total billed charges,63% of total billed charges,352.12,77.22,,281.7,percent of total billed charges,77.22% of total billed charges,301.42,66.1,,241.14,percent of total billed charges,66.1% of total billed charges,378.48,83,,302.78,percent of total billed charges,83% of total,433.2,95,,346.56,percent of total billed charges ,95% of total billed charges,364.8,80,,291.84,percent of total billed charges,78% of total billed charges,355.68,78,,284.544,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,287.28,63,,229.82,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,287.28,63,,229.82,percent of total billed charges,63% of total billed charges,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,360.24,79,,288.19,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,450,
UPPER GI SERIES WO KUB,320074240,CDM,320,RC,74240,HCPCS,outpatient,,,456,319.2,,360.24,79,,288.19,percent of total billed charges,79% of total billed charges,410.4,90,,328.32,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,287.28,63,,229.82,percent of total billed charges,63% of total billed charges,352.12,77.22,,281.7,percent of total billed charges,77.22% of total billed charges,301.42,66.1,,241.14,percent of total billed charges,66.1% of total billed charges,378.48,83,,302.78,percent of total billed charges,83% of total,433.2,95,,346.56,percent of total billed charges ,95% of total billed charges,364.8,80,,291.84,percent of total billed charges,78% of total billed charges,355.68,78,,284.544,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,287.28,63,,229.82,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,287.28,63,,229.82,percent of total billed charges,63% of total billed charges,387.6,85,,310.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,360.24,79,,288.19,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,450,
SM INTESTINE FU STUDY MULT IMG,320074248,CDM,320,RC,74248,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,43.74,100,,,fee schedule,100% of CMS fee schedule,69.98,160,,,fee schedule,160% of CMS fee schedule,56.86,130,,,fee schedule,130% of CMS fee schedule,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,43.74,100,,,fee schedule,100% of CMS fee schedule,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,43.74,100,,,fee schedule ,100% of CMS 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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.68,93,,,fee schedule,93% of CMS fee schedule,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,43.74,100,,,fee schedule,100% of CMS fee schedule,43.74,100,,,fee schedule,100% of CMS fee schedule,40.68,450,
RAD BARIUM ENEMA COLON CH CP,320080011,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD BARI ENEM W/AIR CONTRST CP,320080012,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD CYSTOGRAPHY/VOIDING CP,320080027,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD ESOPHAGUS (BARIUM SWAL) CP,320080030,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD HYSTEROSALPINGOGRAM  CP,320080043,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD IVP COMP CHG CP,320080044,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD UPPER GI SERIES UGI CP,320080089,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD UPPER GI & SM BOWEL CP,320080090,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD UPPER GI W/AIR CONTRAST CP,320080091,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RAD CYSTOGRAM CHG CP,320080103,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BABYGRAM CP,320080135,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CMPLT LT KNEE W STANDING AP CP,320080159,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CMPLT RT KNEE W STANDING AP CP,320080160,CDM,320,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SOLIOSIS ORTHO 2 OR 3 VIEWS,3201414-7,CDM,320,RC,72082,HCPCS,outpatient,,,333,233.1,,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,299.7,90,,239.76,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,257.14,77.22,,205.71,percent of total billed charges,77.22% of total billed charges,220.11,66.1,,176.09,percent of total billed charges,66.1% of total billed charges,276.39,83,,221.11,percent of total billed charges,83% of total,316.35,95,,253.08,percent of total billed charges ,95% of total billed charges,266.4,80,,213.12,percent of total billed charges,78% of total billed charges,259.74,78,,207.792,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
CERV SPINE CMPL ORTHO 4/5 VIEW,3201415-7,CDM,320,RC,72050,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
THORACIC COMP ORTHO 3 VIEWS,3201416-7,CDM,320,RC,72072,HCPCS,outpatient,,,442,309.4,,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,341.31,77.22,,273.05,percent of total billed charges,77.22% of total billed charges,292.16,66.1,,233.73,percent of total billed charges,66.1% of total billed charges,366.86,83,,293.49,percent of total billed charges,83% of total,419.9,95,,335.92,percent of total billed charges ,95% of total billed charges,353.6,80,,282.88,percent of total billed charges,78% of total billed charges,344.76,78,,275.808,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
THORACIC SPINE 2 VIEW,3201417-7,CDM,320,RC,72070,HCPCS,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,160.62,66.1,,128.5,percent of total billed charges,66.1% of total billed charges,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
L-SPINE CMPL ORTHO MIN 4 VIEWS,3201418-7,CDM,320,RC,72110,HCPCS,outpatient,,,617,431.9,,487.43,79,,389.94,percent of total billed charges,79% of total billed charges,555.3,90,,444.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,476.45,77.22,,381.16,percent of total billed charges,77.22% of total billed charges,407.84,66.1,,326.27,percent of total billed charges,66.1% of total billed charges,512.11,83,,409.69,percent of total billed charges,83% of total,586.15,95,,468.92,percent of total billed charges ,95% of total billed charges,493.6,80,,394.88,percent of total billed charges,78% of total billed charges,481.26,78,,385.008,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,487.43,79,,389.94,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,586.15,
L-SPINE LTD ORTHO 2/3 VIEWS,3201419-7,CDM,320,RC,72100,HCPCS,outpatient,,,442,309.4,,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,341.31,77.22,,273.05,percent of total billed charges,77.22% of total billed charges,292.16,66.1,,233.73,percent of total billed charges,66.1% of total billed charges,366.86,83,,293.49,percent of total billed charges,83% of total,419.9,95,,335.92,percent of total billed charges ,95% of total billed charges,353.6,80,,282.88,percent of total billed charges,78% of total billed charges,344.76,78,,275.808,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
PELVIS ORTHO 1 OR 2 VIEWS,3201420-7,CDM,320,RC,72170,HCPCS,outpatient,,,442,309.4,,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,341.31,77.22,,273.05,percent of total billed charges,77.22% of total billed charges,292.16,66.1,,233.73,percent of total billed charges,66.1% of total billed charges,366.86,83,,293.49,percent of total billed charges,83% of total,419.9,95,,335.92,percent of total billed charges ,95% of total billed charges,353.6,80,,282.88,percent of total billed charges,78% of total billed charges,344.76,78,,275.808,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
CERVICAL SPINE ORTHO 2/3 VIEWS,3201421-7,CDM,320,RC,72040,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
STERNUM ORTHO MIN 2 VIEWS,3201422-7,CDM,320,RC,71120,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
STERNOCLAVICULA JNT MIN 3 VIEW,3201423-7,CDM,320,RC,71130,HCPCS,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIBS COMP BILAT ORTHO MIN 4 VI,3201427-7,CDM,320,RC,71111,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SCARUM/COCCYX ORTHO MIN 2 VIEW,3201472-7,CDM,320,RC,72220,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,191.03,66.1,,152.82,percent of total billed charges,66.1% of total billed charges,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LATERAL SPINE ORTHO SINGLE VIE,3201480-7,CDM,320,RC,72020,HCPCS,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,142.12,66.1,,113.7,percent of total billed charges,66.1% of total billed charges,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
AP BOTH KNEES STANDING,3201481-7,CDM,320,RC,73565,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
PA BOTH KNEES STANDING,3201482-7,CDM,320,RC,73565,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
AP & PA BOTH KNEES STANDING,3201483-7,CDM,320,RC,73565,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SPINE/SINGLE VIEW,3201485-7,CDM,320,RC,72020,HCPCS,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,142.12,66.1,,113.7,percent of total billed charges,66.1% of total billed charges,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
AC JOINTS ORTHO BILATERAL,3201504-7,CDM,320,RC,73050,HCPCS,outpatient,,,186,130.2,,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,167.4,90,,133.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,143.63,77.22,,114.9,percent of total billed charges,77.22% of total billed charges,122.95,66.1,,98.36,percent of total billed charges,66.1% of total billed charges,154.38,83,,123.5,percent of total billed charges,83% of total,176.7,95,,141.36,percent of total billed charges ,95% of total billed charges,148.8,80,,119.04,percent of total billed charges,78% of total billed charges,145.08,78,,116.064,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,117.18,63,,93.74,percent of total billed charges,63% of total billed charges,158.1,85,,126.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,146.94,79,,117.55,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LATERAL C-SPINE ONLY SING VIEW,3201532-7,CDM,320,RC,72020,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,144.76,66.1,,115.81,percent of total billed charges,66.1% of total billed charges,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ANKLE LTD ORTHO RIGHT2 VIEWS,3201546-7,CDM,320,RC,73600,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
CLAVICLE ORTHO RIGHT,3201547-7,CDM,320,RC,73000,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,197.5,79,,158,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW LTD ORTHO RIGHT 2 VIEWS,3201548-7,CDM,320,RC,73070,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW CMPLT ORTHO RIGHT MIN 3V,3201549-7,CDM,320,RC,73080,HCPCS,outpatient,,,386,270.2,,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,298.07,77.22,,238.46,percent of total billed charges,77.22% of total billed charges,255.15,66.1,,204.12,percent of total billed charges,66.1% of total billed charges,320.38,83,,256.3,percent of total billed charges,83% of total,366.7,95,,293.36,percent of total billed charges ,95% of total billed charges,308.8,80,,247.04,percent of total billed charges,78% of total billed charges,301.08,78,,240.864,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FEMUR ORTHOMIN 2 VIEWS,3201550-7,CDM,320,RC,73552,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOREARM ORTHO RIGHT 2 VIEWS,3201551-7,CDM,320,RC,73090,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,204.25,66.1,,163.4,percent of total billed charges,66.1% of total billed charges,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT CMPL ORTHO MIN 3 VIEWS,3201552-7,CDM,320,RC,73630,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HAND CMPL ORTHO R MIN 3 VIEWS,3201553-7,CDM,320,RC,73130,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,608,
OS CALCIS R HEEL ORTHO MIN 2V,3201554-7,CDM,320,RC,73650,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,149.39,66.1,,119.51,percent of total billed charges,66.1% of total billed charges,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R HIP CMPL ORTHO 2-3 VIEWS,3201556-7,CDM,320,RC,73502,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HUMEROUS ORTHO RIGHT MIN 2 VIE,3201557-7,CDM,320,RC,73060,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
KNEE 3 VIEW ORTHO RIGHT,3201558-7,CDM,320,RC,73562,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R KNEE LTD ORTHO 2 VIEWS,3201559-7,CDM,320,RC,73560,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HUMERUS BILATERAL MIN 1 VIEWS,3201560-7,CDM,320,RC,73060,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SCAPULA ORTHO RIGHT,3201564-7,CDM,320,RC,73010,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SHOULDER ORTHO RIGHT 3 VIEWS,3201566-7,CDM,320,RC,73030,HCPCS,outpatient,,,546,382.2,,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,421.62,77.22,,337.3,percent of total billed charges,77.22% of total billed charges,360.91,66.1,,288.73,percent of total billed charges,66.1% of total billed charges,453.18,83,,362.54,percent of total billed charges,83% of total,518.7,95,,414.96,percent of total billed charges ,95% of total billed charges,436.8,80,,349.44,percent of total billed charges,78% of total billed charges,425.88,78,,340.704,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,464.1,85,,371.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,518.7,
R TIBIA/FIBULA ORTHO 2 VIEWS,3201567-7,CDM,320,RC,73590,HCPCS,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST CMPLT ORTHO RIGHT MIN 3V,3201569-7,CDM,320,RC,73110,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST LTD ORTHO RIGHT 2 VIEWS,3201570-7,CDM,320,RC,73100,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIGHT HAND THUMB ORTHO MIN 3 V,3201571-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RHAND 2ND DIGIT ORTHO MIN 3 VI,3201572-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R HAND 3RD DIGIT ORTHO MIN 3V,3201573-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R HAND 4TH DIGIT ORTHO MIN 3VI,3201574-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R HAND 5TH DIGIT ORTHO MIN 3 V,3201575-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LHAND SECOND DIGIT ORTH MIN 3V,3201576-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LHAND THIRD DIG ORTHO MIN 3V,3201577-7,CDM,320,RC,73140,HCPCS,outpatient,,,206,144.2,,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,185.4,90,,148.32,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,159.07,77.22,,127.26,percent of total billed charges,77.22% of total billed charges,136.17,66.1,,108.94,percent of total billed charges,66.1% of total billed charges,170.98,83,,136.78,percent of total billed charges,83% of total,195.7,95,,156.56,percent of total billed charges ,95% of total billed charges,164.8,80,,131.84,percent of total billed charges,78% of total billed charges,160.68,78,,128.544,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.78,63,,103.82,percent of total billed charges,63% of total billed charges,175.1,85,,140.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,162.74,79,,130.19,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LHAND FOURTH DIG ORHTO MIN 3 V,3201578-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LHAND FIFTH DIG ORTHO MIN 3V,3201579-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FOOT 2ND DIGIT ORTHO MIN 3 V,3201580-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FOOT 3RD DIGIT ORTHO MIN 3 V,3201581-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FOOT 4TH DIGIT ORTHO MIN 3 V,3201582-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FOOT 5TH DIGIT ORTHO MIN 3V,3201583-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT GREAT TOE ORTHO MIN 3 V,3201584-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT 2ND DIGIT ORTHO MIN 3 V,3201585-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT 3RD DIGIT ORTHO MIN 3 V,3201586-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT 4TH DIGIT ORTHO MIN 3 V,3201587-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R FOOT 5TH DIGIT ORTHO MIN 3 V,3201588-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R ANKLE CMPL ORTHO MIN 3 VIEWS,3201589-7,CDM,320,RC,73610,HCPCS,outpatient,,,342,239.4,,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,264.09,77.22,,211.27,percent of total billed charges,77.22% of total billed charges,226.06,66.1,,180.85,percent of total billed charges,66.1% of total billed charges,283.86,83,,227.09,percent of total billed charges,83% of total,324.9,95,,259.92,percent of total billed charges ,95% of total billed charges,273.6,80,,218.88,percent of total billed charges,78% of total billed charges,266.76,78,,213.408,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L ANKLE COMPLETE ORTHO MIN 3 V,3201590-7,CDM,320,RC,73610,HCPCS,outpatient,,,342,239.4,,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,264.09,77.22,,211.27,percent of total billed charges,77.22% of total billed charges,226.06,66.1,,180.85,percent of total billed charges,66.1% of total billed charges,283.86,83,,227.09,percent of total billed charges,83% of total,324.9,95,,259.92,percent of total billed charges ,95% of total billed charges,273.6,80,,218.88,percent of total billed charges,78% of total billed charges,266.76,78,,213.408,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ANKLE LTD ORTHO LEFT 2 VIEWS,3201591-7,CDM,320,RC,73600,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
CLAVICLE ORTHO LEFT,3201592-7,CDM,320,RC,73000,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,197.5,79,,158,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW LTD ORTHO LEFT 2 VIEWS,3201593-7,CDM,320,RC,73070,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW CMPLT ORTHO LEFT MIN 3V,3201594-7,CDM,320,RC,73080,HCPCS,outpatient,,,386,270.2,,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,298.07,77.22,,238.46,percent of total billed charges,77.22% of total billed charges,255.15,66.1,,204.12,percent of total billed charges,66.1% of total billed charges,320.38,83,,256.3,percent of total billed charges,83% of total,366.7,95,,293.36,percent of total billed charges ,95% of total billed charges,308.8,80,,247.04,percent of total billed charges,78% of total billed charges,301.08,78,,240.864,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FEMUR ORTHO MIN 2VIEWS,3201595-7,CDM,320,RC,73552,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOREARM ORTHO LEFT 2 VIEWS,3201596-7,CDM,320,RC,73090,HCPCS,outpatient,,,309,216.3,,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,278.1,90,,222.48,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,238.61,77.22,,190.89,percent of total billed charges,77.22% of total billed charges,204.25,66.1,,163.4,percent of total billed charges,66.1% of total billed charges,256.47,83,,205.18,percent of total billed charges,83% of total,293.55,95,,234.84,percent of total billed charges ,95% of total billed charges,247.2,80,,197.76,percent of total billed charges,78% of total billed charges,241.02,78,,192.816,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.67,63,,155.74,percent of total billed charges,63% of total billed charges,262.65,85,,210.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,244.11,79,,195.29,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FOOT CMPL ORTHO MIN 3 VIEWS,3201597-7,CDM,320,RC,73630,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HAND CMPLT ORTHO L MIN 3 VIEWS,3201598-7,CDM,320,RC,73130,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,608,
OS CALCIS L HEEL ORTHO MIN 2 V,3201599-7,CDM,320,RC,73650,HCPCS,outpatient,,,226,158.2,,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,203.4,90,,162.72,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,174.52,77.22,,139.62,percent of total billed charges,77.22% of total billed charges,149.39,66.1,,119.51,percent of total billed charges,66.1% of total billed charges,187.58,83,,150.06,percent of total billed charges,83% of total,214.7,95,,171.76,percent of total billed charges ,95% of total billed charges,180.8,80,,144.64,percent of total billed charges,78% of total billed charges,176.28,78,,141.024,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,142.38,63,,113.9,percent of total billed charges,63% of total billed charges,192.1,85,,153.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,178.54,79,,142.83,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L HIP CMPL ORTHO 2-3 VIEWS,3201600-7,CDM,320,RC,73502,HCPCS,outpatient,,,266,186.2,,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,239.4,90,,191.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,205.41,77.22,,164.33,percent of total billed charges,77.22% of total billed charges,175.83,66.1,,140.66,percent of total billed charges,66.1% of total billed charges,220.78,83,,176.62,percent of total billed charges,83% of total,252.7,95,,202.16,percent of total billed charges ,95% of total billed charges,212.8,80,,170.24,percent of total billed charges,78% of total billed charges,207.48,78,,165.984,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,167.58,63,,134.06,percent of total billed charges,63% of total billed charges,226.1,85,,180.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,210.14,79,,168.11,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HUMEROUS ORTHO LEFT MIN 2 VIEW,3201601-7,CDM,320,RC,73060,HCPCS,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
KNEE 3 VIEW ORTHO LEFT,3201602-7,CDM,320,RC,73562,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L KNEE LTD ORTHO 2 VIEWS,3201603-7,CDM,320,RC,73560,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SCAPULA ORTHO LEFT,3201606-7,CDM,320,RC,73010,HCPCS,outpatient,,,254,177.8,,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,228.6,90,,182.88,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,196.14,77.22,,156.91,percent of total billed charges,77.22% of total billed charges,167.89,66.1,,134.31,percent of total billed charges,66.1% of total billed charges,210.82,83,,168.66,percent of total billed charges,83% of total,241.3,95,,193.04,percent of total billed charges ,95% of total billed charges,203.2,80,,162.56,percent of total billed charges,78% of total billed charges,198.12,78,,158.496,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,160.02,63,,128.02,percent of total billed charges,63% of total billed charges,215.9,85,,172.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,200.66,79,,160.53,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
SHOULDER ORTHO LEFT 3 VIEWS,3201607-7,CDM,320,RC,73030,HCPCS,outpatient,,,546,382.2,,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,421.62,77.22,,337.3,percent of total billed charges,77.22% of total billed charges,360.91,66.1,,288.73,percent of total billed charges,66.1% of total billed charges,453.18,83,,362.54,percent of total billed charges,83% of total,518.7,95,,414.96,percent of total billed charges ,95% of total billed charges,436.8,80,,349.44,percent of total billed charges,78% of total billed charges,425.88,78,,340.704,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,491.4,90,,393.12,percent of total billed charges,90% of total billed charges,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,343.98,63,,275.18,percent of total billed charges,63% of total billed charges,464.1,85,,371.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,431.34,79,,345.07,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,518.7,
L TIBIA/FIBULA ORTHO 2 VIEWS,3201609-7,CDM,320,RC,73590,HCPCS,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST CMPLT ORTHO LEFT MIN 3VI,3201611-7,CDM,320,RC,73110,HCPCS,outpatient,,,370,259,,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,333,90,,266.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,285.71,77.22,,228.57,percent of total billed charges,77.22% of total billed charges,244.57,66.1,,195.66,percent of total billed charges,66.1% of total billed charges,307.1,83,,245.68,percent of total billed charges,83% of total,351.5,95,,281.2,percent of total billed charges ,95% of total billed charges,296,80,,236.8,percent of total billed charges,78% of total billed charges,288.6,78,,230.88,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,233.1,63,,186.48,percent of total billed charges,63% of total billed charges,314.5,85,,251.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,292.3,79,,233.84,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST LTD ORTHO LEFT 2 VIEWS,3201612-7,CDM,320,RC,73100,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HAND RECHECK ORTHO LEFT 2 VIEW,3201616-7,CDM,320,RC,73120,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
HAND RECHECK ORTHO RIGHT 2 VIE,3201617-7,CDM,320,RC,73120,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
HIP 1 VIEW ORTHO RIGHT,3201618-7,CDM,320,RC,73501,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HIP 1 VIEW ORTHO LEFT,3201619-7,CDM,320,RC,73501,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HAND ORTHO RIGHT 2 VIEWS,3201626-7,CDM,320,RC,73120,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
HAND 1 VIEW ORTHO LEFT 2 VIEWS,3201627-7,CDM,320,RC,73120,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
ANKLE 1 VIEW ORTHO RIGHT,3201628-7,CDM,320,RC,73600,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ANKLE 1 VIEW ORTHO LEFT,3201629-7,CDM,320,RC,73600,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R HEEL MIN 1 VIEW ORTHO,3201630-7,CDM,320,RC,73650,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HEEL MIN 1VIEW ORTHO LEFT,3201631-7,CDM,320,RC,73650,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 1 VIEW ORTHO RIGHT,3201632-7,CDM,320,RC,73620,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 1 VIEW ORTHO LEFT,3201633-7,CDM,320,RC,73620,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FEMUR 1 VIEW ORTHO RIGHT,3201634-7,CDM,320,RC,73551,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,450,
FEMUR 1 VIEW ORTHO LEFT,3201635-7,CDM,320,RC,73551,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,450,
ELBOW 2 VIEWS ORTHO RIGHT,3201638-7,CDM,320,RC,73070,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,104.44,66.1,,83.55,percent of total billed charges,66.1% of total billed charges,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ELBOW 2 VIEWS ORTHO LEFT,3201639-7,CDM,320,RC,73070,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,104.44,66.1,,83.55,percent of total billed charges,66.1% of total billed charges,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R KNEE 1 VIEW ORTHO,3201640-7,CDM,320,RC,73560,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L KNEE 1 VIEW ORTHO,3201641-7,CDM,320,RC,73560,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LEFT HAND THUMB ORTHO MIN 3 V,3201642-7,CDM,320,RC,73140,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L FOOT GREAT TOE ORTHO MIN 3V,3201643-7,CDM,320,RC,73660,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIBS RIGHT ORTHO 2 VIEWS,3201644-7,CDM,320,RC,71100,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,157.32,66.1,,125.86,percent of total billed charges,66.1% of total billed charges,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST 1 VIEW ORTHO RIGHT 1 VIE,3201646-7,CDM,320,RC,73100,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,157.32,66.1,,125.86,percent of total billed charges,66.1% of total billed charges,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST ORTHO LEFT 1 VIEWS,3201647-7,CDM,320,RC,73100,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,157.32,66.1,,125.86,percent of total billed charges,66.1% of total billed charges,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LUMB FLEXION & EXTEN ORT 2/3 V,3201648-7,CDM,320,RC,72120,HCPCS,outpatient,,,324,226.8,,255.96,79,,204.77,percent of total billed charges,79% of total billed charges,291.6,90,,233.28,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,204.12,63,,163.3,percent of total billed charges,63% of total billed charges,250.19,77.22,,200.15,percent of total billed charges,77.22% of total billed charges,214.16,66.1,,171.33,percent of total billed charges,66.1% of total billed charges,268.92,83,,215.14,percent of total billed charges,83% of total,307.8,95,,246.24,percent of total billed charges ,95% of total billed charges,259.2,80,,207.36,percent of total billed charges,78% of total billed charges,252.72,78,,202.176,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,204.12,63,,163.3,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,204.12,63,,163.3,percent of total billed charges,63% of total billed charges,275.4,85,,220.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,255.96,79,,204.77,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
FOOT 2 VEIWS ORTHO RIGHT,3201654-7,CDM,320,RC,73620,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
FOOT 2 VIEWS ORTHO LEFT,3201655-7,CDM,320,RC,73620,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SHOULDER ORTHO RT  1 VIEW,3201659-7,CDM,320,RC,73020,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SHOULDER ORTHO  LT  1 VIEW,3201660-7,CDM,320,RC,73020,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SHOULDER ORTHO LT 2 VIEWS,3201662-7,CDM,320,RC,73030,HCPCS,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
SHOULDER ORTHO RT 2 VIEWS,3201663-7,CDM,320,RC,73030,HCPCS,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,140.13,66.1,,112.1,percent of total billed charges,66.1% of total billed charges,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,133.56,63,,106.85,percent of total billed charges,63% of total billed charges,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL HEEL ORTHO MIN 2 VIE,3201664-7,CDM,320,RC,73650,HCPCS,outpatient,,,447,312.9,,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,345.17,77.22,,276.14,percent of total billed charges,77.22% of total billed charges,295.47,66.1,,236.38,percent of total billed charges,66.1% of total billed charges,371.01,83,,296.81,percent of total billed charges,83% of total,424.65,95,,339.72,percent of total billed charges ,95% of total billed charges,357.6,80,,286.08,percent of total billed charges,78% of total billed charges,348.66,78,,278.928,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,402.3,90,,321.84,percent of total billed charges,90% of total billed charges,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,281.61,63,,225.29,percent of total billed charges,63% of total billed charges,379.95,85,,303.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,353.13,79,,282.5,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL KNEES STAND 2 V ORTH,3201665-7,CDM,320,RC,73560,HCPCS,outpatient,,,393,275.1,,310.47,79,,248.38,percent of total billed charges,79% of total billed charges,353.7,90,,282.96,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,247.59,63,,198.07,percent of total billed charges,63% of total billed charges,303.47,77.22,,242.78,percent of total billed charges,77.22% of total billed charges,259.77,66.1,,207.82,percent of total billed charges,66.1% of total billed charges,326.19,83,,260.95,percent of total billed charges,83% of total,373.35,95,,298.68,percent of total billed charges ,95% of total billed charges,314.4,80,,251.52,percent of total billed charges,78% of total billed charges,306.54,78,,245.232,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,247.59,63,,198.07,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,353.7,90,,282.96,percent of total billed charges,90% of total billed charges,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,247.59,63,,198.07,percent of total billed charges,63% of total billed charges,334.05,85,,267.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,310.47,79,,248.38,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL KNEES STAND 3 V ORTH,3201666-7,CDM,320,RC,73565,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL FEET 2 VIEWS,3201667-7,CDM,320,RC,73620,HCPCS,outpatient,,,292,204.4,,230.68,79,,184.54,percent of total billed charges,79% of total billed charges,262.8,90,,210.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,183.96,63,,147.17,percent of total billed charges,63% of total billed charges,225.48,77.22,,180.38,percent of total billed charges,77.22% of total billed charges,193.01,66.1,,154.41,percent of total billed charges,66.1% of total billed charges,242.36,83,,193.89,percent of total billed charges,83% of total,277.4,95,,221.92,percent of total billed charges ,95% of total billed charges,233.6,80,,186.88,percent of total billed charges,78% of total billed charges,227.76,78,,182.208,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,183.96,63,,147.17,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,183.96,63,,147.17,percent of total billed charges,63% of total billed charges,248.2,85,,198.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,230.68,79,,184.54,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL FEET 3 VIEWS ORTHO,3201668-7,CDM,320,RC,73630,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL HIPS  ORTHO,3201669-7,CDM,320,RC,73522,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BILATERAL ANKLE ORTHO MIN 3 VI,3201709-7,CDM,320,RC,73610,HCPCS,outpatient,,,378,264.6,,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,291.89,77.22,,233.51,percent of total billed charges,77.22% of total billed charges,249.86,66.1,,199.89,percent of total billed charges,66.1% of total billed charges,313.74,83,,250.99,percent of total billed charges,83% of total,359.1,95,,287.28,percent of total billed charges ,95% of total billed charges,302.4,80,,241.92,percent of total billed charges,78% of total billed charges,294.84,78,,235.872,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,340.2,90,,272.16,percent of total billed charges,90% of total billed charges,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,238.14,63,,190.51,percent of total billed charges,63% of total billed charges,321.3,85,,257.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,298.62,79,,238.9,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
HAND BILAT COMP ORTHO MIN 3 VI,3201710-7,CDM,320,RC,73130,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,608,
ORTHO BILATERAL SHLDER MIN 3 V,3201713-7,CDM,320,RC,73030,HCPCS,outpatient,,,347,242.9,,274.13,79,,219.3,percent of total billed charges,79% of total billed charges,312.3,90,,249.84,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,218.61,63,,174.89,percent of total billed charges,63% of total billed charges,267.95,77.22,,214.36,percent of total billed charges,77.22% of total billed charges,229.37,66.1,,183.5,percent of total billed charges,66.1% of total billed charges,288.01,83,,230.41,percent of total billed charges,83% of total,329.65,95,,263.72,percent of total billed charges ,95% of total billed charges,277.6,80,,222.08,percent of total billed charges,78% of total billed charges,270.66,78,,216.528,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,218.61,63,,174.89,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,218.61,63,,174.89,percent of total billed charges,63% of total billed charges,294.95,85,,235.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,274.13,79,,219.3,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
KNEES 1 VIEW BILATERAL ORTHO,3201714-7,CDM,320,RC,73560,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL KNEES COMP ORTHO,3201715-7,CDM,320,RC,73565,HCPCS,outpatient,,,613,429.1,,484.27,79,,387.42,percent of total billed charges,79% of total billed charges,551.7,90,,441.36,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,386.19,63,,308.95,percent of total billed charges,63% of total billed charges,473.36,77.22,,378.69,percent of total billed charges,77.22% of total billed charges,405.19,66.1,,324.15,percent of total billed charges,66.1% of total billed charges,508.79,83,,407.03,percent of total billed charges,83% of total,582.35,95,,465.88,percent of total billed charges ,95% of total billed charges,490.4,80,,392.32,percent of total billed charges,78% of total billed charges,478.14,78,,382.512,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,386.19,63,,308.95,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,551.7,90,,441.36,percent of total billed charges,90% of total billed charges,490.4,80,,392.32,percent of total billed charges,80% of total billed charges,386.19,63,,308.95,percent of total billed charges,63% of total billed charges,521.05,85,,416.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,484.27,79,,387.42,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,582.35,
BILAT HEEL COMPL ORTHO MIN 2VI,3201716-7,CDM,320,RC,73650,HCPCS,outpatient,,,293,205.1,,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,184.59,63,,147.67,percent of total billed charges,63% of total billed charges,226.25,77.22,,181,percent of total billed charges,77.22% of total billed charges,193.67,66.1,,154.94,percent of total billed charges,66.1% of total billed charges,243.19,83,,194.55,percent of total billed charges,83% of total,278.35,95,,222.68,percent of total billed charges ,95% of total billed charges,234.4,80,,187.52,percent of total billed charges,78% of total billed charges,228.54,78,,182.832,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,184.59,63,,147.67,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,184.59,63,,147.67,percent of total billed charges,63% of total billed charges,249.05,85,,199.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL HEEL MIN 2 VIEW,3201717-7,CDM,320,RC,73650,HCPCS,outpatient,,,385,269.5,,304.15,79,,243.32,percent of total billed charges,79% of total billed charges,346.5,90,,277.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,242.55,63,,194.04,percent of total billed charges,63% of total billed charges,297.3,77.22,,237.84,percent of total billed charges,77.22% of total billed charges,254.49,66.1,,203.59,percent of total billed charges,66.1% of total billed charges,319.55,83,,255.64,percent of total billed charges,83% of total,365.75,95,,292.6,percent of total billed charges ,95% of total billed charges,308,80,,246.4,percent of total billed charges,78% of total billed charges,300.3,78,,240.24,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,242.55,63,,194.04,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,242.55,63,,194.04,percent of total billed charges,63% of total billed charges,327.25,85,,261.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.15,79,,243.32,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
TIBIA & FIBULA BILAT 2VIEWS,3201724-7,CDM,320,RC,73590,HCPCS,outpatient,,,316,221.2,,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,284.4,90,,227.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,244.02,77.22,,195.22,percent of total billed charges,77.22% of total billed charges,208.88,66.1,,167.1,percent of total billed charges,66.1% of total billed charges,262.28,83,,209.82,percent of total billed charges,83% of total,300.2,95,,240.16,percent of total billed charges ,95% of total billed charges,252.8,80,,202.24,percent of total billed charges,78% of total billed charges,246.48,78,,197.184,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.08,63,,159.26,percent of total billed charges,63% of total billed charges,268.6,85,,214.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,249.64,79,,199.71,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILAT SHOULDERS 1 VIEW ORTHO,3201727-7,CDM,320,RC,73020,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILAT SHOULDERS 2 VIEW  ORTHO,3201728-7,CDM,320,RC,73030,HCPCS,outpatient,,,265,185.5,,209.35,79,,167.48,percent of total billed charges,79% of total billed charges,238.5,90,,190.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,204.63,77.22,,163.7,percent of total billed charges,77.22% of total billed charges,175.17,66.1,,140.14,percent of total billed charges,66.1% of total billed charges,219.95,83,,175.96,percent of total billed charges,83% of total,251.75,95,,201.4,percent of total billed charges ,95% of total billed charges,212,80,,169.6,percent of total billed charges,78% of total billed charges,206.7,78,,165.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,238.5,90,,190.8,percent of total billed charges,90% of total billed charges,212,80,,169.6,percent of total billed charges,80% of total billed charges,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,225.25,85,,180.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,209.35,79,,167.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILAT FEET STANDING ORTH 2VIEW,3201729-7,CDM,320,RC,73620,HCPCS,outpatient,,,208,145.6,,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,187.2,90,,149.76,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,160.62,77.22,,128.5,percent of total billed charges,77.22% of total billed charges,137.49,66.1,,109.99,percent of total billed charges,66.1% of total billed charges,172.64,83,,138.11,percent of total billed charges,83% of total,197.6,95,,158.08,percent of total billed charges ,95% of total billed charges,166.4,80,,133.12,percent of total billed charges,78% of total billed charges,162.24,78,,129.792,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,131.04,63,,104.83,percent of total billed charges,63% of total billed charges,176.8,85,,141.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,164.32,79,,131.46,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LOW EXT INFANT 2 VIEW BIL ORTH,3201734-7,CDM,320,RC,73592,HCPCS,outpatient,,,470,329,,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,423,90,,338.4,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,362.93,77.22,,290.34,percent of total billed charges,77.22% of total billed charges,310.67,66.1,,248.54,percent of total billed charges,66.1% of total billed charges,390.1,83,,312.08,percent of total billed charges,83% of total,446.5,95,,357.2,percent of total billed charges ,95% of total billed charges,376,80,,300.8,percent of total billed charges,78% of total billed charges,366.6,78,,293.28,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,296.1,63,,236.88,percent of total billed charges,63% of total billed charges,399.5,85,,319.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,371.3,79,,297.04,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ANKLE BILATERAL ORTHO 2 VIEWS,3201735-7,CDM,320,RC,73600,HCPCS,outpatient,,,215,150.5,,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,193.5,90,,154.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,166.02,77.22,,132.82,percent of total billed charges,77.22% of total billed charges,142.12,66.1,,113.7,percent of total billed charges,66.1% of total billed charges,178.45,83,,142.76,percent of total billed charges,83% of total,204.25,95,,163.4,percent of total billed charges ,95% of total billed charges,172,80,,137.6,percent of total billed charges,78% of total billed charges,167.7,78,,134.16,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,135.45,63,,108.36,percent of total billed charges,63% of total billed charges,182.75,85,,146.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,169.85,79,,135.88,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ANKLE 2 VIEW BILATERAL ORTHO,3201736-7,CDM,320,RC,73600,HCPCS,outpatient,,,385,269.5,,304.15,79,,243.32,percent of total billed charges,79% of total billed charges,346.5,90,,277.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,242.55,63,,194.04,percent of total billed charges,63% of total billed charges,297.3,77.22,,237.84,percent of total billed charges,77.22% of total billed charges,254.49,66.1,,203.59,percent of total billed charges,66.1% of total billed charges,319.55,83,,255.64,percent of total billed charges,83% of total,365.75,95,,292.6,percent of total billed charges ,95% of total billed charges,308,80,,246.4,percent of total billed charges,78% of total billed charges,300.3,78,,240.24,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,242.55,63,,194.04,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,242.55,63,,194.04,percent of total billed charges,63% of total billed charges,327.25,85,,261.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.15,79,,243.32,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ANKLE 3 VIEW BILATERAL ORTHO,3201737-7,CDM,320,RC,73610,HCPCS,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,342.86,77.22,,274.29,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST BILATERAL ORTHO 2VIEWS,3201738-7,CDM,320,RC,73100,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST 2 VIEW BILATERAL ORTHO,3201739-7,CDM,320,RC,73100,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
WRIST 3 VEIW BILATERAL ORTHO,3201740-7,CDM,320,RC,73110,HCPCS,outpatient,,,369,258.3,,291.51,79,,233.21,percent of total billed charges,79% of total billed charges,332.1,90,,265.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,232.47,63,,185.98,percent of total billed charges,63% of total billed charges,284.94,77.22,,227.95,percent of total billed charges,77.22% of total billed charges,243.91,66.1,,195.13,percent of total billed charges,66.1% of total billed charges,306.27,83,,245.02,percent of total billed charges,83% of total,350.55,95,,280.44,percent of total billed charges ,95% of total billed charges,295.2,80,,236.16,percent of total billed charges,78% of total billed charges,287.82,78,,230.256,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,232.47,63,,185.98,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,232.47,63,,185.98,percent of total billed charges,63% of total billed charges,313.65,85,,250.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,291.51,79,,233.21,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT TOE 1ST DIGIT ORTHO MIN 2V,3201741-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 2ND DIGIT ORTHO MIN 2 VI,3201742-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 3RD DIGIT ORTHO MIN 2 VI,3201743-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 4TH DIGIT ORTHO MIN 2 VI,3201744-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 5TH DIGIT ORTHO MIN 2 VI,3201745-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 1ST DIGIT ORTHO MIN 2 V,3201746-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 2ND DIGIT ORTHO MIN 2 V,3201747-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 3RD DIGIT ORTHO MIN 2 V,3201748-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 4TH DIGIT ORTHO MIN 2 V,3201749-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 5TH DIGIT ORTHO MIN 2 V,3201750-7,CDM,320,RC,73660,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FING 1ST DIG IV MIN 2 VIEW,3201751-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FING 1ST DIG  IV MIN 2 VIE,3201752-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FNGER 3RD DIG IV MIN 2 VIE,3201753-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FNGER 4TH DIG IV MIN 2 VIE,3201754-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FING 5TH DIG IV MIN 2 VIEW,3201755-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGHT FING 1ST DIG IV MIN 2 VIE,3201756-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGHT FING 2ND DIG IV MIN 2 VIE,3201757-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGHT FING 3RD DIG ORTH MIN 2VI,3201758-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGHT FING 4TH DIG ORTH MIN 2 V,3201759-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGHT FING 5TH DIG IV MIN 2 VIE,3201760-7,CDM,320,RC,73140,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 1ST DIGIT ORTH MIN 2 V,3201761-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 2ND DIGIT ORTH0 MIN 2 V,3201762-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 3RD DIGIT ORTH0 MIN 2 V,3201763-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 4TH DIGIT ORTHO MIN 2 VI,3201764-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
L TOE 5TH DIGIT ORTHO MIN 2 V,3201765-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 1ST DIGIT ORTHO MIN 2 VI,3201766-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 2ND DIGIT ORTHO MIN 2 VI,3201767-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 3RD DIGIT ORTHO MIN 2 VI,3201768-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 4TH DIGIT ORTHO MIN 2 VI,3201769-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
R TOE 5TH DIGIT ORTHO MIN 2 V,3201770-7,CDM,320,RC,73660,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FING 1ST DIG ORTHO MIN 2 V,3201771-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FING 2ND DIG ORTHO MIN 2 V,3201772-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FING 3RD DIG ORTHO MIN 2 V,3201773-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FING 4TH DIGIT ORTHO MN 2V,3201774-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
LFT FGER 5TH DIG ORTHO MIN 2VI,3201775-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGT FING 1ST DIG ORTHO MIN 2 V,3201776-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGT FING 2ND DIG ORTHO MIN 2 V,3201777-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGHT FING 3RD DIG ORTHO MIN 2V,3201778-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGT FING 4TH DIG ORTHO MIN 2 V,3201779-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RGT FING 5TH DIG ORTHO MIN 2 V,3201780-7,CDM,320,RC,73140,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
CERV SPINE FLEX/EXTEN 6/>VIEWS,3201781-7,CDM,320,RC,72052,HCPCS,outpatient,,,412,288.4,,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,370.8,90,,296.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,318.15,77.22,,254.52,percent of total billed charges,77.22% of total billed charges,272.33,66.1,,217.86,percent of total billed charges,66.1% of total billed charges,341.96,83,,273.57,percent of total billed charges,83% of total,391.4,95,,313.12,percent of total billed charges ,95% of total billed charges,329.6,80,,263.68,percent of total billed charges,78% of total billed charges,321.36,78,,257.088,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,259.56,63,,207.65,percent of total billed charges,63% of total billed charges,350.2,85,,280.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,325.48,79,,260.38,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
L SPINE 2/3 VIEWS AP-LAT SPOT,3201782-7,CDM,320,RC,72100,HCPCS,outpatient,,,442,309.4,,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,397.8,90,,318.24,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,341.31,77.22,,273.05,percent of total billed charges,77.22% of total billed charges,292.16,66.1,,233.73,percent of total billed charges,66.1% of total billed charges,366.86,83,,293.49,percent of total billed charges,83% of total,419.9,95,,335.92,percent of total billed charges ,95% of total billed charges,353.6,80,,282.88,percent of total billed charges,78% of total billed charges,344.76,78,,275.808,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,278.46,63,,222.77,percent of total billed charges,63% of total billed charges,375.7,85,,300.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,349.18,79,,279.34,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BILATERAL WRIST 2 VIEWS,3201784-7,CDM,320,RC,73100,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL HANDS 2 VIEWS,3201785-7,CDM,320,RC,73120,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BILATERAL HANDS 3 VIEWS,3201786-7,CDM,320,RC,73130,HCPCS,outpatient,,,640,448,,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,576,90,,460.8,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,494.21,77.22,,395.37,percent of total billed charges,77.22% of total billed charges,423.04,66.1,,338.43,percent of total billed charges,66.1% of total billed charges,531.2,83,,424.96,percent of total billed charges,83% of total,608,95,,486.4,percent of total billed charges ,95% of total billed charges,512,80,,409.6,percent of total billed charges,78% of total billed charges,499.2,78,,399.36,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,403.2,63,,322.56,percent of total billed charges,63% of total billed charges,544,85,,435.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,505.6,79,,404.48,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,608,
BILATERAL ELBOWS 2 VIEW,3201789-7,CDM,320,RC,73070,HCPCS,outpatient,,,336,235.2,,265.44,79,,212.35,percent of total billed charges,79% of total billed charges,302.4,90,,241.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,211.68,63,,169.34,percent of total billed charges,63% of total billed charges,259.46,77.22,,207.57,percent of total billed charges,77.22% of total billed charges,222.1,66.1,,177.68,percent of total billed charges,66.1% of total billed charges,278.88,83,,223.1,percent of total billed charges,83% of total,319.2,95,,255.36,percent of total billed charges ,95% of total billed charges,268.8,80,,215.04,percent of total billed charges,78% of total billed charges,262.08,78,,209.664,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,211.68,63,,169.34,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,211.68,63,,169.34,percent of total billed charges,63% of total billed charges,285.6,85,,228.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,265.44,79,,212.35,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BILATERAL ELBOWS 3 VIEWS,3201790-7,CDM,320,RC,73080,HCPCS,outpatient,,,386,270.2,,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,347.4,90,,277.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,298.07,77.22,,238.46,percent of total billed charges,77.22% of total billed charges,255.15,66.1,,204.12,percent of total billed charges,66.1% of total billed charges,320.38,83,,256.3,percent of total billed charges,83% of total,366.7,95,,293.36,percent of total billed charges ,95% of total billed charges,308.8,80,,247.04,percent of total billed charges,78% of total billed charges,301.08,78,,240.864,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.18,63,,194.54,percent of total billed charges,63% of total billed charges,328.1,85,,262.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,304.94,79,,243.95,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
PELVIS COMPLETE 3 MIN VIEWS,3201791-7,CDM,320,RC,72190,HCPCS,outpatient,,,400,280,,316,79,,252.8,percent of total billed charges,79% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,252,63,,201.6,percent of total billed charges,63% of total billed charges,308.88,77.22,,247.1,percent of total billed charges,77.22% of total billed charges,264.4,66.1,,211.52,percent of total billed charges,66.1% of total billed charges,332,83,,265.6,percent of total billed charges,83% of total,380,95,,304,percent of total billed charges ,95% of total billed charges,320,80,,256,percent of total billed charges,78% of total billed charges,312,78,,249.6,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,252,63,,201.6,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,252,63,,201.6,percent of total billed charges,63% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,316,79,,252.8,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
CLAVICLE 1 VIEW,3201792-7,CDM,320,RC,73000,HCPCS,outpatient,,,239,167.3,,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,215.1,90,,172.08,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,150.57,63,,120.46,percent of total billed charges,63% of total billed charges,184.56,77.22,,147.65,percent of total billed charges,77.22% of total billed charges,157.98,66.1,,126.38,percent of total billed charges,66.1% of total billed charges,198.37,83,,158.7,percent of total billed charges,83% of total,227.05,95,,181.64,percent of total billed charges ,95% of total billed charges,191.2,80,,152.96,percent of total billed charges,78% of total billed charges,186.42,78,,149.136,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,150.57,63,,120.46,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,150.57,63,,120.46,percent of total billed charges,63% of total billed charges,203.15,85,,162.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,188.81,79,,151.05,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
RIBS XR RIGHT,320771100,CDM,320,RC,71100,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,157.32,66.1,,125.86,percent of total billed charges,66.1% of total billed charges,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
CT SCANOGRAM BONE LENGTH,351001740,CDM,320,RC,77073,HCPCS,outpatient,,,205,143.5,,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,184.5,90,,147.6,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,158.3,77.22,,126.64,percent of total billed charges,77.22% of total billed charges,135.51,66.1,,108.41,percent of total billed charges,66.1% of total billed charges,170.15,83,,136.12,percent of total billed charges,83% of total,194.75,95,,155.8,percent of total billed charges ,95% of total billed charges,164,80,,131.2,percent of total billed charges,78% of total billed charges,159.9,78,,127.92,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,129.15,63,,103.32,percent of total billed charges,63% of total billed charges,174.25,85,,139.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,161.95,79,,129.56,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BREAST SPECIMEN,401001879,CDM,320,RC,76098,HCPCS,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,738.06,160,,,Fee Schedule,160% of CMS OPPS rate,599.68,130,,,Fee Schedule,130% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,429,93,,,fee schedule,93% of CMS OPPS rate,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,429,1129.55,
US BREAST SURGICAL SPECIMEN,402001824,CDM,320,RC,76098,HCPCS,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,738.06,160,,,Fee Schedule,160% of CMS OPPS rate,599.68,130,,,Fee Schedule,130% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,429,93,,,fee schedule,93% of CMS OPPS rate,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,429,1129.55,
MRI FLURO GUID NEDDLE PLAC,610001758,CDM,320,RC,77002,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,217.35,450,
SHOULDER ARTHROGRAM RT,320001694,CDM,322,RC,73040,HCPCS,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1129.55,
SHOULDER ARTHROGRAM LIMITED RT,320001695,CDM,322,RC,73040,HCPCS,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1129.55,
SHOULDER ARTHROGRAM LT,320001696,CDM,322,RC,73040,HCPCS,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1129.55,
SHOULDER ARTHROGRAM LMTD LT,320001697,CDM,322,RC,73040,HCPCS,outpatient,,,1189,832.3,,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,918.15,77.22,,734.52,percent of total billed charges,77.22% of total billed charges,785.93,66.1,,628.74,percent of total billed charges,66.1% of total billed charges,986.87,83,,789.5,percent of total billed charges,83% of total,1129.55,95,,903.64,percent of total billed charges ,95% of total billed charges,951.2,80,,760.96,percent of total billed charges,78% of total billed charges,927.42,78,,741.936,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1070.1,90,,856.08,percent of total billed charges,90% of total billed charges,951.2,80,,760.96,percent of total billed charges,80% of total billed charges,749.07,63,,599.26,percent of total billed charges,63% of total billed charges,1010.65,85,,808.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,939.31,79,,751.45,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1129.55,
ARTHR0GRAM LMTED LEFT KNEE,320001719,CDM,322,RC,73580,HCPCS,outpatient,,,736,515.2,,581.44,79,,465.15,percent of total billed charges,79% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,568.34,77.22,,454.67,percent of total billed charges,77.22% of total billed charges,486.5,66.1,,389.2,percent of total billed charges,66.1% of total billed charges,610.88,83,,488.7,percent of total billed charges,83% of total,699.2,95,,559.36,percent of total billed charges ,95% of total billed charges,588.8,80,,471.04,percent of total billed charges,78% of total billed charges,574.08,78,,459.264,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,581.44,79,,465.15,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,699.2,
ARTHROGRAM LMTED RIGHT KNEE,320001720,CDM,322,RC,73580,HCPCS,outpatient,,,736,515.2,,581.44,79,,465.15,percent of total billed charges,79% of total billed charges,662.4,90,,529.92,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,568.34,77.22,,454.67,percent of total billed charges,77.22% of total billed charges,486.5,66.1,,389.2,percent of total billed charges,66.1% of total billed charges,610.88,83,,488.7,percent of total billed charges,83% of total,699.2,95,,559.36,percent of total billed charges ,95% of total billed charges,588.8,80,,471.04,percent of total billed charges,78% of total billed charges,574.08,78,,459.264,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,463.68,63,,370.94,percent of total billed charges,63% of total billed charges,625.6,85,,500.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,581.44,79,,465.15,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,699.2,
LEFT WRIST ARTHROGRAM LTD,320001744,CDM,322,RC,73115,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,514.51,
INJ PROC FOR WRIST ARTHR,320001745,CDM,322,RC,25246,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.6,450,
RIGHT WRIST ARTHROGRAM LTD,320001746,CDM,322,RC,73115,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,514.51,
ARTHROGRAM LT HIP LIMITED,320001750,CDM,322,RC,73525,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,514.51,
ARTHROGRAM RT HIP LIMITED,320001751,CDM,322,RC,73525,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,514.51,
ARTHROGRAM RT HIP COMPLETE CP,320080144,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM LT WRIST LTD CP,320080146,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM RT WRIST LTD CP,320080147,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM LT HIP LTD CP,320080148,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM RT HIP LTD CP,320080150,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHOROGRAM LT KNEE LTD CP,320080151,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM RT KNEE LTD CP,320080153,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM RT KNEE COMPLETE CP,320080154,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM LT SHOULDER LTD CP,320080155,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM LT SHOULDER COMP CP,320080156,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM RT SHOULDER LTD CP,320080157,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM RT SHOULDER COMP CP,320080158,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM LT HIP COMPLETE CP,320080162,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHRO MED INJ LTD LT HIP CP,320080163,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHRO MED INJ LTD RT HIP CP,320080164,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHRO MED INJ LTD LT SHLDR CP,320080165,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHRO MED INJ LTD RT SHLDR CP,320080166,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ARTHROGRAM LTD LEFT ELBOW,320080167,CDM,322,RC,73085,HCPCS,outpatient,,,475,332.5,,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,427.5,90,,342,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.04,130,,,Fee Schedule,130% of CMS OPPS rate,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,366.8,77.22,,293.44,percent of total billed charges,77.22% of total billed charges,313.98,66.1,,251.18,percent of total billed charges,66.1% of total billed charges,394.25,83,,315.4,percent of total billed charges,83% of total,451.25,95,,361,percent of total billed charges ,95% of total billed charges,380,80,,304,percent of total billed charges,78% of total billed charges,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,427.5,90,,342,percent of total billed charges,90% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,299.25,63,,239.4,percent of total billed charges,63% of total billed charges,403.75,85,,323,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,514.51,
LEFT WRIST ARTHROGRAM LTC CP,32080146,CDM,322,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CHEST PA & LATERAL 2 VIEWS,320001400,CDM,324,RC,71046,HCPCS,outpatient,,,394,275.8,,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.56,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,304.25,77.22,,243.4,percent of total billed charges,77.22% of total billed charges,260.43,66.1,,208.34,percent of total billed charges,66.1% of total billed charges,327.02,83,,261.62,percent of total billed charges,83% of total,374.3,95,,299.44,percent of total billed charges ,95% of total billed charges,315.2,80,,252.16,percent of total billed charges,78% of total billed charges,307.32,78,,245.856,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.65,93,,,fee schedule,93% of CMS OPPS rate,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.65,450,
CHEST SINGLE VIEW,320001401,CDM,324,RC,71045,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.56,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.65,93,,,fee schedule,93% of CMS OPPS rate,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.65,450,
CHEST PA ONLY SINGLE VIEW,320001459,CDM,324,RC,71045,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.56,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.65,93,,,fee schedule,93% of CMS OPPS rate,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.65,450,
HR CHE XRAY 2 VIEW FRONT & LAT,320001659,CDM,324,RC,,,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.93,450,
CHEST 4 VIEW CMPL MIN 4 VIEWS,320001660,CDM,324,RC,71048,HCPCS,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
CHEST FRONT & LATERAL 2 VIEWS,3201400-7,CDM,324,RC,71046,HCPCS,outpatient,,,394,275.8,,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.56,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,304.25,77.22,,243.4,percent of total billed charges,77.22% of total billed charges,260.43,66.1,,208.34,percent of total billed charges,66.1% of total billed charges,327.02,83,,261.62,percent of total billed charges,83% of total,374.3,95,,299.44,percent of total billed charges ,95% of total billed charges,315.2,80,,252.16,percent of total billed charges,78% of total billed charges,307.32,78,,245.856,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.65,93,,,fee schedule,93% of CMS OPPS rate,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.65,450,
CHEST PA ONLY ORTHO,3201457-7,CDM,324,RC,71045,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.56,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.65,93,,,fee schedule,93% of CMS OPPS rate,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.65,450,
LUNG SCAN VENT/PERFUSION CP,340080424,CDM,340,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BONE SCAN/WHOLE BODY,340001801,CDM,341,RC,78306,HCPCS,outpatient,,,1024,716.8,,808.96,79,,647.17,percent of total billed charges,79% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,551.79,160,,,Fee Schedule,160% of CMS OPPS rate,448.33,130,,,Fee Schedule,130% of CMS OPPS rate,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,790.73,77.22,,632.58,percent of total billed charges,77.22% of total billed charges,676.86,66.1,,541.49,percent of total billed charges,66.1% of total billed charges,849.92,83,,679.94,percent of total billed charges,83% of total,972.8,95,,778.24,percent of total billed charges ,95% of total billed charges,819.2,80,,655.36,percent of total billed charges,78% of total billed charges,798.72,78,,638.976,percent of total billed charges,78% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,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,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,320.72,93,,,fee schedule,93% of CMS OPPS rate,808.96,79,,647.17,percent of total billed charges,79% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,320.72,972.8,
THYROID SCAN,340001804,CDM,341,RC,78013,HCPCS,outpatient,,,1252,876.4,,989.08,79,,791.26,percent of total billed charges,79% of total billed charges,1126.8,90,,901.44,percent of total billed charges,90% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,551.79,160,,,Fee Schedule,160% of CMS OPPS rate,448.33,130,,,Fee Schedule,130% of CMS OPPS rate,788.76,63,,631.01,percent of total billed charges,63% of total billed charges,966.79,77.22,,773.43,percent of total billed charges,77.22% of total billed charges,827.57,66.1,,662.06,percent of total billed charges,66.1% of total billed charges,1039.16,83,,831.33,percent of total billed charges,83% of total,1189.4,95,,951.52,percent of total billed charges ,95% of total billed charges,1001.6,80,,801.28,percent of total billed charges,78% of total billed charges,976.56,78,,781.248,percent of total billed charges,78% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,788.76,63,,631.01,percent of total billed charges,63% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,1126.8,90,,901.44,percent of total billed charges,90% of total billed charges,1001.6,80,,801.28,percent of total billed charges,80% of total billed charges,788.76,63,,631.01,percent of total billed charges,63% of total billed charges,1064.2,85,,851.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,320.72,93,,,fee schedule,93% of CMS OPPS rate,989.08,79,,791.26,percent of total billed charges,79% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,320.72,1189.4,
HIDA SCAN/BILIARY,340001805,CDM,341,RC,78227,HCPCS,outpatient,,,1431,1001.7,,1130.49,79,,904.39,percent of total billed charges,79% of total billed charges,1287.9,90,,1030.32,percent of total billed charges,90% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,723.12,160,,,Fee Schedule,160% of CMS OPPS rate,587.53,130,,,Fee Schedule,130% of CMS OPPS rate,901.53,63,,721.22,percent of total billed charges,63% of total billed charges,1105.02,77.22,,884.02,percent of total billed charges,77.22% of total billed charges,945.89,66.1,,756.71,percent of total billed charges,66.1% of total billed charges,1187.73,83,,950.18,percent of total billed charges,83% of total,1359.45,95,,1087.56,percent of total billed charges ,95% of total billed charges,1144.8,80,,915.84,percent of total billed charges,78% of total billed charges,1116.18,78,,892.944,percent of total billed charges,78% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,901.53,63,,721.22,percent of total billed charges,63% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,1287.9,90,,1030.32,percent of total billed charges,90% of total billed charges,1144.8,80,,915.84,percent of total billed charges,80% of total billed charges,901.53,63,,721.22,percent of total billed charges,63% of total billed charges,1216.35,85,,973.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,420.31,93,,,fee schedule,93% of CMS OPPS rate,1130.49,79,,904.39,percent of total billed charges,79% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,420.31,1359.45,
BONE SCAN LIMITED,340001806,CDM,341,RC,78300,HCPCS,outpatient,,,1024,716.8,,808.96,79,,647.17,percent of total billed charges,79% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,551.79,160,,,Fee Schedule,160% of CMS OPPS rate,448.33,130,,,Fee Schedule,130% of CMS OPPS rate,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,790.73,77.22,,632.58,percent of total billed charges,77.22% of total billed charges,676.86,66.1,,541.49,percent of total billed charges,66.1% of total billed charges,849.92,83,,679.94,percent of total billed charges,83% of total,972.8,95,,778.24,percent of total billed charges ,95% of total billed charges,819.2,80,,655.36,percent of total billed charges,78% of total billed charges,798.72,78,,638.976,percent of total billed charges,78% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,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,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,320.72,93,,,fee schedule,93% of CMS OPPS rate,808.96,79,,647.17,percent of total billed charges,79% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,320.72,972.8,
LUNG SCAN PEFUSION & VENT,340001811,CDM,341,RC,78598,HCPCS,outpatient,,,1492,1044.4,,1178.68,79,,942.94,percent of total billed charges,79% of total billed charges,1342.8,90,,1074.24,percent of total billed charges,90% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,723.12,160,,,Fee Schedule,160% of CMS OPPS rate,587.53,130,,,Fee Schedule,130% of CMS OPPS rate,939.96,63,,751.97,percent of total billed charges,63% of total billed charges,1152.12,77.22,,921.7,percent of total billed charges,77.22% of total billed charges,986.21,66.1,,788.97,percent of total billed charges,66.1% of total billed charges,1238.36,83,,990.69,percent of total billed charges,83% of total,1417.4,95,,1133.92,percent of total billed charges ,95% of total billed charges,1193.6,80,,954.88,percent of total billed charges,78% of total billed charges,1163.76,78,,931.008,percent of total billed charges,78% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,939.96,63,,751.97,percent of total billed charges,63% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,1342.8,90,,1074.24,percent of total billed charges,90% of total billed charges,1193.6,80,,954.88,percent of total billed charges,80% of total billed charges,939.96,63,,751.97,percent of total billed charges,63% of total billed charges,1268.2,85,,1014.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,420.31,93,,,fee schedule,93% of CMS OPPS rate,1178.68,79,,942.94,percent of total billed charges,79% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,420.31,1417.4,
LUNG PERFUSION IMAGING,340001813,CDM,341,RC,78580,HCPCS,outpatient,,,884,618.8,,698.36,79,,558.69,percent of total billed charges,79% of total billed charges,795.6,90,,636.48,percent of total billed charges,90% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,551.79,160,,,Fee Schedule,160% of CMS OPPS rate,448.33,130,,,Fee Schedule,130% of CMS OPPS rate,556.92,63,,445.54,percent of total billed charges,63% of total billed charges,682.62,77.22,,546.1,percent of total billed charges,77.22% of total billed charges,584.32,66.1,,467.46,percent of total billed charges,66.1% of total billed charges,733.72,83,,586.98,percent of total billed charges,83% of total,839.8,95,,671.84,percent of total billed charges ,95% of total billed charges,707.2,80,,565.76,percent of total billed charges,78% of total billed charges,689.52,78,,551.616,percent of total billed charges,78% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,556.92,63,,445.54,percent of total billed charges,63% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,795.6,90,,636.48,percent of total billed charges,90% of total billed charges,707.2,80,,565.76,percent of total billed charges,80% of total billed charges,556.92,63,,445.54,percent of total billed charges,63% of total billed charges,751.4,85,,601.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,320.72,93,,,fee schedule,93% of CMS OPPS rate,698.36,79,,558.69,percent of total billed charges,79% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,320.72,839.8,
P Y P NUCLEAR SCAN,340001814,CDM,341,RC,78278,HCPCS,outpatient,,,1534,1073.8,,1211.86,79,,969.49,percent of total billed charges,79% of total billed charges,1380.6,90,,1104.48,percent of total billed charges,90% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,551.79,160,,,Fee Schedule,160% of CMS OPPS rate,448.33,130,,,Fee Schedule,130% of CMS OPPS rate,966.42,63,,773.14,percent of total billed charges,63% of total billed charges,1184.55,77.22,,947.64,percent of total billed charges,77.22% of total billed charges,1013.97,66.1,,811.18,percent of total billed charges,66.1% of total billed charges,1273.22,83,,1018.58,percent of total billed charges,83% of total,1457.3,95,,1165.84,percent of total billed charges ,95% of total billed charges,1227.2,80,,981.76,percent of total billed charges,78% of total billed charges,1196.52,78,,957.216,percent of total billed charges,78% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,966.42,63,,773.14,percent of total billed charges,63% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,1380.6,90,,1104.48,percent of total billed charges,90% of total billed charges,1227.2,80,,981.76,percent of total billed charges,80% of total billed charges,966.42,63,,773.14,percent of total billed charges,63% of total billed charges,1303.9,85,,1043.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,320.72,93,,,fee schedule,93% of CMS OPPS rate,1211.86,79,,969.49,percent of total billed charges,79% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,320.72,1457.3,
BONE SCAN 3 PHASE STUDY,340001819,CDM,341,RC,78315,HCPCS,outpatient,,,1024,716.8,,808.96,79,,647.17,percent of total billed charges,79% of total billed charges,921.6,90,,737.28,percent of total billed charges,90% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,551.79,160,,,Fee Schedule,160% of CMS OPPS rate,448.33,130,,,Fee Schedule,130% of CMS OPPS rate,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,790.73,77.22,,632.58,percent of total billed charges,77.22% of total billed charges,676.86,66.1,,541.49,percent of total billed charges,66.1% of total billed charges,849.92,83,,679.94,percent of total billed charges,83% of total,972.8,95,,778.24,percent of total billed charges ,95% of total billed charges,819.2,80,,655.36,percent of total billed charges,78% of total billed charges,798.72,78,,638.976,percent of total billed charges,78% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,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,645.12,63,,516.1,percent of total billed charges,63% of total billed charges,870.4,85,,696.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,320.72,93,,,fee schedule,93% of CMS OPPS rate,808.96,79,,647.17,percent of total billed charges,79% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,320.72,972.8,
GASTRIC EMPTYING STUDY,340001820,CDM,341,RC,78264,HCPCS,outpatient,,,2658,1860.6,,2099.82,79,,1679.86,percent of total billed charges,79% of total billed charges,2392.2,90,,1913.76,percent of total billed charges,90% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,551.79,160,,,Fee Schedule,160% of CMS OPPS rate,448.33,130,,,Fee Schedule,130% of CMS OPPS rate,1674.54,63,,1339.63,percent of total billed charges,63% of total billed charges,2052.51,77.22,,1642.01,percent of total billed charges,77.22% of total billed charges,1756.94,66.1,,1405.55,percent of total billed charges,66.1% of total billed charges,2206.14,83,,1764.91,percent of total billed charges,83% of total,2525.1,95,,2020.08,percent of total billed charges ,95% of total billed charges,2126.4,80,,1701.12,percent of total billed charges,78% of total billed charges,2073.24,78,,1658.592,percent of total billed charges,78% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,1674.54,63,,1339.63,percent of total billed charges,63% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,2392.2,90,,1913.76,percent of total billed charges,90% of total billed charges,2126.4,80,,1701.12,percent of total billed charges,80% of total billed charges,1674.54,63,,1339.63,percent of total billed charges,63% of total billed charges,2259.3,85,,1807.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,320.72,93,,,fee schedule,93% of CMS OPPS rate,2099.82,79,,1679.86,percent of total billed charges,79% of total billed charges,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,344.87,100,,,Fee Schedule,100% of CMS OPPS rate,320.72,2525.1,
SENTINEL NODE SCAN,340001824,CDM,341,RC,78195,HCPCS,outpatient,,,2892,2024.4,,2284.68,79,,1827.74,percent of total billed charges,79% of total billed charges,2602.8,90,,2082.24,percent of total billed charges,90% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,723.12,160,,,Fee Schedule,160% of CMS OPPS rate,587.53,130,,,Fee Schedule,130% of CMS OPPS rate,1821.96,63,,1457.57,percent of total billed charges,63% of total billed charges,2233.2,77.22,,1786.56,percent of total billed charges,77.22% of total billed charges,1911.61,66.1,,1529.29,percent of total billed charges,66.1% of total billed charges,2400.36,83,,1920.29,percent of total billed charges,83% of total,2747.4,95,,2197.92,percent of total billed charges ,95% of total billed charges,2313.6,80,,1850.88,percent of total billed charges,78% of total billed charges,2255.76,78,,1804.608,percent of total billed charges,78% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,1821.96,63,,1457.57,percent of total billed charges,63% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,2602.8,90,,2082.24,percent of total billed charges,90% of total billed charges,2313.6,80,,1850.88,percent of total billed charges,80% of total billed charges,1821.96,63,,1457.57,percent of total billed charges,63% of total billed charges,2458.2,85,,1966.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,420.31,93,,,fee schedule,93% of CMS OPPS rate,2284.68,79,,1827.74,percent of total billed charges,79% of total billed charges,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,451.95,100,,,Fee Schedule,100% of CMS OPPS rate,420.31,2747.4,
NM BONE SCAN WHOLE BODY CP,340080400,CDM,341,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NUC MED TSC,250017855,CDM,343,RC,A9541,HCPCS,outpatient,,,68,47.6,,53.72,79,,42.98,percent of total billed charges,79% of total billed charges,61.2,90,,48.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.84,63,,34.27,percent of total billed charges,63% of total billed charges,52.51,77.22,,42.01,percent of total billed charges,77.22% of total billed charges,44.95,66.1,,35.96,percent of total billed charges,66.1% of total billed charges,56.44,83,,45.15,percent of total billed charges,83% of total,64.6,95,,51.68,percent of total billed charges ,95% of total billed charges,54.4,80,,43.52,percent of total billed charges,78% of total billed charges,53.04,78,,42.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,42.84,63,,34.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,42.84,63,,34.27,percent of total billed charges,63% of total billed charges,57.8,85,,46.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,53.72,79,,42.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.84,450,
NM LYMPO-LYMPHOSEEK,250017862,CDM,343,RC,A9520,HCPCS,outpatient,,,1571,1099.7,,1241.09,79,,992.87,percent of total billed charges,79% of total billed charges,1413.9,90,,1131.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,989.73,63,,791.78,percent of total billed charges,63% of total billed charges,1213.13,77.22,,970.5,percent of total billed charges,77.22% of total billed charges,1038.43,66.1,,830.74,percent of total billed charges,66.1% of total billed charges,1303.93,83,,1043.14,percent of total billed charges,83% of total,1492.45,95,,1193.96,percent of total billed charges ,95% of total billed charges,1256.8,80,,1005.44,percent of total billed charges,78% of total billed charges,1225.38,78,,980.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,989.73,63,,791.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1413.9,90,,1131.12,percent of total billed charges,90% of total billed charges,1256.8,80,,1005.44,percent of total billed charges,80% of total billed charges,989.73,63,,791.78,percent of total billed charges,63% of total billed charges,1335.35,85,,1068.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1241.09,79,,992.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1492.45,
SULFUR COLLOID- SN,250017896,CDM,343,RC,A9541,HCPCS,outpatient,,,358,250.6,,282.82,79,,226.26,percent of total billed charges,79% of total billed charges,322.2,90,,257.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,225.54,63,,180.43,percent of total billed charges,63% of total billed charges,276.45,77.22,,221.16,percent of total billed charges,77.22% of total billed charges,236.64,66.1,,189.31,percent of total billed charges,66.1% of total billed charges,297.14,83,,237.71,percent of total billed charges,83% of total,340.1,95,,272.08,percent of total billed charges ,95% of total billed charges,286.4,80,,229.12,percent of total billed charges,78% of total billed charges,279.24,78,,223.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,225.54,63,,180.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,225.54,63,,180.43,percent of total billed charges,63% of total billed charges,304.3,85,,243.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,282.82,79,,226.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,225.54,450,
NUC MED SULFUR COLL 10-15 MILL,250050062,CDM,343,RC,A9541,HCPCS,outpatient,,,490,343,,387.1,79,,309.68,percent of total billed charges,79% of total billed charges,441,90,,352.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.7,63,,246.96,percent of total billed charges,63% of total billed charges,378.38,77.22,,302.7,percent of total billed charges,77.22% of total billed charges,323.89,66.1,,259.11,percent of total billed charges,66.1% of total billed charges,406.7,83,,325.36,percent of total billed charges,83% of total,465.5,95,,372.4,percent of total billed charges ,95% of total billed charges,392,80,,313.6,percent of total billed charges,78% of total billed charges,382.2,78,,305.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,308.7,63,,246.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,308.7,63,,246.96,percent of total billed charges,63% of total billed charges,416.5,85,,333.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,387.1,79,,309.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,308.7,465.5,
NUCLEAR MEDICINE MEBROFENIN,255017855,CDM,343,RC,A9537,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69.93,450,
NUC MED PYP,255017857,CDM,343,RC,,,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,122.85,450,
NUC MED MDP 30mCi,255017858,CDM,343,RC,A9503,HCPCS,outpatient,,,124,86.8,,97.96,79,,78.37,percent of total billed charges,79% of total billed charges,111.6,90,,89.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.12,63,,62.5,percent of total billed charges,63% of total billed charges,95.75,77.22,,76.6,percent of total billed charges,77.22% of total billed charges,81.96,66.1,,65.57,percent of total billed charges,66.1% of total billed charges,102.92,83,,82.34,percent of total billed charges,83% of total,117.8,95,,94.24,percent of total billed charges ,95% of total billed charges,99.2,80,,79.36,percent of total billed charges,78% of total billed charges,96.72,78,,77.376,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.12,63,,62.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.12,63,,62.5,percent of total billed charges,63% of total billed charges,105.4,85,,84.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,97.96,79,,78.37,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.12,450,
CT GUIDED CYST ASPIRATION,350081009,CDM,350,RC,,,outpatient,,,1420,994,,1121.8,79,,897.44,percent of total billed charges,79% of total billed charges,1278,90,,1022.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,894.6,63,,715.68,percent of total billed charges,63% of total billed charges,1096.52,77.22,,877.22,percent of total billed charges,77.22% of total billed charges,938.62,66.1,,750.9,percent of total billed charges,66.1% of total billed charges,1178.6,83,,942.88,percent of total billed charges,83% of total,1349,95,,1079.2,percent of total billed charges ,95% of total billed charges,1136,80,,908.8,percent of total billed charges,78% of total billed charges,1107.6,78,,886.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,894.6,63,,715.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1278,90,,1022.4,percent of total billed charges,90% of total billed charges,1136,80,,908.8,percent of total billed charges,80% of total billed charges,894.6,63,,715.68,percent of total billed charges,63% of total billed charges,1207,85,,965.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1121.8,79,,897.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1349,
CT GUID THORACEN W/O TUBE INSE,351001779,CDM,350,RC,32557,HCPCS,outpatient,,,465,325.5,,367.35,79,,293.88,percent of total billed charges,79% of total billed charges,418.5,90,,334.8,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,292.95,63,,234.36,percent of total billed charges,63% of total billed charges,359.07,77.22,,287.26,percent of total billed charges,77.22% of total billed charges,307.37,66.1,,245.9,percent of total billed charges,66.1% of total billed charges,385.95,83,,308.76,percent of total billed charges,83% of total,441.75,95,,353.4,percent of total billed charges ,95% of total billed charges,372,80,,297.6,percent of total billed charges,78% of total billed charges,362.7,78,,290.16,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,292.95,63,,234.36,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,292.95,63,,234.36,percent of total billed charges,63% of total billed charges,395.25,85,,316.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,367.35,79,,293.88,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,292.95,2142.64,
CT M-FACIAL SINUSES W/CONT CP,351080322,CDM,350,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT M-FACIAL SINUS W/WO CONT CP,351080324,CDM,350,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT ORBITS W/CONTRAST COMP CP,351080326,CDM,350,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT ORBITS W/W/O CONTRAST CP,351080328,CDM,350,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT GUIDE THORACEN W/TUB INS CP,351080350,CDM,350,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT CHST ABD PELVS W/WO CONT CP,351080364,CDM,350,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PERFUSION BRAIN CT W/CONT CP,350000281,CDM,351,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
STROKE PROTOCOL CT BRAIN,350000294,CDM,351,RC,70450,HCPCS,outpatient,,,682,477.4,,538.78,79,,431.02,percent of total billed charges,79% of total billed charges,613.8,90,,491.04,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,429.66,63,,343.73,percent of total billed charges,63% of total billed charges,526.64,77.22,,421.31,percent of total billed charges,77.22% of total billed charges,450.8,66.1,,360.64,percent of total billed charges,66.1% of total billed charges,566.06,83,,452.85,percent of total billed charges,83% of total,647.9,95,,518.32,percent of total billed charges ,95% of total billed charges,545.6,80,,436.48,percent of total billed charges,78% of total billed charges,531.96,78,,425.568,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,429.66,63,,343.73,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,429.66,63,,343.73,percent of total billed charges,63% of total billed charges,579.7,85,,463.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,538.78,79,,431.02,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,647.9,
CT PERFUSION W/CONTRAST CBF,351000042,CDM,351,RC,0042T,HCPCS,outpatient,,,1240,868,,979.6,79,,783.68,percent of total billed charges,79% of total billed charges,1116,90,,892.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,781.2,63,,624.96,percent of total billed charges,63% of total billed charges,957.53,77.22,,766.02,percent of total billed charges,77.22% of total billed charges,819.64,66.1,,655.71,percent of total billed charges,66.1% of total billed charges,1029.2,83,,823.36,percent of total billed charges,83% of total,1178,95,,942.4,percent of total billed charges ,95% of total billed charges,992,80,,793.6,percent of total billed charges,78% of total billed charges,967.2,78,,773.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,781.2,63,,624.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1116,90,,892.8,percent of total billed charges,90% of total billed charges,992,80,,793.6,percent of total billed charges,80% of total billed charges,781.2,63,,624.96,percent of total billed charges,63% of total billed charges,1054,85,,843.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,979.6,79,,783.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1178,
CT HEAD/BRAIN W/0 CONTRAST,351001662,CDM,351,RC,70450,HCPCS,outpatient,,,682,477.4,,538.78,79,,431.02,percent of total billed charges,79% of total billed charges,613.8,90,,491.04,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,429.66,63,,343.73,percent of total billed charges,63% of total billed charges,526.64,77.22,,421.31,percent of total billed charges,77.22% of total billed charges,450.8,66.1,,360.64,percent of total billed charges,66.1% of total billed charges,566.06,83,,452.85,percent of total billed charges,83% of total,647.9,95,,518.32,percent of total billed charges ,95% of total billed charges,545.6,80,,436.48,percent of total billed charges,78% of total billed charges,531.96,78,,425.568,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,429.66,63,,343.73,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,429.66,63,,343.73,percent of total billed charges,63% of total billed charges,579.7,85,,463.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,538.78,79,,431.02,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,647.9,
CT HEAD WITH CONTRAST,351001663,CDM,351,RC,70460,HCPCS,outpatient,,,1444,1010.8,,1140.76,79,,912.61,percent of total billed charges,79% of total billed charges,1299.6,90,,1039.68,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,909.72,63,,727.78,percent of total billed charges,63% of total billed charges,1115.06,77.22,,892.05,percent of total billed charges,77.22% of total billed charges,954.48,66.1,,763.58,percent of total billed charges,66.1% of total billed charges,1198.52,83,,958.82,percent of total billed charges,83% of total,1371.8,95,,1097.44,percent of total billed charges ,95% of total billed charges,1155.2,80,,924.16,percent of total billed charges,78% of total billed charges,1126.32,78,,901.056,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,909.72,63,,727.78,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1299.6,90,,1039.68,percent of total billed charges,90% of total billed charges,1155.2,80,,924.16,percent of total billed charges,80% of total billed charges,909.72,63,,727.78,percent of total billed charges,63% of total billed charges,1227.4,85,,981.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1140.76,79,,912.61,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1371.8,
CT HEAD W & W/O CONTRAST,351001664,CDM,351,RC,70470,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1502.9,
M-FACIAL/SINUSES W/0 CONTRAST,351001665,CDM,351,RC,70486,HCPCS,outpatient,,,1525,1067.5,,1204.75,79,,963.8,percent of total billed charges,79% of total billed charges,1372.5,90,,1098,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,960.75,63,,768.6,percent of total billed charges,63% of total billed charges,1177.61,77.22,,942.09,percent of total billed charges,77.22% of total billed charges,1008.03,66.1,,806.42,percent of total billed charges,66.1% of total billed charges,1265.75,83,,1012.6,percent of total billed charges,83% of total,1448.75,95,,1159,percent of total billed charges ,95% of total billed charges,1220,80,,976,percent of total billed charges,78% of total billed charges,1189.5,78,,951.6,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,960.75,63,,768.6,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1372.5,90,,1098,percent of total billed charges,90% of total billed charges,1220,80,,976,percent of total billed charges,80% of total billed charges,960.75,63,,768.6,percent of total billed charges,63% of total billed charges,1296.25,85,,1037,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1204.75,79,,963.8,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1448.75,
M-FACIAL/SINUSES WITH CONTRAST,351001666,CDM,351,RC,70487,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1387,
M-FACIAL/SINUSES W & W/O CONTR,351001667,CDM,351,RC,70488,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1618.8,
CT ORBITS W/0 CONTRAST,351001668,CDM,351,RC,70480,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1387,
CT ORBITS WITH CONTRAST,351001669,CDM,351,RC,70481,HCPCS,outpatient,,,1400,980,,1106,79,,884.8,percent of total billed charges,79% of total billed charges,1260,90,,1008,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,882,63,,705.6,percent of total billed charges,63% of total billed charges,1081.08,77.22,,864.86,percent of total billed charges,77.22% of total billed charges,925.4,66.1,,740.32,percent of total billed charges,66.1% of total billed charges,1162,83,,929.6,percent of total billed charges,83% of total,1330,95,,1064,percent of total billed charges ,95% of total billed charges,1120,80,,896,percent of total billed charges,78% of total billed charges,1092,78,,873.6,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,882,63,,705.6,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1260,90,,1008,percent of total billed charges,90% of total billed charges,1120,80,,896,percent of total billed charges,80% of total billed charges,882,63,,705.6,percent of total billed charges,63% of total billed charges,1190,85,,952,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1106,79,,884.8,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1330,
CT ORBITS W & W/O CONTRAST,351001670,CDM,351,RC,70482,HCPCS,outpatient,,,1521,1064.7,,1201.59,79,,961.27,percent of total billed charges,79% of total billed charges,1368.9,90,,1095.12,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,1174.52,77.22,,939.62,percent of total billed charges,77.22% of total billed charges,1005.38,66.1,,804.3,percent of total billed charges,66.1% of total billed charges,1262.43,83,,1009.94,percent of total billed charges,83% of total,1444.95,95,,1155.96,percent of total billed charges ,95% of total billed charges,1216.8,80,,973.44,percent of total billed charges,78% of total billed charges,1186.38,78,,949.104,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1368.9,90,,1095.12,percent of total billed charges,90% of total billed charges,1216.8,80,,973.44,percent of total billed charges,80% of total billed charges,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,1292.85,85,,1034.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1201.59,79,,961.27,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1444.95,
CT SELLA W/O CONTRAST,351001679,CDM,351,RC,70480,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1387,
CT SOFT TISSUE NECK WO CONT,351001701,CDM,351,RC,70490,HCPCS,outpatient,,,1157,809.9,,914.03,79,,731.22,percent of total billed charges,79% of total billed charges,1041.3,90,,833.04,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,728.91,63,,583.13,percent of total billed charges,63% of total billed charges,893.44,77.22,,714.75,percent of total billed charges,77.22% of total billed charges,764.78,66.1,,611.82,percent of total billed charges,66.1% of total billed charges,960.31,83,,768.25,percent of total billed charges,83% of total,1099.15,95,,879.32,percent of total billed charges ,95% of total billed charges,925.6,80,,740.48,percent of total billed charges,78% of total billed charges,902.46,78,,721.968,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,728.91,63,,583.13,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,728.91,63,,583.13,percent of total billed charges,63% of total billed charges,983.45,85,,786.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,914.03,79,,731.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1099.15,
CT SOFT TISSUE NECK W CONT,351001702,CDM,351,RC,70491,HCPCS,outpatient,,,2435,1704.5,,1923.65,79,,1538.92,percent of total billed charges,79% of total billed charges,2191.5,90,,1753.2,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1534.05,63,,1227.24,percent of total billed charges,63% of total billed charges,1880.31,77.22,,1504.25,percent of total billed charges,77.22% of total billed charges,1609.54,66.1,,1287.63,percent of total billed charges,66.1% of total billed charges,2021.05,83,,1616.84,percent of total billed charges,83% of total,2313.25,95,,1850.6,percent of total billed charges ,95% of total billed charges,1948,80,,1558.4,percent of total billed charges,78% of total billed charges,1899.3,78,,1519.44,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1534.05,63,,1227.24,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,2191.5,90,,1753.2,percent of total billed charges,90% of total billed charges,1948,80,,1558.4,percent of total billed charges,80% of total billed charges,1534.05,63,,1227.24,percent of total billed charges,63% of total billed charges,2069.75,85,,1655.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1923.65,79,,1538.92,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,2313.25,
CT SOFT TISSUE NECK W/WO CONT,351001703,CDM,351,RC,70492,HCPCS,outpatient,,,2006,1404.2,,1584.74,79,,1267.79,percent of total billed charges,79% of total billed charges,1805.4,90,,1444.32,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1263.78,63,,1011.02,percent of total billed charges,63% of total billed charges,1549.03,77.22,,1239.22,percent of total billed charges,77.22% of total billed charges,1325.97,66.1,,1060.78,percent of total billed charges,66.1% of total billed charges,1664.98,83,,1331.98,percent of total billed charges,83% of total,1905.7,95,,1524.56,percent of total billed charges ,95% of total billed charges,1604.8,80,,1283.84,percent of total billed charges,78% of total billed charges,1564.68,78,,1251.744,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1263.78,63,,1011.02,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1805.4,90,,1444.32,percent of total billed charges,90% of total billed charges,1604.8,80,,1283.84,percent of total billed charges,80% of total billed charges,1263.78,63,,1011.02,percent of total billed charges,63% of total billed charges,1705.1,85,,1364.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1584.74,79,,1267.79,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1905.7,
CTA HEAD/NECK W/WO CONTRAST CP,351001749,CDM,351,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT INNER EAR W/O CONTRAST,351001751,CDM,351,RC,70480,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1387,
CT MASTOID W.O CONTRAST,351001753,CDM,351,RC,70480,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1387,
CT MASTOIDS WITH CONTRAST,351001764,CDM,351,RC,70481,HCPCS,outpatient,,,1400,980,,1106,79,,884.8,percent of total billed charges,79% of total billed charges,1260,90,,1008,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,882,63,,705.6,percent of total billed charges,63% of total billed charges,1081.08,77.22,,864.86,percent of total billed charges,77.22% of total billed charges,925.4,66.1,,740.32,percent of total billed charges,66.1% of total billed charges,1162,83,,929.6,percent of total billed charges,83% of total,1330,95,,1064,percent of total billed charges ,95% of total billed charges,1120,80,,896,percent of total billed charges,78% of total billed charges,1092,78,,873.6,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,882,63,,705.6,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1260,90,,1008,percent of total billed charges,90% of total billed charges,1120,80,,896,percent of total billed charges,80% of total billed charges,882,63,,705.6,percent of total billed charges,63% of total billed charges,1190,85,,952,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1106,79,,884.8,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1330,
MAXILLOFACIAL WITH CONTRAST,351001765,CDM,351,RC,70487,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1387,
CT FACIAL W/WO CONTRAST,351001789,CDM,351,RC,70488,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1618.8,
CT ANGIOGRAPHY HEAD W CONT,351001791,CDM,351,RC,70496,HCPCS,outpatient,,,1384,968.8,,1093.36,79,,874.69,percent of total billed charges,79% of total billed charges,1245.6,90,,996.48,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,871.92,63,,697.54,percent of total billed charges,63% of total billed charges,1068.72,77.22,,854.98,percent of total billed charges,77.22% of total billed charges,914.82,66.1,,731.86,percent of total billed charges,66.1% of total billed charges,1148.72,83,,918.98,percent of total billed charges,83% of total,1314.8,95,,1051.84,percent of total billed charges ,95% of total billed charges,1107.2,80,,885.76,percent of total billed charges,78% of total billed charges,1079.52,78,,863.616,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,871.92,63,,697.54,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1245.6,90,,996.48,percent of total billed charges,90% of total billed charges,1107.2,80,,885.76,percent of total billed charges,80% of total billed charges,871.92,63,,697.54,percent of total billed charges,63% of total billed charges,1176.4,85,,941.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1093.36,79,,874.69,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1314.8,
CT ANGIOGRAPHY NECK W CONT,351001792,CDM,351,RC,70498,HCPCS,outpatient,,,1384,968.8,,1093.36,79,,874.69,percent of total billed charges,79% of total billed charges,1245.6,90,,996.48,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,871.92,63,,697.54,percent of total billed charges,63% of total billed charges,1068.72,77.22,,854.98,percent of total billed charges,77.22% of total billed charges,914.82,66.1,,731.86,percent of total billed charges,66.1% of total billed charges,1148.72,83,,918.98,percent of total billed charges,83% of total,1314.8,95,,1051.84,percent of total billed charges ,95% of total billed charges,1107.2,80,,885.76,percent of total billed charges,78% of total billed charges,1079.52,78,,863.616,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,871.92,63,,697.54,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1245.6,90,,996.48,percent of total billed charges,90% of total billed charges,1107.2,80,,885.76,percent of total billed charges,80% of total billed charges,871.92,63,,697.54,percent of total billed charges,63% of total billed charges,1176.4,85,,941.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1093.36,79,,874.69,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1314.8,
CT ANGIO NECK/HEAD W/WO CON CP,351001802,CDM,351,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT BIOPSY LIVER  CP,351080344,CDM,351,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT BIOPSY LUNG CP,351080345,CDM,351,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT GUIDANCE FOR ASPIRATION CP,351080348,CDM,351,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT L SPINE W/WO CONTRAST,350001786,CDM,352,RC,72133,HCPCS,outpatient,,,2805,1963.5,,2215.95,79,,1772.76,percent of total billed charges,79% of total billed charges,2524.5,90,,2019.6,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1767.15,63,,1413.72,percent of total billed charges,63% of total billed charges,2166.02,77.22,,1732.82,percent of total billed charges,77.22% of total billed charges,1854.11,66.1,,1483.29,percent of total billed charges,66.1% of total billed charges,2328.15,83,,1862.52,percent of total billed charges,83% of total,2664.75,95,,2131.8,percent of total billed charges ,95% of total billed charges,2244,80,,1795.2,percent of total billed charges,78% of total billed charges,2187.9,78,,1750.32,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1767.15,63,,1413.72,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,2524.5,90,,2019.6,percent of total billed charges,90% of total billed charges,2244,80,,1795.2,percent of total billed charges,80% of total billed charges,1767.15,63,,1413.72,percent of total billed charges,63% of total billed charges,2384.25,85,,1907.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,2215.95,79,,1772.76,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,2664.75,
CT ABDOMEN W/O CONTRAST,351001650,CDM,352,RC,74150,HCPCS,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1271.1,
CT ABDOMEN WITH CONSTRAST,351001651,CDM,352,RC,74160,HCPCS,outpatient,,,1575,1102.5,,1244.25,79,,995.4,percent of total billed charges,79% of total billed charges,1417.5,90,,1134,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,992.25,63,,793.8,percent of total billed charges,63% of total billed charges,1216.22,77.22,,972.98,percent of total billed charges,77.22% of total billed charges,1041.08,66.1,,832.86,percent of total billed charges,66.1% of total billed charges,1307.25,83,,1045.8,percent of total billed charges,83% of total,1496.25,95,,1197,percent of total billed charges ,95% of total billed charges,1260,80,,1008,percent of total billed charges,78% of total billed charges,1228.5,78,,982.8,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,992.25,63,,793.8,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1417.5,90,,1134,percent of total billed charges,90% of total billed charges,1260,80,,1008,percent of total billed charges,80% of total billed charges,992.25,63,,793.8,percent of total billed charges,63% of total billed charges,1338.75,85,,1071,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1244.25,79,,995.4,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1496.25,
CT ABDOMEN W & W/O CONTRAST,351001652,CDM,352,RC,74170,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1618.8,
CT CHEST DIAG W/O CONTRAST,351001653,CDM,352,RC,71250,HCPCS,outpatient,,,1277,893.9,,1008.83,79,,807.06,percent of total billed charges,79% of total billed charges,1149.3,90,,919.44,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,804.51,63,,643.61,percent of total billed charges,63% of total billed charges,986.1,77.22,,788.88,percent of total billed charges,77.22% of total billed charges,844.1,66.1,,675.28,percent of total billed charges,66.1% of total billed charges,1059.91,83,,847.93,percent of total billed charges,83% of total,1213.15,95,,970.52,percent of total billed charges ,95% of total billed charges,1021.6,80,,817.28,percent of total billed charges,78% of total billed charges,996.06,78,,796.848,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,804.51,63,,643.61,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1149.3,90,,919.44,percent of total billed charges,90% of total billed charges,1021.6,80,,817.28,percent of total billed charges,80% of total billed charges,804.51,63,,643.61,percent of total billed charges,63% of total billed charges,1085.45,85,,868.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1008.83,79,,807.06,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1213.15,
CT CHEST DIAG WITH CONTRAST,351001654,CDM,352,RC,71260,HCPCS,outpatient,,,2181,1526.7,,1722.99,79,,1378.39,percent of total billed charges,79% of total billed charges,1962.9,90,,1570.32,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1374.03,63,,1099.22,percent of total billed charges,63% of total billed charges,1684.17,77.22,,1347.34,percent of total billed charges,77.22% of total billed charges,1441.64,66.1,,1153.31,percent of total billed charges,66.1% of total billed charges,1810.23,83,,1448.18,percent of total billed charges,83% of total,2071.95,95,,1657.56,percent of total billed charges ,95% of total billed charges,1744.8,80,,1395.84,percent of total billed charges,78% of total billed charges,1701.18,78,,1360.944,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1374.03,63,,1099.22,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1962.9,90,,1570.32,percent of total billed charges,90% of total billed charges,1744.8,80,,1395.84,percent of total billed charges,80% of total billed charges,1374.03,63,,1099.22,percent of total billed charges,63% of total billed charges,1853.85,85,,1483.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1722.99,79,,1378.39,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,2071.95,
CT CHEST DIAG W & W/O CONTRAST,351001655,CDM,352,RC,71270,HCPCS,outpatient,,,1880,1316,,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1451.74,77.22,,1161.39,percent of total billed charges,77.22% of total billed charges,1242.68,66.1,,994.14,percent of total billed charges,66.1% of total billed charges,1560.4,83,,1248.32,percent of total billed charges,83% of total,1786,95,,1428.8,percent of total billed charges ,95% of total billed charges,1504,80,,1203.2,percent of total billed charges,78% of total billed charges,1466.4,78,,1173.12,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,1504,80,,1203.2,percent of total billed charges,80% of total billed charges,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1598,85,,1278.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1786,
CT UPPER EXTREMITY W/O CONTRAS,351001656,CDM,352,RC,73200,HCPCS,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1271.1,
CT UPPER EXTREMITY W/CONTRAST,351001657,CDM,352,RC,73201,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1387,
CT LOWER EXTREMITY W/O CONTRAS,351001659,CDM,352,RC,73700,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1803.1,
CT PELVIS W/0 CONTRAST,351001671,CDM,352,RC,72192,HCPCS,outpatient,,,1263,884.1,,997.77,79,,798.22,percent of total billed charges,79% of total billed charges,1136.7,90,,909.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,795.69,63,,636.55,percent of total billed charges,63% of total billed charges,975.29,77.22,,780.23,percent of total billed charges,77.22% of total billed charges,834.84,66.1,,667.87,percent of total billed charges,66.1% of total billed charges,1048.29,83,,838.63,percent of total billed charges,83% of total,1199.85,95,,959.88,percent of total billed charges ,95% of total billed charges,1010.4,80,,808.32,percent of total billed charges,78% of total billed charges,985.14,78,,788.112,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,795.69,63,,636.55,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,795.69,63,,636.55,percent of total billed charges,63% of total billed charges,1073.55,85,,858.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,997.77,79,,798.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1199.85,
CT PELVIS WITH CONTRAST,351001672,CDM,352,RC,72193,HCPCS,outpatient,,,1521,1064.7,,1201.59,79,,961.27,percent of total billed charges,79% of total billed charges,1368.9,90,,1095.12,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,1174.52,77.22,,939.62,percent of total billed charges,77.22% of total billed charges,1005.38,66.1,,804.3,percent of total billed charges,66.1% of total billed charges,1262.43,83,,1009.94,percent of total billed charges,83% of total,1444.95,95,,1155.96,percent of total billed charges ,95% of total billed charges,1216.8,80,,973.44,percent of total billed charges,78% of total billed charges,1186.38,78,,949.104,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1368.9,90,,1095.12,percent of total billed charges,90% of total billed charges,1216.8,80,,973.44,percent of total billed charges,80% of total billed charges,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,1292.85,85,,1034.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1201.59,79,,961.27,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1444.95,
CT PELVIS W & W/O CONTRAST,351001673,CDM,352,RC,72194,HCPCS,outpatient,,,1824,1276.8,,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1408.49,77.22,,1126.79,percent of total billed charges,77.22% of total billed charges,1205.66,66.1,,964.53,percent of total billed charges,66.1% of total billed charges,1513.92,83,,1211.14,percent of total billed charges,83% of total,1732.8,95,,1386.24,percent of total billed charges ,95% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,78% of total billed charges,1422.72,78,,1138.176,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,80% of total billed charges,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1550.4,85,,1240.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1732.8,
CT CERVICAL SPINE W/O CONTRAST,351001677,CDM,352,RC,72125,HCPCS,outpatient,,,1739,1217.3,,1373.81,79,,1099.05,percent of total billed charges,79% of total billed charges,1565.1,90,,1252.08,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,1095.57,63,,876.46,percent of total billed charges,63% of total billed charges,1342.86,77.22,,1074.29,percent of total billed charges,77.22% of total billed charges,1149.48,66.1,,919.58,percent of total billed charges,66.1% of total billed charges,1443.37,83,,1154.7,percent of total billed charges,83% of total,1652.05,95,,1321.64,percent of total billed charges ,95% of total billed charges,1391.2,80,,1112.96,percent of total billed charges,78% of total billed charges,1356.42,78,,1085.136,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1095.57,63,,876.46,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1565.1,90,,1252.08,percent of total billed charges,90% of total billed charges,1391.2,80,,1112.96,percent of total billed charges,80% of total billed charges,1095.57,63,,876.46,percent of total billed charges,63% of total billed charges,1478.15,85,,1182.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1373.81,79,,1099.05,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1652.05,
CT THORACIC SPINE W/O CONTRAST,351001691,CDM,352,RC,72128,HCPCS,outpatient,,,2215,1550.5,,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1710.42,77.22,,1368.34,percent of total billed charges,77.22% of total billed charges,1464.12,66.1,,1171.3,percent of total billed charges,66.1% of total billed charges,1838.45,83,,1470.76,percent of total billed charges,83% of total,2104.25,95,,1683.4,percent of total billed charges ,95% of total billed charges,1772,80,,1417.6,percent of total billed charges,78% of total billed charges,1727.7,78,,1382.16,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,1772,80,,1417.6,percent of total billed charges,80% of total billed charges,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1882.75,85,,1506.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,2104.25,
CT LUMBAR SPINE W/O CONTRAST,351001694,CDM,352,RC,72131,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1803.1,
CT ABDOMEN W/O,351001711,CDM,352,RC,74150,HCPCS,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1271.1,
CT ABDOMEN W CONTRAST LMTD,351001712,CDM,352,RC,74160,HCPCS,outpatient,,,1575,1102.5,,1244.25,79,,995.4,percent of total billed charges,79% of total billed charges,1417.5,90,,1134,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,992.25,63,,793.8,percent of total billed charges,63% of total billed charges,1216.22,77.22,,972.98,percent of total billed charges,77.22% of total billed charges,1041.08,66.1,,832.86,percent of total billed charges,66.1% of total billed charges,1307.25,83,,1045.8,percent of total billed charges,83% of total,1496.25,95,,1197,percent of total billed charges ,95% of total billed charges,1260,80,,1008,percent of total billed charges,78% of total billed charges,1228.5,78,,982.8,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,992.25,63,,793.8,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1417.5,90,,1134,percent of total billed charges,90% of total billed charges,1260,80,,1008,percent of total billed charges,80% of total billed charges,992.25,63,,793.8,percent of total billed charges,63% of total billed charges,1338.75,85,,1071,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1244.25,79,,995.4,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1496.25,
CT GUIDANCE FOR ASPIRATION,351001720,CDM,352,RC,77012,HCPCS,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1271.1,
CT UPPER EXT W/WO CONTRAST,351001752,CDM,352,RC,73202,HCPCS,outpatient,,,1075,752.5,,849.25,79,,679.4,percent of total billed charges,79% of total billed charges,967.5,90,,774,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,677.25,63,,541.8,percent of total billed charges,63% of total billed charges,830.12,77.22,,664.1,percent of total billed charges,77.22% of total billed charges,710.58,66.1,,568.46,percent of total billed charges,66.1% of total billed charges,892.25,83,,713.8,percent of total billed charges,83% of total,1021.25,95,,817,percent of total billed charges ,95% of total billed charges,860,80,,688,percent of total billed charges,78% of total billed charges,838.5,78,,670.8,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,677.25,63,,541.8,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,677.25,63,,541.8,percent of total billed charges,63% of total billed charges,913.75,85,,731,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,849.25,79,,679.4,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1021.25,
CT SHOULDER ARTHROGRAM W CT RT,351001754,CDM,352,RC,73201,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1387,
CT SHLDER ARTHROGRAM W CONT LT,351001758,CDM,352,RC,73201,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1387,
CT PULMONARY EMBOLUS,351001760,CDM,352,RC,71275,HCPCS,outpatient,,,2847,1992.9,,2249.13,79,,1799.3,percent of total billed charges,79% of total billed charges,2562.3,90,,2049.84,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1793.61,63,,1434.89,percent of total billed charges,63% of total billed charges,2198.45,77.22,,1758.76,percent of total billed charges,77.22% of total billed charges,1881.87,66.1,,1505.5,percent of total billed charges,66.1% of total billed charges,2363.01,83,,1890.41,percent of total billed charges,83% of total,2704.65,95,,2163.72,percent of total billed charges ,95% of total billed charges,2277.6,80,,1822.08,percent of total billed charges,78% of total billed charges,2220.66,78,,1776.528,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1793.61,63,,1434.89,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,2562.3,90,,2049.84,percent of total billed charges,90% of total billed charges,2277.6,80,,1822.08,percent of total billed charges,80% of total billed charges,1793.61,63,,1434.89,percent of total billed charges,63% of total billed charges,2419.95,85,,1935.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,2249.13,79,,1799.3,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,2704.65,
CT GUIDED THORACEN W/TUBE INSR,351001777,CDM,352,RC,77012,HCPCS,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1271.1,
HI RES CT THORAX DX W/O CONTRA,351001783,CDM,352,RC,71250,HCPCS,outpatient,,,1277,893.9,,1008.83,79,,807.06,percent of total billed charges,79% of total billed charges,1149.3,90,,919.44,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,804.51,63,,643.61,percent of total billed charges,63% of total billed charges,986.1,77.22,,788.88,percent of total billed charges,77.22% of total billed charges,844.1,66.1,,675.28,percent of total billed charges,66.1% of total billed charges,1059.91,83,,847.93,percent of total billed charges,83% of total,1213.15,95,,970.52,percent of total billed charges ,95% of total billed charges,1021.6,80,,817.28,percent of total billed charges,78% of total billed charges,996.06,78,,796.848,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,804.51,63,,643.61,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1149.3,90,,919.44,percent of total billed charges,90% of total billed charges,1021.6,80,,817.28,percent of total billed charges,80% of total billed charges,804.51,63,,643.61,percent of total billed charges,63% of total billed charges,1085.45,85,,868.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1008.83,79,,807.06,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1213.15,
CT THORAC SPINE W&WO CONTRAST,351001784,CDM,352,RC,72130,HCPCS,outpatient,,,1691,1183.7,,1335.89,79,,1068.71,percent of total billed charges,79% of total billed charges,1521.9,90,,1217.52,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1065.33,63,,852.26,percent of total billed charges,63% of total billed charges,1305.79,77.22,,1044.63,percent of total billed charges,77.22% of total billed charges,1117.75,66.1,,894.2,percent of total billed charges,66.1% of total billed charges,1403.53,83,,1122.82,percent of total billed charges,83% of total,1606.45,95,,1285.16,percent of total billed charges ,95% of total billed charges,1352.8,80,,1082.24,percent of total billed charges,78% of total billed charges,1318.98,78,,1055.184,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1065.33,63,,852.26,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1521.9,90,,1217.52,percent of total billed charges,90% of total billed charges,1352.8,80,,1082.24,percent of total billed charges,80% of total billed charges,1065.33,63,,852.26,percent of total billed charges,63% of total billed charges,1437.35,85,,1149.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1335.89,79,,1068.71,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1606.45,
CT BIL LOWER EXTREMITY WO CONT,351001785,CDM,352,RC,73700,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1803.1,
CT ABDOMEN & PELVIS/RENL WO CT,351001786,CDM,352,RC,74176,HCPCS,outpatient,,,3213,2249.1,,2538.27,79,,2030.62,percent of total billed charges,79% of total billed charges,2891.7,90,,2313.36,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,2024.19,63,,1619.35,percent of total billed charges,63% of total billed charges,2481.08,77.22,,1984.86,percent of total billed charges,77.22% of total billed charges,2123.79,66.1,,1699.03,percent of total billed charges,66.1% of total billed charges,2666.79,83,,2133.43,percent of total billed charges,83% of total,3052.35,95,,2441.88,percent of total billed charges ,95% of total billed charges,2570.4,80,,2056.32,percent of total billed charges,78% of total billed charges,2506.14,78,,2004.912,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2024.19,63,,1619.35,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2891.7,90,,2313.36,percent of total billed charges,90% of total billed charges,2570.4,80,,2056.32,percent of total billed charges,80% of total billed charges,2024.19,63,,1619.35,percent of total billed charges,63% of total billed charges,2731.05,85,,2184.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,2538.27,79,,2030.62,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,3052.35,
CT ABDOMEN & PELVIS WITH CONT,351001787,CDM,352,RC,74177,HCPCS,outpatient,,,5940,4158,,4692.6,79,,3754.08,percent of total billed charges,79% of total billed charges,5346,90,,4276.8,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,3742.2,63,,2993.76,percent of total billed charges,63% of total billed charges,4586.87,77.22,,3669.5,percent of total billed charges,77.22% of total billed charges,3926.34,66.1,,3141.07,percent of total billed charges,66.1% of total billed charges,4930.2,83,,3944.16,percent of total billed charges,83% of total,5643,95,,4514.4,percent of total billed charges ,95% of total billed charges,4752,80,,3801.6,percent of total billed charges,78% of total billed charges,4633.2,78,,3706.56,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,3742.2,63,,2993.76,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,5346,90,,4276.8,percent of total billed charges,90% of total billed charges,4752,80,,3801.6,percent of total billed charges,80% of total billed charges,3742.2,63,,2993.76,percent of total billed charges,63% of total billed charges,5049,85,,4039.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,4692.6,79,,3754.08,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,5643,
CT ABD & PELV W & WO CONT,351001788,CDM,352,RC,74178,HCPCS,outpatient,,,3721,2604.7,,2939.59,79,,2351.67,percent of total billed charges,79% of total billed charges,3348.9,90,,2679.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2344.23,63,,1875.38,percent of total billed charges,63% of total billed charges,2873.36,77.22,,2298.69,percent of total billed charges,77.22% of total billed charges,2459.58,66.1,,1967.66,percent of total billed charges,66.1% of total billed charges,3088.43,83,,2470.74,percent of total billed charges,83% of total,3534.95,95,,2827.96,percent of total billed charges ,95% of total billed charges,2976.8,80,,2381.44,percent of total billed charges,78% of total billed charges,2902.38,78,,2321.904,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2344.23,63,,1875.38,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,3348.9,90,,2679.12,percent of total billed charges,90% of total billed charges,2976.8,80,,2381.44,percent of total billed charges,80% of total billed charges,2344.23,63,,1875.38,percent of total billed charges,63% of total billed charges,3162.85,85,,2530.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2939.59,79,,2351.67,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3534.95,
CT ABDOMINAL BIOPSY,351001793,CDM,352,RC,77012,HCPCS,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1271.1,
CT CHEST W WO CONT LDCT SMOKER,351001799,CDM,352,RC,71271,HCPCS,outpatient,,,437,305.9,,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,337.45,77.22,,269.96,percent of total billed charges,77.22% of total billed charges,288.86,66.1,,231.09,percent of total billed charges,66.1% of total billed charges,362.71,83,,290.17,percent of total billed charges,83% of total,415.15,95,,332.12,percent of total billed charges ,95% of total billed charges,349.6,80,,279.68,percent of total billed charges,78% of total billed charges,340.86,78,,272.688,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,349.6,80,,279.68,percent of total billed charges,80% of total billed charges,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,371.45,85,,297.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
CTA THORACIC AORTA,351001801,CDM,352,RC,71275,HCPCS,outpatient,,,2847,1992.9,,2249.13,79,,1799.3,percent of total billed charges,79% of total billed charges,2562.3,90,,2049.84,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1793.61,63,,1434.89,percent of total billed charges,63% of total billed charges,2198.45,77.22,,1758.76,percent of total billed charges,77.22% of total billed charges,1881.87,66.1,,1505.5,percent of total billed charges,66.1% of total billed charges,2363.01,83,,1890.41,percent of total billed charges,83% of total,2704.65,95,,2163.72,percent of total billed charges ,95% of total billed charges,2277.6,80,,1822.08,percent of total billed charges,78% of total billed charges,2220.66,78,,1776.528,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1793.61,63,,1434.89,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,2562.3,90,,2049.84,percent of total billed charges,90% of total billed charges,2277.6,80,,1822.08,percent of total billed charges,80% of total billed charges,1793.61,63,,1434.89,percent of total billed charges,63% of total billed charges,2419.95,85,,1935.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,2249.13,79,,1799.3,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,2704.65,
CT ABDOMEN W/CONTRAST COMP CP,351080301,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT ABDOMEN W/&W/O CONTRAST CP,351080303,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT CHEST W CONTRAST COMP CP,351080309,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT CHEST W/O CONTRAST COMP CP,351080310,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT CHEST W/W/O CONTRAST CP,351080311,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT PELVIS W/CONTRAST COMP CP,351080330,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT PELVIS W/W/O CONTRAST CP,351080332,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT SOFT TISSUE NECK W CONT CP,351080333,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT SOFT TISS NECK W/WO CONT CP,351080335,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT ABDOMIN W CONTRAST CP,351080340,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT CTA PELVIS W/CONTRAST,352000024,CDM,352,RC,72191,HCPCS,outpatient,,,1974,1381.8,,1559.46,79,,1247.57,percent of total billed charges,79% of total billed charges,1776.6,90,,1421.28,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1243.62,63,,994.9,percent of total billed charges,63% of total billed charges,1524.32,77.22,,1219.46,percent of total billed charges,77.22% of total billed charges,1304.81,66.1,,1043.85,percent of total billed charges,66.1% of total billed charges,1638.42,83,,1310.74,percent of total billed charges,83% of total,1875.3,95,,1500.24,percent of total billed charges ,95% of total billed charges,1579.2,80,,1263.36,percent of total billed charges,78% of total billed charges,1539.72,78,,1231.776,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1243.62,63,,994.9,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1776.6,90,,1421.28,percent of total billed charges,90% of total billed charges,1579.2,80,,1263.36,percent of total billed charges,80% of total billed charges,1243.62,63,,994.9,percent of total billed charges,63% of total billed charges,1677.9,85,,1342.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1559.46,79,,1247.57,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1875.3,
CTA LOWER EXTREM W & WO CONT,352000025,CDM,352,RC,73706,HCPCS,outpatient,,,948,663.6,,748.92,79,,599.14,percent of total billed charges,79% of total billed charges,853.2,90,,682.56,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,732.05,77.22,,585.64,percent of total billed charges,77.22% of total billed charges,626.63,66.1,,501.3,percent of total billed charges,66.1% of total billed charges,786.84,83,,629.47,percent of total billed charges,83% of total,900.6,95,,720.48,percent of total billed charges ,95% of total billed charges,758.4,80,,606.72,percent of total billed charges,78% of total billed charges,739.44,78,,591.552,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,853.2,90,,682.56,percent of total billed charges,90% of total billed charges,758.4,80,,606.72,percent of total billed charges,80% of total billed charges,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,805.8,85,,644.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,748.92,79,,599.14,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,900.6,
CT GUIDED GROIN BIOPSY CP,352000118,CDM,352,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT LOWER EXTREM W/WO CONTRAST,352001730,CDM,352,RC,73702,HCPCS,outpatient,,,1824,1276.8,,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1408.49,77.22,,1126.79,percent of total billed charges,77.22% of total billed charges,1205.66,66.1,,964.53,percent of total billed charges,66.1% of total billed charges,1513.92,83,,1211.14,percent of total billed charges,83% of total,1732.8,95,,1386.24,percent of total billed charges ,95% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,78% of total billed charges,1422.72,78,,1138.176,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,80% of total billed charges,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1550.4,85,,1240.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1732.8,
CT LOWER EXTREMITY W/CONTRAST,352001733,CDM,352,RC,73701,HCPCS,outpatient,,,1706,1194.2,,1347.74,79,,1078.19,percent of total billed charges,79% of total billed charges,1535.4,90,,1228.32,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1074.78,63,,859.82,percent of total billed charges,63% of total billed charges,1317.37,77.22,,1053.9,percent of total billed charges,77.22% of total billed charges,1127.67,66.1,,902.14,percent of total billed charges,66.1% of total billed charges,1415.98,83,,1132.78,percent of total billed charges,83% of total,1620.7,95,,1296.56,percent of total billed charges ,95% of total billed charges,1364.8,80,,1091.84,percent of total billed charges,78% of total billed charges,1330.68,78,,1064.544,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1074.78,63,,859.82,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,1074.78,63,,859.82,percent of total billed charges,63% of total billed charges,1450.1,85,,1160.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1347.74,79,,1078.19,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1620.7,
CT ARTHROGRAM RT KNEE,352001734,CDM,352,RC,73702,HCPCS,outpatient,,,1824,1276.8,,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1408.49,77.22,,1126.79,percent of total billed charges,77.22% of total billed charges,1205.66,66.1,,964.53,percent of total billed charges,66.1% of total billed charges,1513.92,83,,1211.14,percent of total billed charges,83% of total,1732.8,95,,1386.24,percent of total billed charges ,95% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,78% of total billed charges,1422.72,78,,1138.176,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,80% of total billed charges,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1550.4,85,,1240.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1732.8,
CT ARTHROGRAM LT KNEE,352001735,CDM,352,RC,73702,HCPCS,outpatient,,,1824,1276.8,,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1408.49,77.22,,1126.79,percent of total billed charges,77.22% of total billed charges,1205.66,66.1,,964.53,percent of total billed charges,66.1% of total billed charges,1513.92,83,,1211.14,percent of total billed charges,83% of total,1732.8,95,,1386.24,percent of total billed charges ,95% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,78% of total billed charges,1422.72,78,,1138.176,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1641.6,90,,1313.28,percent of total billed charges,90% of total billed charges,1459.2,80,,1167.36,percent of total billed charges,80% of total billed charges,1149.12,63,,919.3,percent of total billed charges,63% of total billed charges,1550.4,85,,1240.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1440.96,79,,1152.77,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1732.8,
CT ANGIOGRAPHY LEGS BILAT,352001736,CDM,352,RC,73706,HCPCS,outpatient,,,948,663.6,,748.92,79,,599.14,percent of total billed charges,79% of total billed charges,853.2,90,,682.56,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,732.05,77.22,,585.64,percent of total billed charges,77.22% of total billed charges,626.63,66.1,,501.3,percent of total billed charges,66.1% of total billed charges,786.84,83,,629.47,percent of total billed charges,83% of total,900.6,95,,720.48,percent of total billed charges ,95% of total billed charges,758.4,80,,606.72,percent of total billed charges,78% of total billed charges,739.44,78,,591.552,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,853.2,90,,682.56,percent of total billed charges,90% of total billed charges,758.4,80,,606.72,percent of total billed charges,80% of total billed charges,597.24,63,,477.79,percent of total billed charges,63% of total billed charges,805.8,85,,644.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,748.92,79,,599.14,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,900.6,
CT CTA ABDOMEN W/WO CONTRAST,352001737,CDM,352,RC,74175,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1618.8,
CT ANGIO ABDOMINAL RUNOFF,352001738,CDM,352,RC,75635,HCPCS,outpatient,,,1071,749.7,,846.09,79,,676.87,percent of total billed charges,79% of total billed charges,963.9,90,,771.12,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.81,160,,,Fee Schedule,160% of CMS OPPS rate,199.72,130,,,Fee Schedule,130% of CMS OPPS rate,674.73,63,,539.78,percent of total billed charges,63% of total billed charges,827.03,77.22,,661.62,percent of total billed charges,77.22% of total billed charges,707.93,66.1,,566.34,percent of total billed charges,66.1% of total billed charges,888.93,83,,711.14,percent of total billed charges,83% of total,1017.45,95,,813.96,percent of total billed charges ,95% of total billed charges,856.8,80,,685.44,percent of total billed charges,78% of total billed charges,835.38,78,,668.304,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,674.73,63,,539.78,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,674.73,63,,539.78,percent of total billed charges,63% of total billed charges,910.35,85,,728.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,846.09,79,,676.87,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,1017.45,
CT CTA ABD PELVIS W CONTRAST,352001739,CDM,352,RC,74174,HCPCS,outpatient,,,2204,1542.8,,1741.16,79,,1392.93,percent of total billed charges,79% of total billed charges,1983.6,90,,1586.88,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1388.52,63,,1110.82,percent of total billed charges,63% of total billed charges,1701.93,77.22,,1361.54,percent of total billed charges,77.22% of total billed charges,1456.84,66.1,,1165.47,percent of total billed charges,66.1% of total billed charges,1829.32,83,,1463.46,percent of total billed charges,83% of total,2093.8,95,,1675.04,percent of total billed charges ,95% of total billed charges,1763.2,80,,1410.56,percent of total billed charges,78% of total billed charges,1719.12,78,,1375.296,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1388.52,63,,1110.82,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1983.6,90,,1586.88,percent of total billed charges,90% of total billed charges,1763.2,80,,1410.56,percent of total billed charges,80% of total billed charges,1388.52,63,,1110.82,percent of total billed charges,63% of total billed charges,1873.4,85,,1498.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1741.16,79,,1392.93,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2093.8,
CT BIOPSY OR EXC OF LYMPH NODE,352038531,CDM,352,RC,38531,HCPCS,outpatient,,,7573,5301.1,,5982.67,79,,4786.14,percent of total billed charges,79% of total billed charges,6815.7,90,,5452.56,percent of total billed charges,90% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,5099.6,160,,,Fee Schedule,160% of CMS OPPS rate,4143.43,130,,,Fee Schedule,130% of CMS OPPS rate,4770.99,63,,3816.79,percent of total billed charges,63% of total billed charges,5847.87,77.22,,4678.3,percent of total billed charges,77.22% of total billed charges,5005.75,66.1,,4004.6,percent of total billed charges,66.1% of total billed charges,6285.59,83,,5028.47,percent of total billed charges,83% of total,7194.35,95,,5755.48,percent of total billed charges ,95% of total billed charges,6058.4,80,,4846.72,percent of total billed charges,78% of total billed charges,5906.94,78,,4725.552,percent of total billed charges,78% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,4770.99,63,,3816.79,percent of total billed charges,63% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,6815.7,90,,5452.56,percent of total billed charges,90% of total billed charges,6058.4,80,,4846.72,percent of total billed charges,80% of total billed charges,4770.99,63,,3816.79,percent of total billed charges,63% of total billed charges,6437.05,85,,5149.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2964.14,93,,,fee schedule,93% of CMS OPPS rate,5982.67,79,,4786.14,percent of total billed charges,79% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,7194.35,
COMP TOPO THORAX LD LUNG CA SC,352071271,CDM,352,RC,71271,HCPCS,outpatient,,,437,305.9,,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,337.45,77.22,,269.96,percent of total billed charges,77.22% of total billed charges,288.86,66.1,,231.09,percent of total billed charges,66.1% of total billed charges,362.71,83,,290.17,percent of total billed charges,83% of total,415.15,95,,332.12,percent of total billed charges ,95% of total billed charges,349.6,80,,279.68,percent of total billed charges,78% of total billed charges,340.86,78,,272.688,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,349.6,80,,279.68,percent of total billed charges,80% of total billed charges,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,371.45,85,,297.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
CT CERVICAL SPINE W CONTRAST,352072126,CDM,352,RC,72126,HCPCS,outpatient,,,1976,1383.2,,1561.04,79,,1248.83,percent of total billed charges,79% of total billed charges,1778.4,90,,1422.72,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1244.88,63,,995.9,percent of total billed charges,63% of total billed charges,1525.87,77.22,,1220.7,percent of total billed charges,77.22% of total billed charges,1306.14,66.1,,1044.91,percent of total billed charges,66.1% of total billed charges,1640.08,83,,1312.06,percent of total billed charges,83% of total,1877.2,95,,1501.76,percent of total billed charges ,95% of total billed charges,1580.8,80,,1264.64,percent of total billed charges,78% of total billed charges,1541.28,78,,1233.024,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1244.88,63,,995.9,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1778.4,90,,1422.72,percent of total billed charges,90% of total billed charges,1580.8,80,,1264.64,percent of total billed charges,80% of total billed charges,1244.88,63,,995.9,percent of total billed charges,63% of total billed charges,1679.6,85,,1343.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1561.04,79,,1248.83,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1877.2,
CT THORACIC SPINE W CONTRAST,352072129,CDM,352,RC,72129,HCPCS,outpatient,,,2475,1732.5,,1955.25,79,,1564.2,percent of total billed charges,79% of total billed charges,2227.5,90,,1782,percent of total billed charges,90% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,245.8,160,,,Fee Schedule,160% of CMS OPPS rate,199.71,130,,,Fee Schedule,130% of CMS OPPS rate,1559.25,63,,1247.4,percent of total billed charges,63% of total billed charges,1911.2,77.22,,1528.96,percent of total billed charges,77.22% of total billed charges,1635.98,66.1,,1308.78,percent of total billed charges,66.1% of total billed charges,2054.25,83,,1643.4,percent of total billed charges,83% of total,2351.25,95,,1881,percent of total billed charges ,95% of total billed charges,1980,80,,1584,percent of total billed charges,78% of total billed charges,1930.5,78,,1544.4,percent of total billed charges,78% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,1559.25,63,,1247.4,percent of total billed charges,63% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,2227.5,90,,1782,percent of total billed charges,90% of total billed charges,1980,80,,1584,percent of total billed charges,80% of total billed charges,1559.25,63,,1247.4,percent of total billed charges,63% of total billed charges,2103.75,85,,1683,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,142.87,93,,,fee schedule,93% of CMS OPPS rate,1955.25,79,,1564.2,percent of total billed charges,79% of total billed charges,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,153.63,100,,,Fee Schedule,100% of CMS OPPS rate,142.87,2351.25,
CT GUIDANCE GROIN,352077012,CDM,352,RC,77012,HCPCS,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1271.1,
BS VASCULAR SURGERY PROCEDURE,230037799,CDM,360,RC,37799,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,92.66,77.22,,74.13,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,75.6,840.46,
OR TENODESIS,3600001199,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INS ANT SEG AQUE DRG DEV EA AD,360000376,CDM,360,RC,0376T,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MISC PROCEDURE,360000555,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RIGID PROCTO,360000702,CDM,360,RC,,,outpatient,,,2917,2041.9,,2304.43,79,,1843.54,percent of total billed charges,79% of total billed charges,2625.3,90,,2100.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1837.71,63,,1470.17,percent of total billed charges,63% of total billed charges,2252.51,77.22,,1802.01,percent of total billed charges,77.22% of total billed charges,1928.14,66.1,,1542.51,percent of total billed charges,66.1% of total billed charges,2421.11,83,,1936.89,percent of total billed charges,83% of total,2771.15,95,,2216.92,percent of total billed charges ,95% of total billed charges,2333.6,80,,1866.88,percent of total billed charges,78% of total billed charges,2275.26,78,,1820.208,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1837.71,63,,1470.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2625.3,90,,2100.24,percent of total billed charges,90% of total billed charges,2333.6,80,,1866.88,percent of total billed charges,80% of total billed charges,1837.71,63,,1470.17,percent of total billed charges,63% of total billed charges,2479.45,85,,1983.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2304.43,79,,1843.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2771.15,
OR CYSTOSCOPE,360000703,CDM,360,RC,,,outpatient,,,936,655.2,,739.44,79,,591.55,percent of total billed charges,79% of total billed charges,842.4,90,,673.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,589.68,63,,471.74,percent of total billed charges,63% of total billed charges,722.78,77.22,,578.22,percent of total billed charges,77.22% of total billed charges,618.7,66.1,,494.96,percent of total billed charges,66.1% of total billed charges,776.88,83,,621.5,percent of total billed charges,83% of total,889.2,95,,711.36,percent of total billed charges ,95% of total billed charges,748.8,80,,599.04,percent of total billed charges,78% of total billed charges,730.08,78,,584.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,589.68,63,,471.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,842.4,90,,673.92,percent of total billed charges,90% of total billed charges,748.8,80,,599.04,percent of total billed charges,80% of total billed charges,589.68,63,,471.74,percent of total billed charges,63% of total billed charges,795.6,85,,636.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,739.44,79,,591.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,889.2,
OR ESOPHAGASCOPY,360000704,CDM,360,RC,,,outpatient,,,3759,2631.3,,2969.61,79,,2375.69,percent of total billed charges,79% of total billed charges,3383.1,90,,2706.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2368.17,63,,1894.54,percent of total billed charges,63% of total billed charges,2902.7,77.22,,2322.16,percent of total billed charges,77.22% of total billed charges,2484.7,66.1,,1987.76,percent of total billed charges,66.1% of total billed charges,3119.97,83,,2495.98,percent of total billed charges,83% of total,3571.05,95,,2856.84,percent of total billed charges ,95% of total billed charges,3007.2,80,,2405.76,percent of total billed charges,78% of total billed charges,2932.02,78,,2345.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2368.17,63,,1894.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3383.1,90,,2706.48,percent of total billed charges,90% of total billed charges,3007.2,80,,2405.76,percent of total billed charges,80% of total billed charges,2368.17,63,,1894.54,percent of total billed charges,63% of total billed charges,3195.15,85,,2556.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2969.61,79,,2375.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3571.05,
OR GASTROSCOPY,360000705,CDM,360,RC,,,outpatient,,,3768,2637.6,,2976.72,79,,2381.38,percent of total billed charges,79% of total billed charges,3391.2,90,,2712.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2373.84,63,,1899.07,percent of total billed charges,63% of total billed charges,2909.65,77.22,,2327.72,percent of total billed charges,77.22% of total billed charges,2490.65,66.1,,1992.52,percent of total billed charges,66.1% of total billed charges,3127.44,83,,2501.95,percent of total billed charges,83% of total,3579.6,95,,2863.68,percent of total billed charges ,95% of total billed charges,3014.4,80,,2411.52,percent of total billed charges,78% of total billed charges,2939.04,78,,2351.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2373.84,63,,1899.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3391.2,90,,2712.96,percent of total billed charges,90% of total billed charges,3014.4,80,,2411.52,percent of total billed charges,80% of total billed charges,2373.84,63,,1899.07,percent of total billed charges,63% of total billed charges,3202.8,85,,2562.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2976.72,79,,2381.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3579.6,
OR LAPRASCOPY,360000707,CDM,360,RC,,,outpatient,,,1326,928.2,,1047.54,79,,838.03,percent of total billed charges,79% of total billed charges,1193.4,90,,954.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,835.38,63,,668.3,percent of total billed charges,63% of total billed charges,1023.94,77.22,,819.15,percent of total billed charges,77.22% of total billed charges,876.49,66.1,,701.19,percent of total billed charges,66.1% of total billed charges,1100.58,83,,880.46,percent of total billed charges,83% of total,1259.7,95,,1007.76,percent of total billed charges ,95% of total billed charges,1060.8,80,,848.64,percent of total billed charges,78% of total billed charges,1034.28,78,,827.424,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,835.38,63,,668.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1193.4,90,,954.72,percent of total billed charges,90% of total billed charges,1060.8,80,,848.64,percent of total billed charges,80% of total billed charges,835.38,63,,668.3,percent of total billed charges,63% of total billed charges,1127.1,85,,901.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1047.54,79,,838.03,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1259.7,
OR ARTHROSCOPE,360000710,CDM,360,RC,,,outpatient,,,3370,2359,,2662.3,79,,2129.84,percent of total billed charges,79% of total billed charges,3033,90,,2426.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2123.1,63,,1698.48,percent of total billed charges,63% of total billed charges,2602.31,77.22,,2081.85,percent of total billed charges,77.22% of total billed charges,2227.57,66.1,,1782.06,percent of total billed charges,66.1% of total billed charges,2797.1,83,,2237.68,percent of total billed charges,83% of total,3201.5,95,,2561.2,percent of total billed charges ,95% of total billed charges,2696,80,,2156.8,percent of total billed charges,78% of total billed charges,2628.6,78,,2102.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2123.1,63,,1698.48,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3033,90,,2426.4,percent of total billed charges,90% of total billed charges,2696,80,,2156.8,percent of total billed charges,80% of total billed charges,2123.1,63,,1698.48,percent of total billed charges,63% of total billed charges,2864.5,85,,2291.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2662.3,79,,2129.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3201.5,
OR BRONCHOSCOPY,360000711,CDM,360,RC,,,outpatient,,,1497,1047.9,,1182.63,79,,946.1,percent of total billed charges,79% of total billed charges,1347.3,90,,1077.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,943.11,63,,754.49,percent of total billed charges,63% of total billed charges,1155.98,77.22,,924.78,percent of total billed charges,77.22% of total billed charges,989.52,66.1,,791.62,percent of total billed charges,66.1% of total billed charges,1242.51,83,,994.01,percent of total billed charges,83% of total,1422.15,95,,1137.72,percent of total billed charges ,95% of total billed charges,1197.6,80,,958.08,percent of total billed charges,78% of total billed charges,1167.66,78,,934.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,943.11,63,,754.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1347.3,90,,1077.84,percent of total billed charges,90% of total billed charges,1197.6,80,,958.08,percent of total billed charges,80% of total billed charges,943.11,63,,754.49,percent of total billed charges,63% of total billed charges,1272.45,85,,1017.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1182.63,79,,946.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1422.15,
OR APPENDECTOMY,360000712,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BREAST BIOPSY,360000713,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLON RESECTION,360000714,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLON REVISION,360000715,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DEBRIDEMENT W GRAFT FLAP,360000716,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DEBRIDEMENT,360000717,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF LESION/CYST,360000718,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION GANGLION,360000719,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL FOREIGN BODY,360000720,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BIOPSY NODE,360000721,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXPLORATORY LAPAROTOMY,360000722,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHOLECYSTECTOMY,360000723,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GASTRIC RESECTION,360000724,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HEMORRHOIDECTOMY,360000725,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HERNIA VENTRICAL/ING,360000726,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR I&D,360000727,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LACERATION REPAIR,360000728,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LUMBAR SYMPATHECTOMY,360000729,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MASTECTOMY,360000730,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR THRYOIDECTOMY,360000731,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VEIN STRIPPING,360000732,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LIP STRIPPING,360000733,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VASECTOMY,360000734,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR POLYP REMOVAL,360000735,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXPLORATORY LAP BSO,360000736,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION VAGINAL LESION/REP,360000737,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MARSHALL MARCHETTI KRANTZ,360000738,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GASTROSTOMY TUBE INSERT,360000739,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR T & A,360000740,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SUCTION LIPECTOMY,360000741,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYFRACTION LESION/WART,360000742,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ESOPHAGEAL DIL (MALONEY),360000743,CDM,360,RC,,,outpatient,,,3171,2219.7,,2505.09,79,,2004.07,percent of total billed charges,79% of total billed charges,2853.9,90,,2283.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1997.73,63,,1598.18,percent of total billed charges,63% of total billed charges,2448.65,77.22,,1958.92,percent of total billed charges,77.22% of total billed charges,2096.03,66.1,,1676.82,percent of total billed charges,66.1% of total billed charges,2631.93,83,,2105.54,percent of total billed charges,83% of total,3012.45,95,,2409.96,percent of total billed charges ,95% of total billed charges,2536.8,80,,2029.44,percent of total billed charges,78% of total billed charges,2473.38,78,,1978.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1997.73,63,,1598.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2853.9,90,,2283.12,percent of total billed charges,90% of total billed charges,2536.8,80,,2029.44,percent of total billed charges,80% of total billed charges,1997.73,63,,1598.18,percent of total billed charges,63% of total billed charges,2695.35,85,,2156.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2505.09,79,,2004.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3012.45,
OR D&C CULDOCENTESIS,360000744,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SUPRA PUBIC PROSTATECTOMY,360000745,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LIGAMANT REPAIR,360000746,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VERTICAL BANDED GASTROPLA,360000747,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HIATAL HERNIA REPAIR,360000748,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLOSTOMY,360000749,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BTL,360000750,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTOCELE/RECTOCELE,360000751,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTOCELE,360000752,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RECTOCELE,360000753,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR D&C,360000754,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR D&C SUCTION,360000755,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR D&C CRYO,360000756,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR D&C CON,360000757,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CONIZATION,360000758,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTHROTOMY,360000759,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LYSIS OF ADHESIONS,360000760,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYSTERECTOMY,360000761,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TAH BSO,360000762,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYFRECATION CONDYLOMA,360000763,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR D&C/LAPAROSCOPY,360000764,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MARSUPILIZATION BARTH,360000765,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYSTOSALPINGOGRAM,360000766,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION SPUR,360000767,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TENDON REPAIR,360000769,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHOLOGIOGRAM,360000770,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EMBOLECTOMY,360000771,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BY PASS GRAFT,360000772,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANEURYSM,360000773,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENDARTERACTOMY,360000774,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTO/DIL W CYSTOMETROGRAM,360000775,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR C-SECTION WITH BTL,360000776,CDM,360,RC,,,outpatient,,,18941,13258.7,,14963.39,79,,11970.71,percent of total billed charges,79% of total billed charges,17046.9,90,,13637.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11932.83,63,,9546.26,percent of total billed charges,63% of total billed charges,14626.24,77.22,,11700.99,percent of total billed charges,77.22% of total billed charges,12520,66.1,,10016,percent of total billed charges,66.1% of total billed charges,15721.03,83,,12576.82,percent of total billed charges,83% of total,17993.95,95,,14395.16,percent of total billed charges ,95% of total billed charges,15152.8,80,,12122.24,percent of total billed charges,78% of total billed charges,14773.98,78,,11819.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11932.83,63,,9546.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,17046.9,90,,13637.52,percent of total billed charges,90% of total billed charges,15152.8,80,,12122.24,percent of total billed charges,80% of total billed charges,11932.83,63,,9546.26,percent of total billed charges,63% of total billed charges,16099.85,85,,12879.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14963.39,79,,11970.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,17993.95,
OR VAGINAL DELIVERY,360000777,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAMINECTOMY,360000778,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BONE GRAFT,360000779,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION BURSAE,360000781,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FASCIOTOMY,360000782,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COCCYGECTOMY,360000783,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HIP PROTHESIS,360000784,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HIP COMPRESSION,360000785,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TOTAL KNEE REPLACEMENT,360000786,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TOTAL HIP REPLACEMENT,360000787,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTHROSCOPY,360000788,CDM,360,RC,,,outpatient,,,3160,2212,,2496.4,79,,1997.12,percent of total billed charges,79% of total billed charges,2844,90,,2275.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1990.8,63,,1592.64,percent of total billed charges,63% of total billed charges,2440.15,77.22,,1952.12,percent of total billed charges,77.22% of total billed charges,2088.76,66.1,,1671.01,percent of total billed charges,66.1% of total billed charges,2622.8,83,,2098.24,percent of total billed charges,83% of total,3002,95,,2401.6,percent of total billed charges ,95% of total billed charges,2528,80,,2022.4,percent of total billed charges,78% of total billed charges,2464.8,78,,1971.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1990.8,63,,1592.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2844,90,,2275.2,percent of total billed charges,90% of total billed charges,2528,80,,2022.4,percent of total billed charges,80% of total billed charges,1990.8,63,,1592.64,percent of total billed charges,63% of total billed charges,2686,85,,2148.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2496.4,79,,1997.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3002,
OR ARTHROSCOPY-MENISECTOMY,360000789,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CIRCUMCISION,360000790,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTO/DILITATION,360000791,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTOMETROGRAM,360000792,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PROSTRATE BIOPSY,360000793,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTO/DIL STONE REMOVAL,360000794,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYDROCELECTOMY,360000795,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FISSURECTOMY/FISTULECTOMY,360000796,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OPEN REDUCTION FRACTURE,360000797,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CLOSED REDUCTION FRACTURE,360000798,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR AMPUTATION,360000799,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BUNIONECTOMY,360000800,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OSTEOTOMY,360000801,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BONE FUSION,360000802,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SALPINGO-OOPHERECTOMY UNI,360000803,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CARPAL TUNNEL RELEASE,360000804,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXTRACTION FOREIGN BODY,360000805,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL OF DIALYSIS CATH,360000806,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ORCHIOPEXY,360000807,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXAMINE UNDER ANESTHESIA,360000808,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENDOMETRAIL BIOPSY,360000809,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TRACHEOSTOMY,360000810,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF NODE,360000811,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXPLORATORY THORACOTOMY,360000812,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TUBAL REANASTOMOSIS,360000813,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL OF PLATE & SCREEN,360000814,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR K WIRE REMOVAL,360000815,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INDIRECT LARYNGOSCOPY,360000816,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SKIN GRAFT,360000817,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF LIPOMA,360000818,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXTRACTION OF FETUS (MAN),360000819,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TOTAL SHOULDER PROSTHESIS,360000820,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERTION BILARY CATHETER,360000821,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYSTERECTOMY VAGINAL,360000822,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERTION DIALYSIS CATHETER,360000823,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GASTRIC VAGOTOMY,360000824,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GUNSHOT WOUND,360000826,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MATURE OF COLOSTOMY,360000827,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION SUBMAXILLARY GLAND,360000828,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXP OF DUCT W STONE REMOVAL,360000829,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DETORSION TESTICLE,360000830,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VAGINAL CUFF REPAIR,360000831,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION BARTHOLIN CYST,360000832,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CLOSED REDUCTION W/PINNING,360000833,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OSTOMY REVISION,360000834,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAPARSCOPIC BTL,360000835,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR IUD REMOVAL OF INSERTION,360000836,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SHOULDER REPAIR,360000837,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR KNOWLES PINNING,360000838,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ORCHIDECTOMY,360000839,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BLADDER REPAIR,360000840,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL OF ORTHO HARDWARE,360000841,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GASTRIC REV GASTRIC BYPASS,360000842,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RIGIFLEX DILATATION,360000843,CDM,360,RC,,,outpatient,,,2949,2064.3,,2329.71,79,,1863.77,percent of total billed charges,79% of total billed charges,2654.1,90,,2123.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,2277.22,77.22,,1821.78,percent of total billed charges,77.22% of total billed charges,1949.29,66.1,,1559.43,percent of total billed charges,66.1% of total billed charges,2447.67,83,,1958.14,percent of total billed charges,83% of total,2801.55,95,,2241.24,percent of total billed charges ,95% of total billed charges,2359.2,80,,1887.36,percent of total billed charges,78% of total billed charges,2300.22,78,,1840.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2654.1,90,,2123.28,percent of total billed charges,90% of total billed charges,2359.2,80,,1887.36,percent of total billed charges,80% of total billed charges,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,2506.65,85,,2005.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2329.71,79,,1863.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2801.55,
OR ENDOSCOPIC BIOPSY,360000844,CDM,360,RC,,,outpatient,,,2828,1979.6,,2234.12,79,,1787.3,percent of total billed charges,79% of total billed charges,2545.2,90,,2036.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1781.64,63,,1425.31,percent of total billed charges,63% of total billed charges,2183.78,77.22,,1747.02,percent of total billed charges,77.22% of total billed charges,1869.31,66.1,,1495.45,percent of total billed charges,66.1% of total billed charges,2347.24,83,,1877.79,percent of total billed charges,83% of total,2686.6,95,,2149.28,percent of total billed charges ,95% of total billed charges,2262.4,80,,1809.92,percent of total billed charges,78% of total billed charges,2205.84,78,,1764.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1781.64,63,,1425.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2545.2,90,,2036.16,percent of total billed charges,90% of total billed charges,2262.4,80,,1809.92,percent of total billed charges,80% of total billed charges,1781.64,63,,1425.31,percent of total billed charges,63% of total billed charges,2403.8,85,,1923.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2234.12,79,,1787.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2686.6,
OR ENDOSCOPIC RETRIEVAL,360000845,CDM,360,RC,,,outpatient,,,2828,1979.6,,2234.12,79,,1787.3,percent of total billed charges,79% of total billed charges,2545.2,90,,2036.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1781.64,63,,1425.31,percent of total billed charges,63% of total billed charges,2183.78,77.22,,1747.02,percent of total billed charges,77.22% of total billed charges,1869.31,66.1,,1495.45,percent of total billed charges,66.1% of total billed charges,2347.24,83,,1877.79,percent of total billed charges,83% of total,2686.6,95,,2149.28,percent of total billed charges ,95% of total billed charges,2262.4,80,,1809.92,percent of total billed charges,78% of total billed charges,2205.84,78,,1764.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1781.64,63,,1425.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2545.2,90,,2036.16,percent of total billed charges,90% of total billed charges,2262.4,80,,1809.92,percent of total billed charges,80% of total billed charges,1781.64,63,,1425.31,percent of total billed charges,63% of total billed charges,2403.8,85,,1923.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2234.12,79,,1787.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2686.6,
OR SNARE/ENDOSCOPIC POLYPECTOM,360000846,CDM,360,RC,,,outpatient,,,2884,2018.8,,2278.36,79,,1822.69,percent of total billed charges,79% of total billed charges,2595.6,90,,2076.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1816.92,63,,1453.54,percent of total billed charges,63% of total billed charges,2227.02,77.22,,1781.62,percent of total billed charges,77.22% of total billed charges,1906.32,66.1,,1525.06,percent of total billed charges,66.1% of total billed charges,2393.72,83,,1914.98,percent of total billed charges,83% of total,2739.8,95,,2191.84,percent of total billed charges ,95% of total billed charges,2307.2,80,,1845.76,percent of total billed charges,78% of total billed charges,2249.52,78,,1799.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1816.92,63,,1453.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2595.6,90,,2076.48,percent of total billed charges,90% of total billed charges,2307.2,80,,1845.76,percent of total billed charges,80% of total billed charges,1816.92,63,,1453.54,percent of total billed charges,63% of total billed charges,2451.4,85,,1961.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2278.36,79,,1822.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2739.8,
OR SALPINGECTOMY EXTOP PREG,360000847,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MEATOTOMY,360000848,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REVISION AMPUTATION STUMP,360000849,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION PELVIC CYST/LESION,360000850,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION PILONIDAL CYST,360000851,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LIGATION LYMPHATIC VESSELL,360000852,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RECTAL ABSCESS,360000853,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR THORACENTESIS,360000854,CDM,360,RC,,,outpatient,,,147,102.9,,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,132.3,90,,105.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,113.51,77.22,,90.81,percent of total billed charges,77.22% of total billed charges,97.17,66.1,,77.74,percent of total billed charges,66.1% of total billed charges,122.01,83,,97.61,percent of total billed charges,83% of total,139.65,95,,111.72,percent of total billed charges ,95% of total billed charges,117.6,80,,94.08,percent of total billed charges,78% of total billed charges,114.66,78,,91.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,92.61,63,,74.09,percent of total billed charges,63% of total billed charges,124.95,85,,99.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.13,79,,92.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.61,450,
OR CRICOPHARYNEGEALOTOMY,360000855,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERTION SUBPUBIC CATH,360000856,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CERCLAGE OF SHIRODKAR PRO,360000857,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RELEASE OF TRIGGER FINGER,360000858,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXPLORATION OF STAB WOUND,360000859,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DUPUYTRENS CONTRACTURE,360000860,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RIVISION OF SCAR,360000861,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SMALL BOWELL RESECTION,360000862,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LIVER BIOPSY,360000863,CDM,360,RC,,,outpatient,,,424,296.8,,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,381.6,90,,305.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,327.41,77.22,,261.93,percent of total billed charges,77.22% of total billed charges,280.26,66.1,,224.21,percent of total billed charges,66.1% of total billed charges,351.92,83,,281.54,percent of total billed charges,83% of total,402.8,95,,322.24,percent of total billed charges ,95% of total billed charges,339.2,80,,271.36,percent of total billed charges,78% of total billed charges,330.72,78,,264.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,267.12,450,
OR LOBECTOMY,360000864,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INTRAOPERATIVE CHOLANGRAM,360000865,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR K WIRE INSERTION,360000866,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RECTAL BIOPSY,360000867,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HIP PINNING,360000868,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETHRAL BIOPSY,360000869,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MAN REM OF RETAINED PLACENT,360000870,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EPISOTOMY REPAIR,360000871,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXT FIXATION DEVICE APPLI,360000872,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SPHINCTEROTOMY,360000874,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR WOUND CLOSURE,360000875,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERT VASCULAR ACC CATH,360000876,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERTION PERCUT ENDO GAS,360000877,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OVARIAN WEDGE RESECTION,360000878,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERTION OF LIFEPORT,360000879,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF BONE,360000880,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NAIL BED REPAIR,360000881,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CECUMOSTOMY,360000882,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR UTERINE SUSPENSION,360000883,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SYMPATHECTOMY,360000885,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENTEROCELE REPAIRS,360000886,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INTRAMEDULLARY ROD PLACE,360000887,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MAMMARY IMPLANT,360000888,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR/SUPP CATARACT/IMPLANT LENS,360000889,CDM,360,RC,,,outpatient,,,1549,1084.3,,1223.71,79,,978.97,percent of total billed charges,79% of total billed charges,1394.1,90,,1115.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,975.87,63,,780.7,percent of total billed charges,63% of total billed charges,1196.14,77.22,,956.91,percent of total billed charges,77.22% of total billed charges,1023.89,66.1,,819.11,percent of total billed charges,66.1% of total billed charges,1285.67,83,,1028.54,percent of total billed charges,83% of total,1471.55,95,,1177.24,percent of total billed charges ,95% of total billed charges,1239.2,80,,991.36,percent of total billed charges,78% of total billed charges,1208.22,78,,966.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,975.87,63,,780.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1394.1,90,,1115.28,percent of total billed charges,90% of total billed charges,1239.2,80,,991.36,percent of total billed charges,80% of total billed charges,975.87,63,,780.7,percent of total billed charges,63% of total billed charges,1316.65,85,,1053.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1223.71,79,,978.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1471.55,
OR DRESSING CHANGE,360000890,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF PTERIGIUM,360000891,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VITRECTOMY,360000892,CDM,360,RC,,,outpatient,,,1088,761.6,,859.52,79,,687.62,percent of total billed charges,79% of total billed charges,979.2,90,,783.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,685.44,63,,548.35,percent of total billed charges,63% of total billed charges,840.15,77.22,,672.12,percent of total billed charges,77.22% of total billed charges,719.17,66.1,,575.34,percent of total billed charges,66.1% of total billed charges,903.04,83,,722.43,percent of total billed charges,83% of total,1033.6,95,,826.88,percent of total billed charges ,95% of total billed charges,870.4,80,,696.32,percent of total billed charges,78% of total billed charges,848.64,78,,678.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,685.44,63,,548.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,685.44,63,,548.35,percent of total billed charges,63% of total billed charges,924.8,85,,739.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,859.52,79,,687.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1033.6,
OR INSERTION OF PORT-A-CATH,360000893,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FRENULOTOMY,360000894,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FIBEROPTIC INTUBATION,360000895,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REDUCTION INTRAPPED UTERUS,360000896,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COMMON DUCT EXPLORATION,360000897,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RADIAL NODE DISECTION,360000898,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INTRAMEULLARY RODDING,360000899,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FEMORAL POPLITEAL BY PASS,360000900,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHOLEDOCHOTOMY,360000901,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CAST APPLICATION,360000903,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAPASCOPIC CHOLECYSTECTOMY,360000904,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GUNDERSON FLAP,360000905,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR D&C W POLYP REMOVAL,360000906,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLOSTOMY CLOSURE,360000907,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION CATARACT,360000908,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LENS IMPLANT,360000909,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REDUCTION OF INTUSSCEPTION,360000910,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ASPIRATION OF CYST,360000911,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TREBECULECTOMY,360000912,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR IRIDECTOMY,360000913,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL OF IOL,360000914,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHOLEDUOJEJUNOSTOMY,360000916,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NERVE REPAIR,360000917,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ROTATOR CUFF,360000918,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF LIVER ABCESS,360000919,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENTROPIAN,360000920,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SCROTAL EXPLORATION,360000921,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TESTICAL BIOPSY,360000922,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETHAL DILATATION,360000923,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CERVICAL REPAIR,360000924,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR WOUND EXPLORATION,360000925,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PYLOROMYOTOMY,360000926,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR METATARSAL OSTESTOMY,360000927,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LACRIMAL DUCT INTUBATE,360000928,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPOSTIONING OF LENS,360000929,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RESSESION RESECTION EYE MUS,360000930,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TEMPORAL ARTERY BIOPSY,360000931,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NEPHRECTOMY,360000932,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BI POLAR HIP,360000933,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VARICOCELE,360000934,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REATTACHMENT OF EXTREMITY,360000935,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAPASCOPIC APPENDECTOMY,360000936,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION BREAST MASS,360000937,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ECTROPIAN REPAIR,360000938,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BILATERAL OOPHORECTOMY,360000939,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR UNILATERAL OOPHORECTOMY,360000940,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CORE DPRESSION OF HIP,360000941,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ESOPHAGOGASTRODUODENOSCOPY,360000943,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PELVISCOPY,360000945,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SECOND DEGREE LENS IMPLANT,360000946,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENDOSCOPIC WASHINGS,360000947,CDM,360,RC,,,outpatient,,,2759,1931.3,,2179.61,79,,1743.69,percent of total billed charges,79% of total billed charges,2483.1,90,,1986.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1738.17,63,,1390.54,percent of total billed charges,63% of total billed charges,2130.5,77.22,,1704.4,percent of total billed charges,77.22% of total billed charges,1823.7,66.1,,1458.96,percent of total billed charges,66.1% of total billed charges,2289.97,83,,1831.98,percent of total billed charges,83% of total,2621.05,95,,2096.84,percent of total billed charges ,95% of total billed charges,2207.2,80,,1765.76,percent of total billed charges,78% of total billed charges,2152.02,78,,1721.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1738.17,63,,1390.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2483.1,90,,1986.48,percent of total billed charges,90% of total billed charges,2207.2,80,,1765.76,percent of total billed charges,80% of total billed charges,1738.17,63,,1390.54,percent of total billed charges,63% of total billed charges,2345.15,85,,1876.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2179.61,79,,1743.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2621.05,
OR ENDOSCOPIC BRUSHINGS,360000948,CDM,360,RC,,,outpatient,,,2759,1931.3,,2179.61,79,,1743.69,percent of total billed charges,79% of total billed charges,2483.1,90,,1986.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1738.17,63,,1390.54,percent of total billed charges,63% of total billed charges,2130.5,77.22,,1704.4,percent of total billed charges,77.22% of total billed charges,1823.7,66.1,,1458.96,percent of total billed charges,66.1% of total billed charges,2289.97,83,,1831.98,percent of total billed charges,83% of total,2621.05,95,,2096.84,percent of total billed charges ,95% of total billed charges,2207.2,80,,1765.76,percent of total billed charges,78% of total billed charges,2152.02,78,,1721.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1738.17,63,,1390.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2483.1,90,,1986.48,percent of total billed charges,90% of total billed charges,2207.2,80,,1765.76,percent of total billed charges,80% of total billed charges,1738.17,63,,1390.54,percent of total billed charges,63% of total billed charges,2345.15,85,,1876.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2179.61,79,,1743.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2621.05,
OR SEPARATION OF LAT. AGGULAT.,360000949,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENUCLIETION,360000950,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TACHELECTOMY,360000951,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PATENTOMPHALOMESENTARIA DUC,360000952,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXT RETAINED PLACENTA,360000953,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHONDROPLASTY,360000954,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR UNILATERAL SALPINGOSTOMY,360000955,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BILATERAL SALPINGOSTOMY,360000956,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHOLECYSTOSTOMY,360000957,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXPLOR/EXCISION SINUS TRACT,360000958,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INTERNAL HERNIA REPAIR,360000959,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PYLOROPLASTY,360000960,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TENOTOMY,360000961,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BLEFAROPLASTY,360000962,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHALAZION,360000963,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PROBE LACRIMAL DUCT,360000964,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SEQUESTRECTOMY,360000965,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RECTAL REPAIR,360000966,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL CERVICAL CERCLAGE,360000967,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PACEMAKER INSERTION,360000968,CDM,360,RC,,,outpatient,,,4635,3244.5,,3661.65,79,,2929.32,percent of total billed charges,79% of total billed charges,4171.5,90,,3337.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2920.05,63,,2336.04,percent of total billed charges,63% of total billed charges,3579.15,77.22,,2863.32,percent of total billed charges,77.22% of total billed charges,3063.74,66.1,,2450.99,percent of total billed charges,66.1% of total billed charges,3847.05,83,,3077.64,percent of total billed charges,83% of total,4403.25,95,,3522.6,percent of total billed charges ,95% of total billed charges,3708,80,,2966.4,percent of total billed charges,78% of total billed charges,3615.3,78,,2892.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2920.05,63,,2336.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4171.5,90,,3337.2,percent of total billed charges,90% of total billed charges,3708,80,,2966.4,percent of total billed charges,80% of total billed charges,2920.05,63,,2336.04,percent of total billed charges,63% of total billed charges,3939.75,85,,3151.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3661.65,79,,2929.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4403.25,
OR SURGERY OUT OF OPER ROOM,360000969,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR KERATECTOMY,360000970,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SCREW FIXATION JOINT,360000971,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COAGULATION PELVIC LIGAMENT,360000972,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXTERNALIZATION SIG COLON,360000973,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL EXTERNAL FIXATOR,360000974,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FULL THICKNESS SKIN GRAFT,360000975,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PARTIAL ANAL PLASTY,360000976,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHEST TUBE INSERTION,360000977,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INTEROTOMY,360000978,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR ENTERAL FISTULA,360000979,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TARSAL TUNNEL RELEASE,360000980,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ASPIRATION & ARTHROGRAM HIP,360000981,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DACROCYSTORHINOSTOMY,360000982,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HEMIPHALANGECTOMY,360000983,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NAIL BED EXCISION,360000984,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NAIL BED ABLATION,360000985,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PARACENTESIS ANT CHAMBR EYE,360000986,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF PIP JOINT,360000987,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PEG,360000988,CDM,360,RC,,,outpatient,,,4314,3019.8,,3408.06,79,,2726.45,percent of total billed charges,79% of total billed charges,3882.6,90,,3106.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2717.82,63,,2174.26,percent of total billed charges,63% of total billed charges,3331.27,77.22,,2665.02,percent of total billed charges,77.22% of total billed charges,2851.55,66.1,,2281.24,percent of total billed charges,66.1% of total billed charges,3580.62,83,,2864.5,percent of total billed charges,83% of total,4098.3,95,,3278.64,percent of total billed charges ,95% of total billed charges,3451.2,80,,2760.96,percent of total billed charges,78% of total billed charges,3364.92,78,,2691.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2717.82,63,,2174.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3882.6,90,,3106.08,percent of total billed charges,90% of total billed charges,3451.2,80,,2760.96,percent of total billed charges,80% of total billed charges,2717.82,63,,2174.26,percent of total billed charges,63% of total billed charges,3666.9,85,,2933.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3408.06,79,,2726.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4098.3,
OR ESOPHAGEAL DILITATION (SG),360000989,CDM,360,RC,,,outpatient,,,2949,2064.3,,2329.71,79,,1863.77,percent of total billed charges,79% of total billed charges,2654.1,90,,2123.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,2277.22,77.22,,1821.78,percent of total billed charges,77.22% of total billed charges,1949.29,66.1,,1559.43,percent of total billed charges,66.1% of total billed charges,2447.67,83,,1958.14,percent of total billed charges,83% of total,2801.55,95,,2241.24,percent of total billed charges ,95% of total billed charges,2359.2,80,,1887.36,percent of total billed charges,78% of total billed charges,2300.22,78,,1840.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2654.1,90,,2123.28,percent of total billed charges,90% of total billed charges,2359.2,80,,1887.36,percent of total billed charges,80% of total billed charges,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,2506.65,85,,2005.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2329.71,79,,1863.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2801.55,
OR HOT BIOPSY,360000990,CDM,360,RC,,,outpatient,,,2949,2064.3,,2329.71,79,,1863.77,percent of total billed charges,79% of total billed charges,2654.1,90,,2123.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,2277.22,77.22,,1821.78,percent of total billed charges,77.22% of total billed charges,1949.29,66.1,,1559.43,percent of total billed charges,66.1% of total billed charges,2447.67,83,,1958.14,percent of total billed charges,83% of total,2801.55,95,,2241.24,percent of total billed charges ,95% of total billed charges,2359.2,80,,1887.36,percent of total billed charges,78% of total billed charges,2300.22,78,,1840.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2654.1,90,,2123.28,percent of total billed charges,90% of total billed charges,2359.2,80,,1887.36,percent of total billed charges,80% of total billed charges,1857.87,63,,1486.3,percent of total billed charges,63% of total billed charges,2506.65,85,,2005.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2329.71,79,,1863.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2801.55,
OR VULVA EXCISION,360000991,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FISTULATOMY,360000992,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SCHLEROTHERAPY,360000993,CDM,360,RC,,,outpatient,,,3282,2297.4,,2592.78,79,,2074.22,percent of total billed charges,79% of total billed charges,2953.8,90,,2363.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2067.66,63,,1654.13,percent of total billed charges,63% of total billed charges,2534.36,77.22,,2027.49,percent of total billed charges,77.22% of total billed charges,2169.4,66.1,,1735.52,percent of total billed charges,66.1% of total billed charges,2724.06,83,,2179.25,percent of total billed charges,83% of total,3117.9,95,,2494.32,percent of total billed charges ,95% of total billed charges,2625.6,80,,2100.48,percent of total billed charges,78% of total billed charges,2559.96,78,,2047.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2067.66,63,,1654.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2953.8,90,,2363.04,percent of total billed charges,90% of total billed charges,2625.6,80,,2100.48,percent of total billed charges,80% of total billed charges,2067.66,63,,1654.13,percent of total billed charges,63% of total billed charges,2789.7,85,,2231.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2592.78,79,,2074.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3117.9,
OR PERITONEAL WASHINGS,360000994,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GRAHAM PATCH STOMACH REPAIR,360000995,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BI MEDIAL RECTUS RECESSION,360000996,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LACRIMAL DUCT PROBE,360000997,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PYLORIC DILITATION,360000998,CDM,360,RC,,,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.65,450,
OR REPAIR SCALP AVULSION,360000999,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXTRA SCOPE USE,360001005,CDM,360,RC,,,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
OR PLEURAL BIOPSY,360001006,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR AVULSION OF WOUND,360001007,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LT PARTIAL FIMBRIECTOMY,360001008,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BIOPSY OF MASS,360001009,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SPLEENECTOMY,360001010,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF THYROID NODULE,360001011,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ABD WALL SUBQ EXPLORATION,360001012,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CAPSULOTOMY,360001013,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RETRO GRADE & PYELOGRAM,360001014,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TEETH EXTRACTION,360001015,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BONE MARROW ASPIRATION,360001016,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION PAROTID GLANDS CYS,360001017,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PROCEDURE UNABLE TO COMPLET,360001018,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION SOFT TISSUE TUMOR,360001019,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL ABD FIBROID,360001020,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL CORTEX OF THE EYE,360001021,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MYOMECTOMY,360001022,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NORPLANT REMOVAL,360001023,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYSTEROTOMY,360001024,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TIBIAL NAILING,360001025,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LEEPS,360001026,CDM,360,RC,,,outpatient,,,1770,1239,,1398.3,79,,1118.64,percent of total billed charges,79% of total billed charges,1593,90,,1274.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1115.1,63,,892.08,percent of total billed charges,63% of total billed charges,1366.79,77.22,,1093.43,percent of total billed charges,77.22% of total billed charges,1169.97,66.1,,935.98,percent of total billed charges,66.1% of total billed charges,1469.1,83,,1175.28,percent of total billed charges,83% of total,1681.5,95,,1345.2,percent of total billed charges ,95% of total billed charges,1416,80,,1132.8,percent of total billed charges,78% of total billed charges,1380.6,78,,1104.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1115.1,63,,892.08,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1593,90,,1274.4,percent of total billed charges,90% of total billed charges,1416,80,,1132.8,percent of total billed charges,80% of total billed charges,1115.1,63,,892.08,percent of total billed charges,63% of total billed charges,1504.5,85,,1203.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1398.3,79,,1118.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1681.5,
OR MYRONGOTOMY W/TUBE PLACEMT,360001027,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION BRANCHIAL CLEFT CY,360001028,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL GASTROSTOMY TUBE,360001029,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLOTOMY W/POLYP REMOVAL,360001031,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DORSAL SLIT,360001032,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INGUINAL HERNIA REPAIR,360001033,CDM,360,RC,,,outpatient,,,3207,2244.9,,2533.53,79,,2026.82,percent of total billed charges,79% of total billed charges,2886.3,90,,2309.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2020.41,63,,1616.33,percent of total billed charges,63% of total billed charges,2476.45,77.22,,1981.16,percent of total billed charges,77.22% of total billed charges,2119.83,66.1,,1695.86,percent of total billed charges,66.1% of total billed charges,2661.81,83,,2129.45,percent of total billed charges,83% of total,3046.65,95,,2437.32,percent of total billed charges ,95% of total billed charges,2565.6,80,,2052.48,percent of total billed charges,78% of total billed charges,2501.46,78,,2001.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2020.41,63,,1616.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2886.3,90,,2309.04,percent of total billed charges,90% of total billed charges,2565.6,80,,2052.48,percent of total billed charges,80% of total billed charges,2020.41,63,,1616.33,percent of total billed charges,63% of total billed charges,2725.95,85,,2180.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2533.53,79,,2026.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3046.65,
OR UMBILICAL HERNIA REPAIR,360001034,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VENTRAL HERNIA REPAIR,360001035,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLECYSTECTOMY W/IOC,360001036,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLECYSTECTOMY IOC W/CD EXP,360001037,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LUMBAR PUNCTURE,360001038,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF HEMATOMA,360001052,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR 3RD WEB NEURECTOMY STEIN ST,360001053,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR 2ND METATARSAL CAPSULOTOMY,360001054,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR 2ND METATARSAL HEAD RESECTI,360001055,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INCISIONAL HERNIA REPAIR,360001056,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR WRIST ARTHODESIS,360001057,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SALPINGOTOMY W/ EXT ECT GES,360001058,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RESECTION DISTAL CLAV/MUMFO,360001059,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TENDON RELEASE,360001060,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MYRINGOTOMY TUBE PLACEMENT,360001061,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REVISION COLOSTOMY,360001062,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANAL DILATATION,360001063,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ADENOIDECTOMY,360001064,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR JOINT FUSION,360001065,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HAMMER TOE REPAIR,360001066,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYDRODISTENTION,360001067,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TRANSURETHRAL INCISION PROS,360001068,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BLADDER BIOPSY,360001069,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETHROTHOMY,360001070,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAPRASCOPIC BURCH PROCEDURE,360001071,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SMALL JOINT ARTHROPLASTY,360001072,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETEROSCOPY,360001073,CDM,360,RC,,,outpatient,,,255,178.5,,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,229.5,90,,183.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,196.91,77.22,,157.53,percent of total billed charges,77.22% of total billed charges,168.56,66.1,,134.85,percent of total billed charges,66.1% of total billed charges,211.65,83,,169.32,percent of total billed charges,83% of total,242.25,95,,193.8,percent of total billed charges ,95% of total billed charges,204,80,,163.2,percent of total billed charges,78% of total billed charges,198.9,78,,159.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,160.65,63,,128.52,percent of total billed charges,63% of total billed charges,216.75,85,,173.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,201.45,79,,161.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,160.65,450,
OR PLACEMENT OF URETERAL STENT,360001074,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYPOSPADIAS REPAIR,360001075,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TONSILLECTOMY,360001076,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REDUCTION OF FACIAL FX,360001077,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYPOSPADIAS REPAIR,360001078,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR D&C HYSTEROSCOPY,360001079,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TRANNURETHRAL INC PROSTATE,360001080,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TURP,360001081,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANT CAPSULAR SHIFT REPAIR,360001082,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LABIAL AGGLUTINATION,360001083,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR STENT REMOVAL,360001084,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTO W/COLLAGEN INJECTION,360001085,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MANIPULATION UNDER ANES,360001086,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INT DRAIN PANCRE PSEUDOCYST,360001087,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PUBO VAGINAL FASCIAL SLING,360001088,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PERITONEAL BIOPSY,360001089,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ERCP,360001095,CDM,360,RC,,,outpatient,,,1154,807.8,,911.66,79,,729.33,percent of total billed charges,79% of total billed charges,1038.6,90,,830.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,727.02,63,,581.62,percent of total billed charges,63% of total billed charges,891.12,77.22,,712.9,percent of total billed charges,77.22% of total billed charges,762.79,66.1,,610.23,percent of total billed charges,66.1% of total billed charges,957.82,83,,766.26,percent of total billed charges,83% of total,1096.3,95,,877.04,percent of total billed charges ,95% of total billed charges,923.2,80,,738.56,percent of total billed charges,78% of total billed charges,900.12,78,,720.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,727.02,63,,581.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1038.6,90,,830.88,percent of total billed charges,90% of total billed charges,923.2,80,,738.56,percent of total billed charges,80% of total billed charges,727.02,63,,581.62,percent of total billed charges,63% of total billed charges,980.9,85,,784.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,911.66,79,,729.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1096.3,
OR ULNER NERVE,360001096,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BANDING ESOG VARICES,360001097,CDM,360,RC,,,outpatient,,,672,470.4,,530.88,79,,424.7,percent of total billed charges,79% of total billed charges,604.8,90,,483.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,518.92,77.22,,415.14,percent of total billed charges,77.22% of total billed charges,444.19,66.1,,355.35,percent of total billed charges,66.1% of total billed charges,557.76,83,,446.21,percent of total billed charges,83% of total,638.4,95,,510.72,percent of total billed charges ,95% of total billed charges,537.6,80,,430.08,percent of total billed charges,78% of total billed charges,524.16,78,,419.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,423.36,63,,338.69,percent of total billed charges,63% of total billed charges,571.2,85,,456.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,530.88,79,,424.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,423.36,638.4,
OR CYSTOTOMY CLOSURE,360001098,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF PLANTAR WART,360001099,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR UPPER AND LOWER BLEPH,360001100,CDM,360,RC,,,outpatient,,,2183,1528.1,,1724.57,79,,1379.66,percent of total billed charges,79% of total billed charges,1964.7,90,,1571.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1375.29,63,,1100.23,percent of total billed charges,63% of total billed charges,1685.71,77.22,,1348.57,percent of total billed charges,77.22% of total billed charges,1442.96,66.1,,1154.37,percent of total billed charges,66.1% of total billed charges,1811.89,83,,1449.51,percent of total billed charges,83% of total,2073.85,95,,1659.08,percent of total billed charges ,95% of total billed charges,1746.4,80,,1397.12,percent of total billed charges,78% of total billed charges,1702.74,78,,1362.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1375.29,63,,1100.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1964.7,90,,1571.76,percent of total billed charges,90% of total billed charges,1746.4,80,,1397.12,percent of total billed charges,80% of total billed charges,1375.29,63,,1100.23,percent of total billed charges,63% of total billed charges,1855.55,85,,1484.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1724.57,79,,1379.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2073.85,
OR ARTHRODESIS,360001101,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ACL REPAIR,360001102,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR STEINLER STRIPPING,360001103,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CLSED TREATMNT SHOULDER DIS,360001104,CDM,360,RC,,,outpatient,,,768,537.6,,606.72,79,,485.38,percent of total billed charges,79% of total billed charges,691.2,90,,552.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,483.84,63,,387.07,percent of total billed charges,63% of total billed charges,593.05,77.22,,474.44,percent of total billed charges,77.22% of total billed charges,507.65,66.1,,406.12,percent of total billed charges,66.1% of total billed charges,637.44,83,,509.95,percent of total billed charges,83% of total,729.6,95,,583.68,percent of total billed charges ,95% of total billed charges,614.4,80,,491.52,percent of total billed charges,78% of total billed charges,599.04,78,,479.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,483.84,63,,387.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,483.84,63,,387.07,percent of total billed charges,63% of total billed charges,652.8,85,,522.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,606.72,79,,485.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,729.6,
OR TUBE REMOVAL/EAR,360001105,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ABD PERINEAL RE-SECTION,360001106,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RESECTION OF MANDIBLE,360001107,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NECK DISECTION,360001108,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ORIF FEMUR DALLE MILES CABLE,360001109,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SUB-ACROMIAL DECOMPRESSION,360001110,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CEPTOPOPLASTY,360001111,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SPERMATOCELECTOMY,360001112,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANTIBIOTIC CEMENTING,360001113,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PACEMAKER BATTERY CHANGE,360001114,CDM,360,RC,,,outpatient,,,497,347.9,,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.11,63,,250.49,percent of total billed charges,63% of total billed charges,383.78,77.22,,307.02,percent of total billed charges,77.22% of total billed charges,328.52,66.1,,262.82,percent of total billed charges,66.1% of total billed charges,412.51,83,,330.01,percent of total billed charges,83% of total,472.15,95,,377.72,percent of total billed charges ,95% of total billed charges,397.6,80,,318.08,percent of total billed charges,78% of total billed charges,387.66,78,,310.128,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,313.11,63,,250.49,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,447.3,90,,357.84,percent of total billed charges,90% of total billed charges,397.6,80,,318.08,percent of total billed charges,80% of total billed charges,313.11,63,,250.49,percent of total billed charges,63% of total billed charges,422.45,85,,337.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,392.63,79,,314.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,313.11,472.15,
OR PARTIAL GOSSECTOMY,360001115,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETERAL STONE REMOVAL,360001116,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PUBOVAGINAL SLING,360001117,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXOSTECTOMY,360001118,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SHOULDER ARTHROPLASTY,360001119,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PERINEAL EXPLORATION,360001120,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION FACIAL LESIONS,360001121,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PERCUTANEOUS NEPHROSTOMY,360001122,CDM,360,RC,,,outpatient,,,320,224,,252.8,79,,202.24,percent of total billed charges,79% of total billed charges,288,90,,230.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,247.1,77.22,,197.68,percent of total billed charges,77.22% of total billed charges,211.52,66.1,,169.22,percent of total billed charges,66.1% of total billed charges,265.6,83,,212.48,percent of total billed charges,83% of total,304,95,,243.2,percent of total billed charges ,95% of total billed charges,256,80,,204.8,percent of total billed charges,78% of total billed charges,249.6,78,,199.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,288,90,,230.4,percent of total billed charges,90% of total billed charges,256,80,,204.8,percent of total billed charges,80% of total billed charges,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,272,85,,217.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,252.8,79,,202.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.6,450,
OR EXTRACTED RETAINED PLACENTA,360001124,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TRIGGER FINGER RELEASE,360001125,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MPJ OSTEOPLASTY,360001126,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TOTAL ELBOW REPLACEMENT,360001127,CDM,360,RC,,,outpatient,,,4102,2871.4,,3240.58,79,,2592.46,percent of total billed charges,79% of total billed charges,3691.8,90,,2953.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2584.26,63,,2067.41,percent of total billed charges,63% of total billed charges,3167.56,77.22,,2534.05,percent of total billed charges,77.22% of total billed charges,2711.42,66.1,,2169.14,percent of total billed charges,66.1% of total billed charges,3404.66,83,,2723.73,percent of total billed charges,83% of total,3896.9,95,,3117.52,percent of total billed charges ,95% of total billed charges,3281.6,80,,2625.28,percent of total billed charges,78% of total billed charges,3199.56,78,,2559.648,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2584.26,63,,2067.41,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3691.8,90,,2953.44,percent of total billed charges,90% of total billed charges,3281.6,80,,2625.28,percent of total billed charges,80% of total billed charges,2584.26,63,,2067.41,percent of total billed charges,63% of total billed charges,3486.7,85,,2789.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3240.58,79,,2592.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3896.9,
OR TOTAL FIRST HOUR NC,360001128,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENDOPYLEOTOMY,360001129,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REVISION OF JOINT,360001130,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTOLITHOLAPAXY,360001132,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTOTOMY,360001133,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LT URETHERAL CATHERIZATION,360001134,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INJECTION/JOINTS,360001172,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PLATEAR FASCIECTOMY,360001175,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BREAST LUMPECTOMY,360001176,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LITHOTRIPSY,360001180,CDM,360,RC,,,outpatient,,,13775,9642.5,,10882.25,79,,8705.8,percent of total billed charges,79% of total billed charges,12397.5,90,,9918,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8678.25,63,,6942.6,percent of total billed charges,63% of total billed charges,10637.06,77.22,,8509.65,percent of total billed charges,77.22% of total billed charges,9105.28,66.1,,7284.22,percent of total billed charges,66.1% of total billed charges,11433.25,83,,9146.6,percent of total billed charges,83% of total,13086.25,95,,10469,percent of total billed charges ,95% of total billed charges,11020,80,,8816,percent of total billed charges,78% of total billed charges,10744.5,78,,8595.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,8678.25,63,,6942.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,12397.5,90,,9918,percent of total billed charges,90% of total billed charges,11020,80,,8816,percent of total billed charges,80% of total billed charges,8678.25,63,,6942.6,percent of total billed charges,63% of total billed charges,11708.75,85,,9367,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,10882.25,79,,8705.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,13086.25,
OR REMOVAL/FINGERNAIL/TOENAIL,360001181,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PENILE IMPLANT,360001182,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SCROTUMECTOMY,360001183,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ORGAN PROCURMENT,360001184,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MUSCLE BIOPSY,360001185,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR UPP,360001186,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR OVARIAN CYST,360001187,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOV LT SUBCLAVIN LF PORT,360001188,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INCISION URETERAL STRICTURE,360001189,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TURBT,360001190,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETHERAL SUSPENSION,360001191,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LT DISMEMBERED PYLEOPLASTY,360001192,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RAD PERINEAL PROSTATECTOMY,360001193,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INCISION/BLADR NECK CONTRCT,360001194,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CIRCUMCISION EXPL & REPAIR,360001195,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RETROGRAM URETHROGRAM,360001196,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BILAT SALPINGO-OOPHERECTOMY,360001198,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VALGUS DEFORMITY REPAIR,360001199,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CONDYLECTOMY,360001200,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BICEP TENODESIS,360001201,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MESH REMOVAL,360001202,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
COLONSCOPY W/SUBMUCOSAL INJECT,360001203,CDM,360,RC,,,outpatient,,,726,508.2,,573.54,79,,458.83,percent of total billed charges,79% of total billed charges,653.4,90,,522.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457.38,63,,365.9,percent of total billed charges,63% of total billed charges,560.62,77.22,,448.5,percent of total billed charges,77.22% of total billed charges,479.89,66.1,,383.91,percent of total billed charges,66.1% of total billed charges,602.58,83,,482.06,percent of total billed charges,83% of total,689.7,95,,551.76,percent of total billed charges ,95% of total billed charges,580.8,80,,464.64,percent of total billed charges,78% of total billed charges,566.28,78,,453.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,457.38,63,,365.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,457.38,63,,365.9,percent of total billed charges,63% of total billed charges,617.1,85,,493.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,573.54,79,,458.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,689.7,
OR AMBULATORY EPIDURAL STEROID,360001263,CDM,360,RC,,,outpatient,,,850,595,,671.5,79,,537.2,percent of total billed charges,79% of total billed charges,765,90,,612,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535.5,63,,428.4,percent of total billed charges,63% of total billed charges,656.37,77.22,,525.1,percent of total billed charges,77.22% of total billed charges,561.85,66.1,,449.48,percent of total billed charges,66.1% of total billed charges,705.5,83,,564.4,percent of total billed charges,83% of total,807.5,95,,646,percent of total billed charges ,95% of total billed charges,680,80,,544,percent of total billed charges,78% of total billed charges,663,78,,530.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,535.5,63,,428.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,535.5,63,,428.4,percent of total billed charges,63% of total billed charges,722.5,85,,578,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,671.5,79,,537.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,807.5,
OR REMOVAL LOOSE BODY,360001264,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TENOLYSIS OF TENDON,360001266,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RESECTION ELBOW W/FIXATOR,360001267,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GASTROCNEMIUS RECESSION,360001268,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TYMPANOPLASTY W/CART GRAFT,360001269,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF CALLOUS,360001270,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BIOPSY OF OVARY,360001271,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTECTOMY,360001272,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR POST CAPSULARY RELEASE,360001273,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PERINEALPLASTY,360001274,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TRACH REPLACEMENT,360001275,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LIMBAL RELAXING INCISION,360001276,CDM,360,RC,,,outpatient,,,943,660.1,,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,728.18,77.22,,582.54,percent of total billed charges,77.22% of total billed charges,623.32,66.1,,498.66,percent of total billed charges,66.1% of total billed charges,782.69,83,,626.15,percent of total billed charges,83% of total,895.85,95,,716.68,percent of total billed charges ,95% of total billed charges,754.4,80,,603.52,percent of total billed charges,78% of total billed charges,735.54,78,,588.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,754.4,80,,603.52,percent of total billed charges,80% of total billed charges,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,801.55,85,,641.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,895.85,
OR COLONOSCOPY INJECTION PROC,360001278,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MINOR PROCED 60 MIN NONBILL,360005555,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DEBRIDE BONE 1ST 20 SQCM <,360011044,CDM,360,RC,11044,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3117.37,77.22,,2493.9,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
INTMD RPR S/A/F/EXT 2.6-7.5 CM,360012032,CDM,360,RC,12032,HCPCS,outpatient,,,847,592.9,,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,654.05,77.22,,523.24,percent of total billed charges,77.22% of total billed charges,559.87,66.1,,447.9,percent of total billed charges,66.1% of total billed charges,703.01,83,,562.41,percent of total billed charges,83% of total,804.65,95,,643.72,percent of total billed charges ,95% of total billed charges,677.6,80,,542.08,percent of total billed charges,78% of total billed charges,660.66,78,,528.528,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,677.6,80,,542.08,percent of total billed charges,80% of total billed charges,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,719.95,85,,575.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,804.65,
OR INTMD RPR N-HF/GENIT 2.5CM<,360012041,CDM,360,RC,12041,HCPCS,outpatient,,,847,592.9,,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,654.05,77.22,,523.24,percent of total billed charges,77.22% of total billed charges,559.87,66.1,,447.9,percent of total billed charges,66.1% of total billed charges,703.01,83,,562.41,percent of total billed charges,83% of total,804.65,95,,643.72,percent of total billed charges ,95% of total billed charges,677.6,80,,542.08,percent of total billed charges,78% of total billed charges,660.66,78,,528.528,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,677.6,80,,542.08,percent of total billed charges,80% of total billed charges,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,719.95,85,,575.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,804.65,
ENDOTRACHEAL INTUBATION,360031500,CDM,360,RC,31500,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,314.29,77.22,,251.43,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,450,
OR CLUB FOOT REPAIR,360040000,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR WEDGE CANTHOPLASTY,360040001,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXC SUPRA DIGITS BIL HANDS,360040002,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR OVARIAN LACERATION,360040003,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL RENAL CYST,360040004,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MESENTERIC VESSEL REPAIR,360040005,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTHRO EXTENSOR TENOTOMY,360040006,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DEQUERVAINS RELEASE,360040007,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SUPRASCAPULAR NERVE DECOM,360040008,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RESUTURE LENS,360040009,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXTERNAL SPHICTECTOMY,360040010,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VOIDING URETHAL CYSTOGRAM,360040011,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ILEOSTOMY,360040012,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION SUPRA-DIGIT,360040013,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SUPRAPUBIC CATH PLACEMENT,360040014,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CORRECTION CURVATURE PENIS,360040015,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHEMICAL PLEURODESIS,360040016,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYSTOSCOPE W/FULGURATION,360040017,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SEPTOPLASTY,360040018,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DIRECT LARYNGOSCOPY,360040020,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BONE GRAFT STIMULATOR,360040021,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RE-ANASTOMOSIS URETER,360040023,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PENILE IMPLANT REVISION,360040024,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAP HERNIA REPAIR,360040025,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION ORAL LESION/MASS,360040026,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTHROSCOPIC LAT RELEASE,360040027,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CYST GASTROSTOMY,360040028,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL V C NODULES,360040029,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TRAN INCIN BLADDERNECK CON,360040030,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENDO CERVICAL CURETTAGE,360040031,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETHROLYSIS,360040032,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR URETHROPLASTY,360040033,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PARTIAL PENECTOMY,360040034,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PENECTOMY,360040035,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXTERNAL VERSION,360040036,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INTERNAL VERSION,360040037,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BREAST IMPLANT,360040038,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR KIDNER PROCEDURE,360040039,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR THORACOTOMY PLEURODESIS,360040040,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR HYPOSPADIAS REPAIR,360040041,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXC PERIURETHERAL DIVERTICU,360040042,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF DIGIT,360040043,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PROCEDURE NOT DONE,360040045,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TENDON LENGTHENING,360040046,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SYNOVECTOMY,360040047,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SUTURE REMOVAL,360040048,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DELTOID REPAIR,360040049,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DIP JOINT MALLET REPAIR,360040050,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL BILATERAL TUBES,360040051,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR COLECTOMY,360040052,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VERSION ATTEMPT,360040054,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RECONSTRUCTION OF DIGITS,360040055,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF MASS,360040057,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANTRECTOMY,360040058,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EPIDURAL INJECTION,360040061,CDM,360,RC,,,outpatient,,,2237,1565.9,,1767.23,79,,1413.78,percent of total billed charges,79% of total billed charges,2013.3,90,,1610.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1409.31,63,,1127.45,percent of total billed charges,63% of total billed charges,1727.41,77.22,,1381.93,percent of total billed charges,77.22% of total billed charges,1478.66,66.1,,1182.93,percent of total billed charges,66.1% of total billed charges,1856.71,83,,1485.37,percent of total billed charges,83% of total,2125.15,95,,1700.12,percent of total billed charges ,95% of total billed charges,1789.6,80,,1431.68,percent of total billed charges,78% of total billed charges,1744.86,78,,1395.888,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1409.31,63,,1127.45,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2013.3,90,,1610.64,percent of total billed charges,90% of total billed charges,1789.6,80,,1431.68,percent of total billed charges,80% of total billed charges,1409.31,63,,1127.45,percent of total billed charges,63% of total billed charges,1901.45,85,,1521.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1767.23,79,,1413.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2125.15,
OR TRIGGER POINT INJECTION,360040062,CDM,360,RC,,,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
OR GASTROSTOMY TUBE REMOVAL,360040063,CDM,360,RC,,,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
OR EPICONDYLOTOMY,360040064,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NEURECTOMY,360040065,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTHROPLASTY,360040066,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CERVICAL DILITATION,360040067,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OPPONENPLASYT,360040068,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF SKIN FLAP,360040069,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TIBIAL BIOPSY,360040070,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAP ASSISTED TOT VAG HYSTER,360040071,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PARACENTESIS,360040072,CDM,360,RC,,,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
OR OPEN BRISTOW,360040073,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LATERAL RELEASE,360040074,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR COMMON BILE DUCT,360040075,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DORSAL RELEASE,360040076,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SPIGELIAN HERNIA REPAIR,360040077,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REVISION PORT-A CATHETER,360040078,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PARATHYROIDECTOMY,360040082,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BAND LIGATION,360040083,CDM,360,RC,,,outpatient,,,516,361.2,,407.64,79,,326.11,percent of total billed charges,79% of total billed charges,464.4,90,,371.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,398.46,77.22,,318.77,percent of total billed charges,77.22% of total billed charges,341.08,66.1,,272.86,percent of total billed charges,66.1% of total billed charges,428.28,83,,342.62,percent of total billed charges,83% of total,490.2,95,,392.16,percent of total billed charges ,95% of total billed charges,412.8,80,,330.24,percent of total billed charges,78% of total billed charges,402.48,78,,321.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,464.4,90,,371.52,percent of total billed charges,90% of total billed charges,412.8,80,,330.24,percent of total billed charges,80% of total billed charges,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,438.6,85,,350.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,407.64,79,,326.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,325.08,490.2,
OR CERVICAL BIOPSY,360040084,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REDUC OF DISLOCA HIP PROSTH,360040085,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INJECTION VAGINAL CUFF,360040086,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERT TISSUE EXPANDER,360040089,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTERY BIOPSY,360040090,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FEMORAL RESECTION,360040091,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CENTRAL LINE PLACEMENT,360040092,CDM,360,RC,,,outpatient,,,409,286.3,,323.11,79,,258.49,percent of total billed charges,79% of total billed charges,368.1,90,,294.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.67,63,,206.14,percent of total billed charges,63% of total billed charges,315.83,77.22,,252.66,percent of total billed charges,77.22% of total billed charges,270.35,66.1,,216.28,percent of total billed charges,66.1% of total billed charges,339.47,83,,271.58,percent of total billed charges,83% of total,388.55,95,,310.84,percent of total billed charges ,95% of total billed charges,327.2,80,,261.76,percent of total billed charges,78% of total billed charges,319.02,78,,255.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,257.67,63,,206.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,257.67,63,,206.14,percent of total billed charges,63% of total billed charges,347.65,85,,278.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,323.11,79,,258.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.67,450,
OR PATELLA RECONSTRUCTION,360040093,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NON UNION REVISION,360040094,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SACROSPINOUS LIGAMENT,360040095,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MUSCLE RELEASE,360040096,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RECONSTRUCTIN OF TOE(S),360040098,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CERVOTOMY,360040099,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR METOSTOMY,360040100,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR POSTERIOR LIGAMENT REPAIR,360040101,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GROIN EXPLORATION,360040102,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR UNI KNEE REPLACEMENT,360040103,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BROSTROM PROCEDURE,360040104,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXTENSOR SHORTENING,360040105,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LATERAL RELEASE OF KNEE,360040106,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OSTEOCHON,360040107,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TIBIAL EPIPHYSIODESIS,360040108,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SMALL BOWEL REPAIR,360040110,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VULVAR BIOPSY,360040111,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VAGINOSCOPY,360040112,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REVISION PUBO-VAGINAL SLING,360040113,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR O'DONNELL PROCEDURE,360040115,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OOPHERECTOMY,360040116,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MICROFRACTURE,360040117,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERTION FOLEY CATHETER,360040118,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ECTOPIC PREGNANCY,360040119,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PATELLA SHAVING,360040121,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHEVRONECTOMY,360040122,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NEUROLYSIS,360040123,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VAGOTOMY,360040124,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NECK EXPLORATION,360040125,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ACHILLES TENDON LENGTHENING,360040126,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TIBIAL TENDON TRANSFER,360040127,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BONE BIOPSY,360040128,CDM,360,RC,,,outpatient,,,256,179.2,,202.24,79,,161.79,percent of total billed charges,79% of total billed charges,230.4,90,,184.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.28,63,,129.02,percent of total billed charges,63% of total billed charges,197.68,77.22,,158.14,percent of total billed charges,77.22% of total billed charges,169.22,66.1,,135.38,percent of total billed charges,66.1% of total billed charges,212.48,83,,169.98,percent of total billed charges,83% of total,243.2,95,,194.56,percent of total billed charges ,95% of total billed charges,204.8,80,,163.84,percent of total billed charges,78% of total billed charges,199.68,78,,159.744,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,161.28,63,,129.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,161.28,63,,129.02,percent of total billed charges,63% of total billed charges,217.6,85,,174.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,202.24,79,,161.79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,161.28,450,
OR URTEHERAL CALIBRATION,360040129,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR STRAYER PROCEDURE,360040130,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXPLORATION OF HEMATOMA,360040131,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR TALOR FRACTURE,360040132,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ISTHMUSECTOMY,360040133,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENDOSCOPIC INTRANASAL ETHMO,360040134,CDM,360,RC,,,outpatient,,,1116,781.2,,881.64,79,,705.31,percent of total billed charges,79% of total billed charges,1004.4,90,,803.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,703.08,63,,562.46,percent of total billed charges,63% of total billed charges,861.78,77.22,,689.42,percent of total billed charges,77.22% of total billed charges,737.68,66.1,,590.14,percent of total billed charges,66.1% of total billed charges,926.28,83,,741.02,percent of total billed charges,83% of total,1060.2,95,,848.16,percent of total billed charges ,95% of total billed charges,892.8,80,,714.24,percent of total billed charges,78% of total billed charges,870.48,78,,696.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,703.08,63,,562.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,703.08,63,,562.46,percent of total billed charges,63% of total billed charges,948.6,85,,758.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,881.64,79,,705.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1060.2,
OR ACROMIOPLASTY,360040135,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR IV SEDATION,360040136,CDM,360,RC,,,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
OR AXILLARY DISECTION,360040137,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SHOULDER RESURFACING,360040138,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SURGICAL HEMOSTASIS,360040139,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RESECTION MEDIAL RECTUS EYE,360040140,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR RESECTION LAT RECTUS EYE,360040141,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CENTRALIZATION EXTENSOR TEN,360040142,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OATS,360040143,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MANDIBULAR GLAND RESECTION,360040144,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ABLATION OF ENDOMETRIOSIS,360040145,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LABIA PLASTY,360040146,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NASOLACRIMAL DUCT INTUBATIO,360040147,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR MALLET FINGER,360040148,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ENDOSCOPIC AUTROTOMY,360040150,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CALDWELL LUC PROCEDURE,360040151,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INTEROENTERAL BYPASS,360040152,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR G TUBE REPLACEMENT,360040153,CDM,360,RC,,,outpatient,,,545,381.5,,430.55,79,,344.44,percent of total billed charges,79% of total billed charges,490.5,90,,392.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,343.35,63,,274.68,percent of total billed charges,63% of total billed charges,420.85,77.22,,336.68,percent of total billed charges,77.22% of total billed charges,360.25,66.1,,288.2,percent of total billed charges,66.1% of total billed charges,452.35,83,,361.88,percent of total billed charges,83% of total,517.75,95,,414.2,percent of total billed charges ,95% of total billed charges,436,80,,348.8,percent of total billed charges,78% of total billed charges,425.1,78,,340.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,343.35,63,,274.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,490.5,90,,392.4,percent of total billed charges,90% of total billed charges,436,80,,348.8,percent of total billed charges,80% of total billed charges,343.35,63,,274.68,percent of total billed charges,63% of total billed charges,463.25,85,,370.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,430.55,79,,344.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,343.35,517.75,
OR OPEN GLOBE REPAIR (EYE),360040154,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MENISCAL REPAIR,360040155,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL EPIDIDYMIS,360040156,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NG TUBE PLACEMENT,360040158,CDM,360,RC,,,outpatient,,,329,230.3,,259.91,79,,207.93,percent of total billed charges,79% of total billed charges,296.1,90,,236.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.27,63,,165.82,percent of total billed charges,63% of total billed charges,254.05,77.22,,203.24,percent of total billed charges,77.22% of total billed charges,217.47,66.1,,173.98,percent of total billed charges,66.1% of total billed charges,273.07,83,,218.46,percent of total billed charges,83% of total,312.55,95,,250.04,percent of total billed charges ,95% of total billed charges,263.2,80,,210.56,percent of total billed charges,78% of total billed charges,256.62,78,,205.296,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,207.27,63,,165.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,207.27,63,,165.82,percent of total billed charges,63% of total billed charges,279.65,85,,223.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,259.91,79,,207.93,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,207.27,450,
OR MENISCAL REPAIR,360040159,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPOSITION UVEAL TISSUE,360040160,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PTOSIS REPAIR,360040161,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ABDOMINOPLASTY,360040162,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANOSCOPY,360040163,CDM,360,RC,,,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,136.68,77.22,,109.34,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,450,
OR ASPIRATION OF JOINT,360040164,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SCAPHOIDECTOMY,360040165,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION ENDOMETRIOSIS,360040167,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CAUTERY OF SEPTUM,360040169,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR OATS PROCEDURE,360040170,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR POLYDACTYLY,360040171,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANTERIOR VITRECTOMY,360040172,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MYRINGOPLASTY,360040173,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL PET (EAR TUBES),360040174,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BLEB REVISION,360040175,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL FECAL IMPACTION,360040176,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR AQUEOUS SHUNT REVISION,360040177,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EPIGASTRIC HERNIA REPAIR,360040179,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR WOUND EVISCERATION OF BOWEL,360040182,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL SKIN TAGS,360040183,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INDIRECT OPTHALMOSCOPIC LAS,360040184,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LATERAL RELEASE OF ELBOW,360040185,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INSERTION CECOSTOMY TUBE PL,360040186,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VESSEL CAUTERIZATION,360040187,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR IV START,360040188,CDM,360,RC,,,outpatient,,,306,214.2,,241.74,79,,193.39,percent of total billed charges,79% of total billed charges,275.4,90,,220.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.78,63,,154.22,percent of total billed charges,63% of total billed charges,236.29,77.22,,189.03,percent of total billed charges,77.22% of total billed charges,202.27,66.1,,161.82,percent of total billed charges,66.1% of total billed charges,253.98,83,,203.18,percent of total billed charges,83% of total,290.7,95,,232.56,percent of total billed charges ,95% of total billed charges,244.8,80,,195.84,percent of total billed charges,78% of total billed charges,238.68,78,,190.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,192.78,63,,154.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,192.78,63,,154.22,percent of total billed charges,63% of total billed charges,260.1,85,,208.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,241.74,79,,193.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,192.78,450,
OR UTERINE ENDOMETRIAL ABLATIO,360040189,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR  REM UTERINE VAG FIB TUMOR,360040190,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ALC DEBRIDEMENT,360040191,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SUB URETHRAL SLING,360040192,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR GLOBE LEFT EYE,360040193,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BLADDER INSTILLATION,360040194,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR  PLATELET GEL PROCEDURE,360040195,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CAPSULAT SHIFT,360040196,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LEFORTE PROCEDURE,360040197,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LAP HYSTERECTOMY,360040198,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TUBE SHUNT W/ TUTOPLAST,360040199,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ETHMOIDECTOMY,360040200,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TVUD RESECTION,360040201,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ILEOSCOPY,360040202,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VERSA POINT PROCEDURE,360040203,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ABD SACRO CULPO SUSPENSION,360040204,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PAP SMEAR,360040205,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR INJECTION,360040207,CDM,360,RC,,,outpatient,,,130,91,,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,100.39,77.22,,80.31,percent of total billed charges,77.22% of total billed charges,85.93,66.1,,68.74,percent of total billed charges,66.1% of total billed charges,107.9,83,,86.32,percent of total billed charges,83% of total,123.5,95,,98.8,percent of total billed charges ,95% of total billed charges,104,80,,83.2,percent of total billed charges,78% of total billed charges,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.9,450,
OR BURCH PROCEDURE,360040208,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FIBRIN GLU APPL ANAL FISTUL,360040209,CDM,360,RC,,,outpatient,,,286,200.2,,225.94,79,,180.75,percent of total billed charges,79% of total billed charges,257.4,90,,205.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.18,63,,144.14,percent of total billed charges,63% of total billed charges,220.85,77.22,,176.68,percent of total billed charges,77.22% of total billed charges,189.05,66.1,,151.24,percent of total billed charges,66.1% of total billed charges,237.38,83,,189.9,percent of total billed charges,83% of total,271.7,95,,217.36,percent of total billed charges ,95% of total billed charges,228.8,80,,183.04,percent of total billed charges,78% of total billed charges,223.08,78,,178.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,180.18,63,,144.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,180.18,63,,144.14,percent of total billed charges,63% of total billed charges,243.1,85,,194.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,225.94,79,,180.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,180.18,450,
OR HEMICOLECTOMY,360040210,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EX SUBMANDIBULAR GLAND,360040211,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SYNDACTYLY,360040212,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR GUILLIAN SUSPENSION,360040213,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR MUSCLE,360040214,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DISIMPACTION,360040215,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR IUD PLACEMENT,360040216,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CHROMOTUBATION,360040217,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL OF IMPLANT,360040218,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REVISION OF SHUNT TUBE,360040219,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR BI COMPART KNEE ARTHROPLAST,360040220,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SOFT TISSUE RELEASE (FOOT),360040221,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CALCANECTOMY,360040222,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXC ENDOMETRIOMA,360040223,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DRAINAGE PERITONEAL INCL CY,360040224,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PATELLECTOMY,360040225,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REPAIR MALLET FINGER,360040226,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ABDOMINAL LAVAGE,360040227,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTERY LIGATION,360040230,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION LACRIMAL FISTULA,360040231,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR NEEDLE CORE BREAST BIOPSY,360040232,CDM,360,RC,,,outpatient,,,224,156.8,,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,172.97,77.22,,138.38,percent of total billed charges,77.22% of total billed charges,148.06,66.1,,118.45,percent of total billed charges,66.1% of total billed charges,185.92,83,,148.74,percent of total billed charges,83% of total,212.8,95,,170.24,percent of total billed charges ,95% of total billed charges,179.2,80,,143.36,percent of total billed charges,78% of total billed charges,174.72,78,,139.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,141.12,450,
OR OPTIC MUSCLE REPAIR,360040233,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CLOSED REDUCTION TKR,360040234,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION OF FECALOLITH,360040235,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR PLACEMENT OF 5 SETONS,360040236,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR DRAINAGE OF OVARIAN CYST,360040244,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MITOMYCIN C,360040248,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR EXCISION TVT O,360040249,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR VESTIBULECTOMY,360040250,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR R SHOULDER MANIP UNDER ANES,360040251,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR SA W/INTERNAL FIXATION,360040254,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REMOVAL LESION W/BIOPSY,360040255,CDM,360,RC,,,outpatient,,,970,679,,766.3,79,,613.04,percent of total billed charges,79% of total billed charges,873,90,,698.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,611.1,63,,488.88,percent of total billed charges,63% of total billed charges,749.03,77.22,,599.22,percent of total billed charges,77.22% of total billed charges,641.17,66.1,,512.94,percent of total billed charges,66.1% of total billed charges,805.1,83,,644.08,percent of total billed charges,83% of total,921.5,95,,737.2,percent of total billed charges ,95% of total billed charges,776,80,,620.8,percent of total billed charges,78% of total billed charges,756.6,78,,605.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,611.1,63,,488.88,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,873,90,,698.4,percent of total billed charges,90% of total billed charges,776,80,,620.8,percent of total billed charges,80% of total billed charges,611.1,63,,488.88,percent of total billed charges,63% of total billed charges,824.5,85,,659.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,766.3,79,,613.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,921.5,
OR RECONST AC JOINT R SHOULDER,360040257,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR UTERINE BIOPSY,360040258,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ARTHRO SHLDR W/SURG DEBR/EX,360040259,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR REVISION OF TKR,360040260,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR C-SECTION W/O COMPLICATIONS,360040261,CDM,360,RC,,,outpatient,,,16467,11526.9,,13008.93,79,,10407.14,percent of total billed charges,79% of total billed charges,14820.3,90,,11856.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10374.21,63,,8299.37,percent of total billed charges,63% of total billed charges,12715.82,77.22,,10172.66,percent of total billed charges,77.22% of total billed charges,10884.69,66.1,,8707.75,percent of total billed charges,66.1% of total billed charges,13667.61,83,,10934.09,percent of total billed charges,83% of total,15643.65,95,,12514.92,percent of total billed charges ,95% of total billed charges,13173.6,80,,10538.88,percent of total billed charges,78% of total billed charges,12844.26,78,,10275.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10374.21,63,,8299.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,14820.3,90,,11856.24,percent of total billed charges,90% of total billed charges,13173.6,80,,10538.88,percent of total billed charges,80% of total billed charges,10374.21,63,,8299.37,percent of total billed charges,63% of total billed charges,13996.95,85,,11197.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13008.93,79,,10407.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,15643.65,
OR C-SECTION WITH HEALTH FACTO,360040262,CDM,360,RC,,,outpatient,,,18114,12679.8,,14310.06,79,,11448.05,percent of total billed charges,79% of total billed charges,16302.6,90,,13042.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11411.82,63,,9129.46,percent of total billed charges,63% of total billed charges,13987.63,77.22,,11190.1,percent of total billed charges,77.22% of total billed charges,11973.35,66.1,,9578.68,percent of total billed charges,66.1% of total billed charges,15034.62,83,,12027.7,percent of total billed charges,83% of total,17208.3,95,,13766.64,percent of total billed charges ,95% of total billed charges,14491.2,80,,11592.96,percent of total billed charges,78% of total billed charges,14128.92,78,,11303.136,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11411.82,63,,9129.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,16302.6,90,,13042.08,percent of total billed charges,90% of total billed charges,14491.2,80,,11592.96,percent of total billed charges,80% of total billed charges,11411.82,63,,9129.46,percent of total billed charges,63% of total billed charges,15396.9,85,,12317.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14310.06,79,,11448.05,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,17208.3,
OR BANKHART,360040263,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR TUBAL REANASTAMOSIS,360040265,CDM,360,RC,,,outpatient,,,2875,2012.5,,2271.25,79,,1817,percent of total billed charges,79% of total billed charges,2587.5,90,,2070,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1811.25,63,,1449,percent of total billed charges,63% of total billed charges,2220.08,77.22,,1776.06,percent of total billed charges,77.22% of total billed charges,1900.38,66.1,,1520.3,percent of total billed charges,66.1% of total billed charges,2386.25,83,,1909,percent of total billed charges,83% of total,2731.25,95,,2185,percent of total billed charges ,95% of total billed charges,2300,80,,1840,percent of total billed charges,78% of total billed charges,2242.5,78,,1794,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1811.25,63,,1449,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2587.5,90,,2070,percent of total billed charges,90% of total billed charges,2300,80,,1840,percent of total billed charges,80% of total billed charges,1811.25,63,,1449,percent of total billed charges,63% of total billed charges,2443.75,85,,1955,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2271.25,79,,1817,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2731.25,
OR HYSTERSCOPE,360040266,CDM,360,RC,,,outpatient,,,957,669.9,,756.03,79,,604.82,percent of total billed charges,79% of total billed charges,861.3,90,,689.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,602.91,63,,482.33,percent of total billed charges,63% of total billed charges,739,77.22,,591.2,percent of total billed charges,77.22% of total billed charges,632.58,66.1,,506.06,percent of total billed charges,66.1% of total billed charges,794.31,83,,635.45,percent of total billed charges,83% of total,909.15,95,,727.32,percent of total billed charges ,95% of total billed charges,765.6,80,,612.48,percent of total billed charges,78% of total billed charges,746.46,78,,597.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,602.91,63,,482.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,861.3,90,,689.04,percent of total billed charges,90% of total billed charges,765.6,80,,612.48,percent of total billed charges,80% of total billed charges,602.91,63,,482.33,percent of total billed charges,63% of total billed charges,813.45,85,,650.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,756.03,79,,604.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,909.15,
OR REPAIR DUOD ULCR PREFORATIN,360040268,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR CONJUNCTIVOPLASTY,360040269,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR MUMFORD PROCEDURE,360040270,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ANTERIOR CHAMBER WASHOUT,360040271,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ORBITAL IMPLANT,360040272,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR ADDITIONAL 30 MINS IN OR,360040273,CDM,360,RC,,,outpatient,,,2309,1616.3,,1824.11,79,,1459.29,percent of total billed charges,79% of total billed charges,2078.1,90,,1662.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1454.67,63,,1163.74,percent of total billed charges,63% of total billed charges,1783.01,77.22,,1426.41,percent of total billed charges,77.22% of total billed charges,1526.25,66.1,,1221,percent of total billed charges,66.1% of total billed charges,1916.47,83,,1533.18,percent of total billed charges,83% of total,2193.55,95,,1754.84,percent of total billed charges ,95% of total billed charges,1847.2,80,,1477.76,percent of total billed charges,78% of total billed charges,1801.02,78,,1440.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1454.67,63,,1163.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2078.1,90,,1662.48,percent of total billed charges,90% of total billed charges,1847.2,80,,1477.76,percent of total billed charges,80% of total billed charges,1454.67,63,,1163.74,percent of total billed charges,63% of total billed charges,1962.65,85,,1570.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1824.11,79,,1459.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2193.55,
OR ADDITIONAL PROCEDURE IN OR,360040274,CDM,360,RC,,,outpatient,,,943,660.1,,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,728.18,77.22,,582.54,percent of total billed charges,77.22% of total billed charges,623.32,66.1,,498.66,percent of total billed charges,66.1% of total billed charges,782.69,83,,626.15,percent of total billed charges,83% of total,895.85,95,,716.68,percent of total billed charges ,95% of total billed charges,754.4,80,,603.52,percent of total billed charges,78% of total billed charges,735.54,78,,588.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,754.4,80,,603.52,percent of total billed charges,80% of total billed charges,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,801.55,85,,641.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,895.85,
OR MAJOR PROCEDURE X 60 MIN,360040275,CDM,360,RC,,,outpatient,,,8450,5915,,6675.5,79,,5340.4,percent of total billed charges,79% of total billed charges,7605,90,,6084,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5323.5,63,,4258.8,percent of total billed charges,63% of total billed charges,6525.09,77.22,,5220.07,percent of total billed charges,77.22% of total billed charges,5585.45,66.1,,4468.36,percent of total billed charges,66.1% of total billed charges,7013.5,83,,5610.8,percent of total billed charges,83% of total,8027.5,95,,6422,percent of total billed charges ,95% of total billed charges,6760,80,,5408,percent of total billed charges,78% of total billed charges,6591,78,,5272.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5323.5,63,,4258.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7605,90,,6084,percent of total billed charges,90% of total billed charges,6760,80,,5408,percent of total billed charges,80% of total billed charges,5323.5,63,,4258.8,percent of total billed charges,63% of total billed charges,7182.5,85,,5746,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6675.5,79,,5340.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,8027.5,
OR MINOR PROCEDURE X 60 MIN,360040276,CDM,360,RC,,,outpatient,,,7150,5005,,5648.5,79,,4518.8,percent of total billed charges,79% of total billed charges,6435,90,,5148,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4504.5,63,,3603.6,percent of total billed charges,63% of total billed charges,5521.23,77.22,,4416.98,percent of total billed charges,77.22% of total billed charges,4726.15,66.1,,3780.92,percent of total billed charges,66.1% of total billed charges,5934.5,83,,4747.6,percent of total billed charges,83% of total,6792.5,95,,5434,percent of total billed charges ,95% of total billed charges,5720,80,,4576,percent of total billed charges,78% of total billed charges,5577,78,,4461.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4504.5,63,,3603.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6435,90,,5148,percent of total billed charges,90% of total billed charges,5720,80,,4576,percent of total billed charges,80% of total billed charges,4504.5,63,,3603.6,percent of total billed charges,63% of total billed charges,6077.5,85,,4862,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5648.5,79,,4518.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,6792.5,
OR MAJOR CS >3 PM/WKNDS 60 MIN,360040277,CDM,360,RC,,,outpatient,,,3678,2574.6,,2905.62,79,,2324.5,percent of total billed charges,79% of total billed charges,3310.2,90,,2648.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2317.14,63,,1853.71,percent of total billed charges,63% of total billed charges,2840.15,77.22,,2272.12,percent of total billed charges,77.22% of total billed charges,2431.16,66.1,,1944.93,percent of total billed charges,66.1% of total billed charges,3052.74,83,,2442.19,percent of total billed charges,83% of total,3494.1,95,,2795.28,percent of total billed charges ,95% of total billed charges,2942.4,80,,2353.92,percent of total billed charges,78% of total billed charges,2868.84,78,,2295.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2317.14,63,,1853.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3310.2,90,,2648.16,percent of total billed charges,90% of total billed charges,2942.4,80,,2353.92,percent of total billed charges,80% of total billed charges,2317.14,63,,1853.71,percent of total billed charges,63% of total billed charges,3126.3,85,,2501.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2905.62,79,,2324.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3494.1,
OR MINOR CS >3 PM/WKNDS 60 MIN,360040278,CDM,360,RC,,,outpatient,,,3015,2110.5,,2381.85,79,,1905.48,percent of total billed charges,79% of total billed charges,2713.5,90,,2170.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1899.45,63,,1519.56,percent of total billed charges,63% of total billed charges,2328.18,77.22,,1862.54,percent of total billed charges,77.22% of total billed charges,1992.92,66.1,,1594.34,percent of total billed charges,66.1% of total billed charges,2502.45,83,,2001.96,percent of total billed charges,83% of total,2864.25,95,,2291.4,percent of total billed charges ,95% of total billed charges,2412,80,,1929.6,percent of total billed charges,78% of total billed charges,2351.7,78,,1881.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1899.45,63,,1519.56,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2713.5,90,,2170.8,percent of total billed charges,90% of total billed charges,2412,80,,1929.6,percent of total billed charges,80% of total billed charges,1899.45,63,,1519.56,percent of total billed charges,63% of total billed charges,2562.75,85,,2050.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2381.85,79,,1905.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2864.25,
OR SECONDARY PROCEDURE FEE,360040279,CDM,360,RC,,,outpatient,,,2101,1470.7,,1659.79,79,,1327.83,percent of total billed charges,79% of total billed charges,1890.9,90,,1512.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1323.63,63,,1058.9,percent of total billed charges,63% of total billed charges,1622.39,77.22,,1297.91,percent of total billed charges,77.22% of total billed charges,1388.76,66.1,,1111.01,percent of total billed charges,66.1% of total billed charges,1743.83,83,,1395.06,percent of total billed charges,83% of total,1995.95,95,,1596.76,percent of total billed charges ,95% of total billed charges,1680.8,80,,1344.64,percent of total billed charges,78% of total billed charges,1638.78,78,,1311.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1323.63,63,,1058.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1890.9,90,,1512.72,percent of total billed charges,90% of total billed charges,1680.8,80,,1344.64,percent of total billed charges,80% of total billed charges,1323.63,63,,1058.9,percent of total billed charges,63% of total billed charges,1785.85,85,,1428.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1659.79,79,,1327.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1995.95,
EXCISION MALIG LESON 2.1-3.0CM,360040280,CDM,360,RC,11603,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1040.15,77.22,,832.12,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
ORBITOTOMY WO BONE FLAP WWO BI,360040281,CDM,360,RC,67412,HCPCS,outpatient,,,4254,2977.8,,3360.66,79,,2688.53,percent of total billed charges,79% of total billed charges,3828.6,90,,3062.88,percent of total billed charges,90% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,3126.32,160,,,Fee Schedule,160% of CMS OPPS rate,2540.14,130,,,Fee Schedule,130% of CMS OPPS rate,2680.02,63,,2144.02,percent of total billed charges,63% of total billed charges,3284.94,77.22,,2627.95,percent of total billed charges,77.22% of total billed charges,2811.89,66.1,,2249.51,percent of total billed charges,66.1% of total billed charges,3530.82,83,,2824.66,percent of total billed charges,83% of total,4041.3,95,,3233.04,percent of total billed charges ,95% of total billed charges,3403.2,80,,2722.56,percent of total billed charges,78% of total billed charges,3318.12,78,,2654.496,percent of total billed charges,78% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,2680.02,63,,2144.02,percent of total billed charges,63% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,3828.6,90,,3062.88,percent of total billed charges,90% of total billed charges,3403.2,80,,2722.56,percent of total billed charges,80% of total billed charges,2680.02,63,,2144.02,percent of total billed charges,63% of total billed charges,3615.9,85,,2892.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1817.17,93,,,fee schedule,93% of CMS OPPS rate,3360.66,79,,2688.53,percent of total billed charges,79% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,4041.3,
OR MAJOR PROC W NAV 60 MIN,360040282,CDM,360,RC,,,outpatient,,,7198,5038.6,,5686.42,79,,4549.14,percent of total billed charges,79% of total billed charges,6478.2,90,,5182.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4534.74,63,,3627.79,percent of total billed charges,63% of total billed charges,5558.3,77.22,,4446.64,percent of total billed charges,77.22% of total billed charges,4757.88,66.1,,3806.3,percent of total billed charges,66.1% of total billed charges,5974.34,83,,4779.47,percent of total billed charges,83% of total,6838.1,95,,5470.48,percent of total billed charges ,95% of total billed charges,5758.4,80,,4606.72,percent of total billed charges,78% of total billed charges,5614.44,78,,4491.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4534.74,63,,3627.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6478.2,90,,5182.56,percent of total billed charges,90% of total billed charges,5758.4,80,,4606.72,percent of total billed charges,80% of total billed charges,4534.74,63,,3627.79,percent of total billed charges,63% of total billed charges,6118.3,85,,4894.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5686.42,79,,4549.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,6838.1,
OR INSERTION OF IUD,360058300,CDM,360,RC,58300,HCPCS,outpatient,,,740,518,,584.6,79,,467.68,percent of total billed charges,79% of total billed charges,666,90,,532.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,466.2,63,,372.96,percent of total billed charges,63% of total billed charges,571.43,77.22,,457.14,percent of total billed charges,77.22% of total billed charges,489.14,66.1,,391.31,percent of total billed charges,66.1% of total billed charges,614.2,83,,491.36,percent of total billed charges,83% of total,703,95,,562.4,percent of total billed charges ,95% of total billed charges,592,80,,473.6,percent of total billed charges,78% of total billed charges,577.2,78,,461.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,466.2,63,,372.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,466.2,63,,372.96,percent of total billed charges,63% of total billed charges,629,85,,503.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,584.6,79,,467.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,703,
HYSTEROSCOPY REMOV LEIOMYOMATA,360058561,CDM,360,RC,58561,HCPCS,outpatient,,,10315,7220.5,,8148.85,79,,6519.08,percent of total billed charges,79% of total billed charges,9283.5,90,,7426.8,percent of total billed charges,90% of total billed charges,4159.03,100,,,Fee Schedule,100% of CMS OPPS rate,6654.45,160,,,Fee Schedule,160% of CMS OPPS rate,5406.74,130,,,Fee Schedule,130% of CMS OPPS rate,6498.45,63,,5198.76,percent of total billed charges,63% of total billed charges,7965.24,77.22,,6372.19,percent of total billed charges,77.22% of total billed charges,6818.22,66.1,,5454.58,percent of total billed charges,66.1% of total billed charges,8561.45,83,,6849.16,percent of total billed charges,83% of total,9799.25,95,,7839.4,percent of total billed charges ,95% of total billed charges,8252,80,,6601.6,percent of total billed charges,78% of total billed charges,8045.7,78,,6436.56,percent of total billed charges,78% of total billed charges,4159.03,100,,,Fee Schedule,100% of CMS OPPS rate,6498.45,63,,5198.76,percent of total billed charges,63% of total billed charges,4159.03,100,,,Fee Schedule,100% of CMS OPPS rate,9283.5,90,,7426.8,percent of total billed charges,90% of total billed charges,8252,80,,6601.6,percent of total billed charges,80% of total billed charges,6498.45,63,,5198.76,percent of total billed charges,63% of total billed charges,8767.75,85,,7014.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3867.9,93,,,fee schedule,93% of CMS OPPS rate,8148.85,79,,6519.08,percent of total billed charges,79% of total billed charges,4159.03,100,,,Fee Schedule,100% of CMS OPPS rate,4159.03,100,,,Fee Schedule,100% of CMS OPPS rate,450,9799.25,
OR NJX AA&/STRD AX NERVE IMG,360064417,CDM,360,RC,64417,HCPCS,outpatient,,,2556,1789.2,,2019.24,79,,1615.39,percent of total billed charges,79% of total billed charges,2300.4,90,,1840.32,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,1973.74,77.22,,1578.99,percent of total billed charges,77.22% of total billed charges,1689.52,66.1,,1351.62,percent of total billed charges,66.1% of total billed charges,2121.48,83,,1697.18,percent of total billed charges,83% of total,2428.2,95,,1942.56,percent of total billed charges ,95% of total billed charges,2044.8,80,,1635.84,percent of total billed charges,78% of total billed charges,1993.68,78,,1594.944,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,2300.4,90,,1840.32,percent of total billed charges,90% of total billed charges,2044.8,80,,1635.84,percent of total billed charges,80% of total billed charges,1610.28,63,,1288.22,percent of total billed charges,63% of total billed charges,2172.6,85,,1738.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,2019.24,79,,1615.39,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,2428.2,
XCAPSL CATAR REM W INS INTR LS,360066991,CDM,360,RC,66991,HCPCS,outpatient,,,11245,7871.5,,8883.55,79,,7106.84,percent of total billed charges,79% of total billed charges,10120.5,90,,8096.4,percent of total billed charges,90% of total billed charges,4370.27,100,,,Fee Schedule,100% of CMS OPPS rate,6992.43,160,,,Fee Schedule,160% of CMS OPPS rate,5681.35,130,,,Fee Schedule,130% of CMS OPPS rate,7084.35,63,,5667.48,percent of total billed charges,63% of total billed charges,8683.39,77.22,,6946.71,percent of total billed charges,77.22% of total billed charges,7432.95,66.1,,5946.36,percent of total billed charges,66.1% of total billed charges,9333.35,83,,7466.68,percent of total billed charges,83% of total,10682.75,95,,8546.2,percent of total billed charges ,95% of total billed charges,8996,80,,7196.8,percent of total billed charges,78% of total billed charges,8771.1,78,,7016.88,percent of total billed charges,78% of total billed charges,4370.27,100,,,Fee Schedule,100% of CMS OPPS rate,7084.35,63,,5667.48,percent of total billed charges,63% of total billed charges,4370.27,100,,,Fee Schedule,100% of CMS OPPS rate,10120.5,90,,8096.4,percent of total billed charges,90% of total billed charges,8996,80,,7196.8,percent of total billed charges,80% of total billed charges,7084.35,63,,5667.48,percent of total billed charges,63% of total billed charges,9558.25,85,,7646.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4064.35,93,,,fee schedule,93% of CMS OPPS rate,8883.55,79,,7106.84,percent of total billed charges,79% of total billed charges,4370.27,100,,,Fee Schedule,100% of CMS OPPS rate,4370.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,10682.75,
OR CLSD TX ULNAR SHFT FX W/MAN,360090836,CDM,360,RC,,,outpatient,,,1763,1234.1,,1392.77,79,,1114.22,percent of total billed charges,79% of total billed charges,1586.7,90,,1269.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1110.69,63,,888.55,percent of total billed charges,63% of total billed charges,1361.39,77.22,,1089.11,percent of total billed charges,77.22% of total billed charges,1165.34,66.1,,932.27,percent of total billed charges,66.1% of total billed charges,1463.29,83,,1170.63,percent of total billed charges,83% of total,1674.85,95,,1339.88,percent of total billed charges ,95% of total billed charges,1410.4,80,,1128.32,percent of total billed charges,78% of total billed charges,1375.14,78,,1100.112,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1110.69,63,,888.55,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1110.69,63,,888.55,percent of total billed charges,63% of total billed charges,1498.55,85,,1198.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1392.77,79,,1114.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1674.85,
OR NEG PRES WND THER <50 CM,360097605,CDM,360,RC,97605,HCPCS,outpatient,,,715,500.5,,564.85,79,,451.88,percent of total billed charges,79% of total billed charges,643.5,90,,514.8,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,552.12,77.22,,441.7,percent of total billed charges,77.22% of total billed charges,472.62,66.1,,378.1,percent of total billed charges,66.1% of total billed charges,593.45,83,,474.76,percent of total billed charges,83% of total,679.25,95,,543.4,percent of total billed charges ,95% of total billed charges,572,80,,457.6,percent of total billed charges,78% of total billed charges,557.7,78,,446.16,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,643.5,90,,514.8,percent of total billed charges,90% of total billed charges,572,80,,457.6,percent of total billed charges,80% of total billed charges,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,607.75,85,,486.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,564.85,79,,451.88,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,679.25,
OR NEG PRES WND THER >50 CM,360097606,CDM,360,RC,97606,HCPCS,outpatient,,,1059,741.3,,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,817.76,77.22,,654.21,percent of total billed charges,77.22% of total billed charges,700,66.1,,560,percent of total billed charges,66.1% of total billed charges,878.97,83,,703.18,percent of total billed charges,83% of total,1006.05,95,,804.84,percent of total billed charges ,95% of total billed charges,847.2,80,,677.76,percent of total billed charges,78% of total billed charges,826.02,78,,660.816,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,1006.05,
OR ARTHROSCOPY OF KNEE/REM FB,3600G0289,CDM,360,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INSERTION OF CHEST TUBE,450032020,CDM,360,RC,32551,HCPCS,outpatient,,,3262,2283.4,,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,2518.92,77.22,,2015.14,percent of total billed charges,77.22% of total billed charges,2156.18,66.1,,1724.94,percent of total billed charges,66.1% of total billed charges,2707.46,83,,2165.97,percent of total billed charges,83% of total,3098.9,95,,2479.12,percent of total billed charges ,95% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,78% of total billed charges,2544.36,78,,2035.488,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,80% of total billed charges,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,2772.7,85,,2218.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3098.9,
OPEN CHEST HEART MASSAGE,450032160,CDM,360,RC,32160,HCPCS,outpatient,,,1131,791.7,,893.49,79,,714.79,percent of total billed charges,79% of total billed charges,1017.9,90,,814.32,percent of total billed charges,90% of total billed charges,1131,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1131,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1131,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,712.53,63,,570.02,percent of total billed charges,63% of total billed charges,873.36,77.22,,698.69,percent of total billed charges,77.22% of total billed charges,747.59,66.1,,598.07,percent of total billed charges,66.1% of total billed charges,938.73,83,,750.98,percent of total billed charges,83% of total,1074.45,95,,859.56,percent of total billed charges ,95% of total billed charges,904.8,80,,723.84,percent of total billed charges,78% of total billed charges,882.18,78,,705.744,percent of total billed charges,78% of total billed charges,1131,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,712.53,63,,570.02,percent of total billed charges,63% of total billed charges,1131,100,,,fee schedule ,100% of CMS fee schedule,1017.9,90,,814.32,percent of total billed charges,90% of total billed charges,904.8,80,,723.84,percent of total billed charges,80% of total billed charges,712.53,63,,570.02,percent of total billed charges,63% of total billed charges,961.35,85,,769.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1131,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,893.49,79,,714.79,percent of total billed charges,79% of total billed charges,1131,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1131,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,450,1131,
REPAIR OF HEART WOUND WO BYPAS,450033300,CDM,360,RC,33300,HCPCS,outpatient,,,3165,2215.5,,2500.35,79,,2000.28,percent of total billed charges,79% of total billed charges,2848.5,90,,2278.8,percent of total billed charges,90% of total billed charges,3165,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,3165,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,3165,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1993.95,63,,1595.16,percent of total billed charges,63% of total billed charges,2444.01,77.22,,1955.21,percent of total billed charges,77.22% of total billed charges,2092.07,66.1,,1673.66,percent of total billed charges,66.1% of total billed charges,2626.95,83,,2101.56,percent of total billed charges,83% of total,3006.75,95,,2405.4,percent of total billed charges ,95% of total billed charges,2532,80,,2025.6,percent of total billed charges,78% of total billed charges,2468.7,78,,1974.96,percent of total billed charges,78% of total billed charges,3165,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1993.95,63,,1595.16,percent of total billed charges,63% of total billed charges,3165,100,,,fee schedule ,100% of CMS fee schedule,2848.5,90,,2278.8,percent of total billed charges,90% of total billed charges,2532,80,,2025.6,percent of total billed charges,80% of total billed charges,1993.95,63,,1595.16,percent of total billed charges,63% of total billed charges,2690.25,85,,2152.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3165,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,2500.35,79,,2000.28,percent of total billed charges,79% of total billed charges,3165,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,3165,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,450,3165,
VAGINAL DELIVERY ONLY,450059409,CDM,360,RC,59409,HCPCS,outpatient,,,2888,2021.6,,2281.52,79,,1825.22,percent of total billed charges,79% of total billed charges,2599.2,90,,2079.36,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,1819.44,63,,1455.55,percent of total billed charges,63% of total billed charges,2230.11,77.22,,1784.09,percent of total billed charges,77.22% of total billed charges,1908.97,66.1,,1527.18,percent of total billed charges,66.1% of total billed charges,2397.04,83,,1917.63,percent of total billed charges,83% of total,2743.6,95,,2194.88,percent of total billed charges ,95% of total billed charges,2310.4,80,,1848.32,percent of total billed charges,78% of total billed charges,2252.64,78,,1802.112,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,1819.44,63,,1455.55,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2599.2,90,,2079.36,percent of total billed charges,90% of total billed charges,2310.4,80,,1848.32,percent of total billed charges,80% of total billed charges,1819.44,63,,1455.55,percent of total billed charges,63% of total billed charges,2454.8,85,,1963.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,2281.52,79,,1825.22,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,4182.66,
CERCLAGE SUTURING,761059900,CDM,360,RC,59320,HCPCS,outpatient,,,3907,2734.9,,3086.53,79,,2469.22,percent of total billed charges,79% of total billed charges,3516.3,90,,2813.04,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,2461.41,63,,1969.13,percent of total billed charges,63% of total billed charges,3016.99,77.22,,2413.59,percent of total billed charges,77.22% of total billed charges,2582.53,66.1,,2066.02,percent of total billed charges,66.1% of total billed charges,3242.81,83,,2594.25,percent of total billed charges,83% of total,3711.65,95,,2969.32,percent of total billed charges ,95% of total billed charges,3125.6,80,,2500.48,percent of total billed charges,78% of total billed charges,3047.46,78,,2437.968,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2461.41,63,,1969.13,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,3516.3,90,,2813.04,percent of total billed charges,90% of total billed charges,3125.6,80,,2500.48,percent of total billed charges,80% of total billed charges,2461.41,63,,1969.13,percent of total billed charges,63% of total billed charges,3320.95,85,,2656.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,3086.53,79,,2469.22,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,4182.66,
CIRCUMCISION <28 DAYS,171100005,CDM,361,RC,54160,HCPCS,outpatient,,,865,605.5,,683.35,79,,546.68,percent of total billed charges,79% of total billed charges,778.5,90,,622.8,percent of total billed charges,90% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,913.9,160,,,Fee Schedule,160% of CMS OPPS rate,742.54,130,,,Fee Schedule,130% of CMS OPPS rate,544.95,63,,435.96,percent of total billed charges,63% of total billed charges,667.95,77.22,,534.36,percent of total billed charges,77.22% of total billed charges,571.77,66.1,,457.42,percent of total billed charges,66.1% of total billed charges,717.95,83,,574.36,percent of total billed charges,83% of total,821.75,95,,657.4,percent of total billed charges ,95% of total billed charges,692,80,,553.6,percent of total billed charges,78% of total billed charges,674.7,78,,539.76,percent of total billed charges,78% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,544.95,63,,435.96,percent of total billed charges,63% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,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,544.95,63,,435.96,percent of total billed charges,63% of total billed charges,735.25,85,,588.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,531.2,93,,,fee schedule,93% of CMS OPPS rate,683.35,79,,546.68,percent of total billed charges,79% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,450,913.9,
EXC SKIN FACE 1.1-2.0 CM BEDSI,230011442,CDM,361,RC,11442,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1040.15,77.22,,832.12,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
SECOND CLOS SURG WND EXTN/COMP,230013160,CDM,361,RC,13160,HCPCS,outpatient,,,7223,5056.1,,5706.17,79,,4564.94,percent of total billed charges,79% of total billed charges,6500.7,90,,5200.56,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,4550.49,63,,3640.39,percent of total billed charges,63% of total billed charges,5577.6,77.22,,4462.08,percent of total billed charges,77.22% of total billed charges,4774.4,66.1,,3819.52,percent of total billed charges,66.1% of total billed charges,5995.09,83,,4796.07,percent of total billed charges,83% of total,6861.85,95,,5489.48,percent of total billed charges ,95% of total billed charges,5778.4,80,,4622.72,percent of total billed charges,78% of total billed charges,5633.94,78,,4507.152,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,4550.49,63,,3640.39,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,6500.7,90,,5200.56,percent of total billed charges,90% of total billed charges,5778.4,80,,4622.72,percent of total billed charges,80% of total billed charges,4550.49,63,,3640.39,percent of total billed charges,63% of total billed charges,6139.55,85,,4911.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,5706.17,79,,4564.94,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,6861.85,
ENDOTRACHEAL INTUBATION BEDSID,230031500,CDM,361,RC,31500,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,314.29,77.22,,251.43,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,450,
CENTRAL LINE PLACEMENT >5YRS,230036556,CDM,361,RC,36556,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2250.96,77.22,,1800.77,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
INJECT MEDICATION DIAG / TREAT,320001701,CDM,361,RC,61055,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS 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,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,450,
CERVICAL DILITATION,320001763,CDM,361,RC,57800,HCPCS,outpatient,,,2195,1536.5,,1734.05,79,,1387.24,percent of total billed charges,79% of total billed charges,1975.5,90,,1580.4,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,1382.85,63,,1106.28,percent of total billed charges,63% of total billed charges,1694.98,77.22,,1355.98,percent of total billed charges,77.22% of total billed charges,1450.9,66.1,,1160.72,percent of total billed charges,66.1% of total billed charges,1821.85,83,,1457.48,percent of total billed charges,83% of total,2085.25,95,,1668.2,percent of total billed charges ,95% of total billed charges,1756,80,,1404.8,percent of total billed charges,78% of total billed charges,1712.1,78,,1369.68,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,1382.85,63,,1106.28,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,1975.5,90,,1580.4,percent of total billed charges,90% of total billed charges,1756,80,,1404.8,percent of total billed charges,80% of total billed charges,1382.85,63,,1106.28,percent of total billed charges,63% of total billed charges,1865.75,85,,1492.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,1734.05,79,,1387.24,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,4182.66,
CT BIOPSY BONE,351001768,CDM,361,RC,20220,HCPCS,outpatient,,,3183,2228.1,,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2457.91,77.22,,1966.33,percent of total billed charges,77.22% of total billed charges,2103.96,66.1,,1683.17,percent of total billed charges,66.1% of total billed charges,2641.89,83,,2113.51,percent of total billed charges,83% of total,3023.85,95,,2419.08,percent of total billed charges ,95% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,78% of total billed charges,2482.74,78,,1986.192,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,80% of total billed charges,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2705.55,85,,2164.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3023.85,
OR SUCTION LIPECTOMY ABDOMEN,360000709,CDM,361,RC,,,outpatient,,,2501,1750.7,,1975.79,79,,1580.63,percent of total billed charges,79% of total billed charges,2250.9,90,,1800.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1575.63,63,,1260.5,percent of total billed charges,63% of total billed charges,1931.27,77.22,,1545.02,percent of total billed charges,77.22% of total billed charges,1653.16,66.1,,1322.53,percent of total billed charges,66.1% of total billed charges,2075.83,83,,1660.66,percent of total billed charges,83% of total,2375.95,95,,1900.76,percent of total billed charges ,95% of total billed charges,2000.8,80,,1600.64,percent of total billed charges,78% of total billed charges,1950.78,78,,1560.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1575.63,63,,1260.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2250.9,90,,1800.72,percent of total billed charges,90% of total billed charges,2000.8,80,,1600.64,percent of total billed charges,80% of total billed charges,1575.63,63,,1260.5,percent of total billed charges,63% of total billed charges,2125.85,85,,1700.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1975.79,79,,1580.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2375.95,
OR EXCISION INGROWN TOENAIL,360000768,CDM,361,RC,,,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,875.9,
EXCIS MALIG LESION 1.1 TO 2CM,360011642,CDM,361,RC,11642,HCPCS,outpatient,,,896,627.2,,707.84,79,,566.27,percent of total billed charges,79% of total billed charges,806.4,90,,645.12,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,691.89,77.22,,553.51,percent of total billed charges,77.22% of total billed charges,592.26,66.1,,473.81,percent of total billed charges,66.1% of total billed charges,743.68,83,,594.94,percent of total billed charges,83% of total,851.2,95,,680.96,percent of total billed charges ,95% of total billed charges,716.8,80,,573.44,percent of total billed charges,78% of total billed charges,698.88,78,,559.104,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,806.4,90,,645.12,percent of total billed charges,90% of total billed charges,716.8,80,,573.44,percent of total billed charges,80% of total billed charges,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,761.6,85,,609.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,707.84,79,,566.27,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,941.28,
OB EPIDURAL INJECTION,360040059,CDM,361,RC,,,outpatient,,,1950,1365,,1540.5,79,,1232.4,percent of total billed charges,79% of total billed charges,1755,90,,1404,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,1505.79,77.22,,1204.63,percent of total billed charges,77.22% of total billed charges,1288.95,66.1,,1031.16,percent of total billed charges,66.1% of total billed charges,1618.5,83,,1294.8,percent of total billed charges,83% of total,1852.5,95,,1482,percent of total billed charges ,95% of total billed charges,1560,80,,1248,percent of total billed charges,78% of total billed charges,1521,78,,1216.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1755,90,,1404,percent of total billed charges,90% of total billed charges,1560,80,,1248,percent of total billed charges,80% of total billed charges,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,1657.5,85,,1326,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1540.5,79,,1232.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1852.5,
TANGNTL BX SKIN SINGLE LESION,361011102,CDM,361,RC,11102,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
TANGENTIAL BX SKIN EA SEP/ADDL,361011103,CDM,361,RC,11103,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
PUNCH BX SKIN SINGLE LESION,361011104,CDM,361,RC,11104,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,533.46,
PUNCH BX SKIN EA SEP/ADDL,361011105,CDM,361,RC,11105,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
INCISIONAL BX SKIN SGL LESION,361011106,CDM,361,RC,11106,HCPCS,outpatient,,,310,217,,244.9,79,,195.92,percent of total billed charges,79% of total billed charges,279,90,,223.2,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,239.38,77.22,,191.5,percent of total billed charges,77.22% of total billed charges,204.91,66.1,,163.93,percent of total billed charges,66.1% of total billed charges,257.3,83,,205.84,percent of total billed charges,83% of total,294.5,95,,235.6,percent of total billed charges ,95% of total billed charges,248,80,,198.4,percent of total billed charges,78% of total billed charges,241.8,78,,193.44,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,279,90,,223.2,percent of total billed charges,90% of total billed charges,248,80,,198.4,percent of total billed charges,80% of total billed charges,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,263.5,85,,210.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,244.9,79,,195.92,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,195.3,840.25,
INCISIONAL BX SKIN EA SEP/ADDL,361011107,CDM,361,RC,11107,HCPCS,outpatient,,,461,322.7,,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,414.9,90,,331.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,355.98,77.22,,284.78,percent of total billed charges,77.22% of total billed charges,304.72,66.1,,243.78,percent of total billed charges,66.1% of total billed charges,382.63,83,,306.1,percent of total billed charges,83% of total,437.95,95,,350.36,percent of total billed charges ,95% of total billed charges,368.8,80,,295.04,percent of total billed charges,78% of total billed charges,359.58,78,,287.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,391.85,85,,313.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,290.43,450,
INSJ PICC RS&I 5 YR+,361036573,CDM,361,RC,36573,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2250.96,77.22,,1800.77,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,2769.25,
OPEN BX/EXC INGUINOFEM NODES,361038531,CDM,361,RC,38531,HCPCS,outpatient,,,7573,5301.1,,5982.67,79,,4786.14,percent of total billed charges,79% of total billed charges,6815.7,90,,5452.56,percent of total billed charges,90% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,5099.6,160,,,Fee Schedule,160% of CMS OPPS rate,4143.43,130,,,Fee Schedule,130% of CMS OPPS rate,4770.99,63,,3816.79,percent of total billed charges,63% of total billed charges,5847.87,77.22,,4678.3,percent of total billed charges,77.22% of total billed charges,5005.75,66.1,,4004.6,percent of total billed charges,66.1% of total billed charges,6285.59,83,,5028.47,percent of total billed charges,83% of total,7194.35,95,,5755.48,percent of total billed charges ,95% of total billed charges,6058.4,80,,4846.72,percent of total billed charges,78% of total billed charges,5906.94,78,,4725.552,percent of total billed charges,78% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,4770.99,63,,3816.79,percent of total billed charges,63% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,6815.7,90,,5452.56,percent of total billed charges,90% of total billed charges,6058.4,80,,4846.72,percent of total billed charges,80% of total billed charges,4770.99,63,,3816.79,percent of total billed charges,63% of total billed charges,6437.05,85,,5149.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2964.14,93,,,fee schedule,93% of CMS OPPS rate,5982.67,79,,4786.14,percent of total billed charges,79% of total billed charges,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,3187.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,7194.35,
RPLC GASTRO TUBE NO REVJ TRC,361043762,CDM,361,RC,43762,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,447.1,77.22,,357.68,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,550.05,
REPLC GTUBE REVJ GSTRST TRC,361043763,CDM,361,RC,43763,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,447.1,77.22,,357.68,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,550.05,
PUNCT ASPIRATION CYST BREAST,402001826,CDM,361,RC,19000,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1254.05,77.22,,1003.24,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1542.8,
US ASPIRATION ADDITIONAL CYST,402001827,CDM,361,RC,19001,HCPCS,outpatient,,,130,91,,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,117,90,,93.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,100.39,77.22,,80.31,percent of total billed charges,77.22% of total billed charges,85.93,66.1,,68.74,percent of total billed charges,66.1% of total billed charges,107.9,83,,86.32,percent of total billed charges,83% of total,123.5,95,,98.8,percent of total billed charges ,95% of total billed charges,104,80,,83.2,percent of total billed charges,78% of total billed charges,101.4,78,,81.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,81.9,63,,65.52,percent of total billed charges,63% of total billed charges,110.5,85,,88.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,102.7,79,,82.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.9,450,
THYROID ASPIRATION CP,402080347,CDM,361,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
THROMBOLYSIS CORNARY BY IV INF,450092977,CDM,361,RC,92977,HCPCS,outpatient,,,387,270.9,,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,453.08,160,,,Fee Schedule,160% of CMS OPPS rate,368.13,130,,,Fee Schedule,130% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,298.84,77.22,,239.07,percent of total billed charges,77.22% of total billed charges,255.81,66.1,,204.65,percent of total billed charges,66.1% of total billed charges,321.21,83,,256.97,percent of total billed charges,83% of total,367.65,95,,294.12,percent of total billed charges ,95% of total billed charges,309.6,80,,247.68,percent of total billed charges,78% of total billed charges,301.86,78,,241.488,percent of total billed charges,78% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,263.35,93,,,fee schedule,93% of CMS OPPS rate,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,453.08,
BIOPSY ANORECTAL WALL,45100P,CDM,361,RC,45100,HCPCS,outpatient,,,270,189,,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,243,90,,194.4,percent of total billed charges,90% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,3756.46,160,,,Fee Schedule,160% of CMS OPPS rate,3052.12,130,,,Fee Schedule,130% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,208.49,77.22,,166.79,percent of total billed charges,77.22% of total billed charges,178.47,66.1,,142.78,percent of total billed charges,66.1% of total billed charges,224.1,83,,179.28,percent of total billed charges,83% of total,256.5,95,,205.2,percent of total billed charges ,95% of total billed charges,216,80,,172.8,percent of total billed charges,78% of total billed charges,210.6,78,,168.48,percent of total billed charges,78% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,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,170.1,63,,136.08,percent of total billed charges,63% of total billed charges,229.5,85,,183.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2183.44,93,,,fee schedule,93% of CMS OPPS rate,213.3,79,,170.64,percent of total billed charges,79% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,170.1,3756.46,
BIOPSY ANORECTAL WALL,45100T,CDM,361,RC,45100,HCPCS,outpatient,,,404,282.8,,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,363.6,90,,290.88,percent of total billed charges,90% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,3756.46,160,,,Fee Schedule,160% of CMS OPPS rate,3052.12,130,,,Fee Schedule,130% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,311.97,77.22,,249.58,percent of total billed charges,77.22% of total billed charges,267.04,66.1,,213.63,percent of total billed charges,66.1% of total billed charges,335.32,83,,268.26,percent of total billed charges,83% of total,383.8,95,,307.04,percent of total billed charges ,95% of total billed charges,323.2,80,,258.56,percent of total billed charges,78% of total billed charges,315.12,78,,252.096,percent of total billed charges,78% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,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,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2183.44,93,,,fee schedule,93% of CMS OPPS rate,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,254.52,3756.46,
SDC INSERT EMER AIRWAY,490031500,CDM,361,RC,31500,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,314.29,77.22,,251.43,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,450,
ARTHROSCOPY KNEE REM FORN BODY,4900G0289,CDM,361,RC,G0289,HCPCS,outpatient,,,163,114.1,,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,146.7,90,,117.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,125.87,77.22,,100.7,percent of total billed charges,77.22% of total billed charges,107.74,66.1,,86.19,percent of total billed charges,66.1% of total billed charges,135.29,83,,108.23,percent of total billed charges,83% of total,154.85,95,,123.88,percent of total billed charges ,95% of total billed charges,130.4,80,,104.32,percent of total billed charges,78% of total billed charges,127.14,78,,101.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,102.69,63,,82.15,percent of total billed charges,63% of total billed charges,138.55,85,,110.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,128.77,79,,103.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.69,450,
DILATION OF URETHRA,762053620,CDM,361,RC,53620,HCPCS,outpatient,,,1113,779.1,,879.27,79,,703.42,percent of total billed charges,79% of total billed charges,1001.7,90,,801.36,percent of total billed charges,90% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,913.9,160,,,Fee Schedule,160% of CMS OPPS rate,742.54,130,,,Fee Schedule,130% of CMS OPPS rate,701.19,63,,560.95,percent of total billed charges,63% of total billed charges,859.46,77.22,,687.57,percent of total billed charges,77.22% of total billed charges,735.69,66.1,,588.55,percent of total billed charges,66.1% of total billed charges,923.79,83,,739.03,percent of total billed charges,83% of total,1057.35,95,,845.88,percent of total billed charges ,95% of total billed charges,890.4,80,,712.32,percent of total billed charges,78% of total billed charges,868.14,78,,694.512,percent of total billed charges,78% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,701.19,63,,560.95,percent of total billed charges,63% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,1001.7,90,,801.36,percent of total billed charges,90% of total billed charges,890.4,80,,712.32,percent of total billed charges,80% of total billed charges,701.19,63,,560.95,percent of total billed charges,63% of total billed charges,946.05,85,,756.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,531.2,93,,,fee schedule,93% of CMS OPPS rate,879.27,79,,703.42,percent of total billed charges,79% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,450,1057.35,
OBS TREAT VAGINAL BLEEDING,762057180,CDM,361,RC,57180,HCPCS,outpatient,,,276,193.2,,218.04,79,,174.43,percent of total billed charges,79% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,173.88,63,,139.1,percent of total billed charges,63% of total billed charges,213.13,77.22,,170.5,percent of total billed charges,77.22% of total billed charges,182.44,66.1,,145.95,percent of total billed charges,66.1% of total billed charges,229.08,83,,183.26,percent of total billed charges,83% of total,262.2,95,,209.76,percent of total billed charges ,95% of total billed charges,220.8,80,,176.64,percent of total billed charges,78% of total billed charges,215.28,78,,172.224,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,173.88,63,,139.1,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,173.88,63,,139.1,percent of total billed charges,63% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,218.04,79,,174.43,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,450,
OBS PELVIC EXAM UNDER ANES,762057410,CDM,361,RC,57410,HCPCS,outpatient,,,2244,1570.8,,1772.76,79,,1418.21,percent of total billed charges,79% of total billed charges,2019.6,90,,1615.68,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,1413.72,63,,1130.98,percent of total billed charges,63% of total billed charges,1732.82,77.22,,1386.26,percent of total billed charges,77.22% of total billed charges,1483.28,66.1,,1186.62,percent of total billed charges,66.1% of total billed charges,1862.52,83,,1490.02,percent of total billed charges,83% of total,2131.8,95,,1705.44,percent of total billed charges ,95% of total billed charges,1795.2,80,,1436.16,percent of total billed charges,78% of total billed charges,1750.32,78,,1400.256,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,1413.72,63,,1130.98,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,1413.72,63,,1130.98,percent of total billed charges,63% of total billed charges,1907.4,85,,1525.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,1772.76,79,,1418.21,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,4182.66,
ENDOMETRAL BIOPSY W/O DILATION,762058100,CDM,361,RC,58100,HCPCS,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,307.34,77.22,,245.87,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,450,
OBS EPISIOTOMY OR VAG REPAIR,762059300,CDM,361,RC,59300,HCPCS,outpatient,,,3458,2420.6,,2731.82,79,,2185.46,percent of total billed charges,79% of total billed charges,3112.2,90,,2489.76,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,2178.54,63,,1742.83,percent of total billed charges,63% of total billed charges,2670.27,77.22,,2136.22,percent of total billed charges,77.22% of total billed charges,2285.74,66.1,,1828.59,percent of total billed charges,66.1% of total billed charges,2870.14,83,,2296.11,percent of total billed charges,83% of total,3285.1,95,,2628.08,percent of total billed charges ,95% of total billed charges,2766.4,80,,2213.12,percent of total billed charges,78% of total billed charges,2697.24,78,,2157.792,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2178.54,63,,1742.83,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,3112.2,90,,2489.76,percent of total billed charges,90% of total billed charges,2766.4,80,,2213.12,percent of total billed charges,80% of total billed charges,2178.54,63,,1742.83,percent of total billed charges,63% of total billed charges,2939.3,85,,2351.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,2731.82,79,,2185.46,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,4182.66,
OBS REMOVE FOREIGN BODY EYE,762065205,CDM,361,RC,65205,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,169.11,77.22,,135.29,percent of total billed charges,77.22% of total billed charges,144.76,66.1,,115.81,percent of total billed charges,66.1% of total billed charges,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
NON-BILLABLE CHARGE SDC,369005555,CDM,369,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
AGENTS  ANESTHESIA,370016635,CDM,370,RC,,,outpatient,,,44,30.8,,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,39.6,90,,31.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,33.98,77.22,,27.18,percent of total billed charges,77.22% of total billed charges,29.08,66.1,,23.26,percent of total billed charges,66.1% of total billed charges,36.52,83,,29.22,percent of total billed charges,83% of total,41.8,95,,33.44,percent of total billed charges ,95% of total billed charges,35.2,80,,28.16,percent of total billed charges,78% of total billed charges,34.32,78,,27.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,27.72,63,,22.18,percent of total billed charges,63% of total billed charges,37.4,85,,29.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,34.76,79,,27.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,450,
"MOD SEDATION, EA ADDL 15 MINS",370099153,CDM,370,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
"SEDATION MOD 5YR/>, 1ST 30 MIN",450099144,CDM,370,RC,,,outpatient,,,213,149.1,,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,164.48,77.22,,131.58,percent of total billed charges,77.22% of total billed charges,140.79,66.1,,112.63,percent of total billed charges,66.1% of total billed charges,176.79,83,,141.43,percent of total billed charges,83% of total,202.35,95,,161.88,percent of total billed charges ,95% of total billed charges,170.4,80,,136.32,percent of total billed charges,78% of total billed charges,166.14,78,,132.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.19,450,
"SEDATION MOD,EA ADDL 15 MINS",450099145,CDM,370,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
"MOD SEDATION <5 YO,1ST 30 MINS",371099148,CDM,371,RC,,,outpatient,,,213,149.1,,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,164.48,77.22,,131.58,percent of total billed charges,77.22% of total billed charges,140.79,66.1,,112.63,percent of total billed charges,66.1% of total billed charges,176.79,83,,141.43,percent of total billed charges,83% of total,202.35,95,,161.88,percent of total billed charges ,95% of total billed charges,170.4,80,,136.32,percent of total billed charges,78% of total billed charges,166.14,78,,132.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.19,450,
MOD SEDATION >5YRS 1ST 30 MN,371099149,CDM,371,RC,,,outpatient,,,213,149.1,,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,164.48,77.22,,131.58,percent of total billed charges,77.22% of total billed charges,140.79,66.1,,112.63,percent of total billed charges,66.1% of total billed charges,176.79,83,,141.43,percent of total billed charges,83% of total,202.35,95,,161.88,percent of total billed charges ,95% of total billed charges,170.4,80,,136.32,percent of total billed charges,78% of total billed charges,166.14,78,,132.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.19,450,
MOD SEDATION EA ADDL 15 MIN,371099150,CDM,371,RC,,,outpatient,,,105,73.5,,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,94.5,90,,75.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,81.08,77.22,,64.86,percent of total billed charges,77.22% of total billed charges,69.41,66.1,,55.53,percent of total billed charges,66.1% of total billed charges,87.15,83,,69.72,percent of total billed charges,83% of total,99.75,95,,79.8,percent of total billed charges ,95% of total billed charges,84,80,,67.2,percent of total billed charges,78% of total billed charges,81.9,78,,65.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,66.15,63,,52.92,percent of total billed charges,63% of total billed charges,89.25,85,,71.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,82.95,79,,66.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66.15,450,
"MOD SEDATION <5 YO,1ST 15 MINS",371099155,CDM,371,RC,99155,HCPCS,outpatient,,,231,161.7,,182.49,79,,145.99,percent of total billed charges,79% of total billed charges,207.9,90,,166.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,178.38,77.22,,142.7,percent of total billed charges,77.22% of total billed charges,152.69,66.1,,122.15,percent of total billed charges,66.1% of total billed charges,191.73,83,,153.38,percent of total billed charges,83% of total,219.45,95,,175.56,percent of total billed charges ,95% of total billed charges,184.8,80,,147.84,percent of total billed charges,78% of total billed charges,180.18,78,,144.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,145.53,63,,116.42,percent of total billed charges,63% of total billed charges,196.35,85,,157.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,182.49,79,,145.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,145.53,450,
"MOD SEDATION >5 YO,1ST 15 MINS",371099156,CDM,371,RC,99156,HCPCS,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,119.7,450,
MOD SED INITIAL 15 MINS <5YRS,450099151,CDM,372,RC,99151,HCPCS,outpatient,,,59,41.3,,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,53.1,90,,42.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,45.56,77.22,,36.45,percent of total billed charges,77.22% of total billed charges,39,66.1,,31.2,percent of total billed charges,66.1% of total billed charges,48.97,83,,39.18,percent of total billed charges,83% of total,56.05,95,,44.84,percent of total billed charges ,95% of total billed charges,47.2,80,,37.76,percent of total billed charges,78% of total billed charges,46.02,78,,36.816,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,37.17,63,,29.74,percent of total billed charges,63% of total billed charges,50.15,85,,40.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,46.61,79,,37.29,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37.17,450,
MOD SED INITIAL 15 MIN 5YR>,450099152,CDM,372,RC,99152,HCPCS,outpatient,,,31,21.7,,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,27.9,90,,22.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,23.94,77.22,,19.15,percent of total billed charges,77.22% of total billed charges,20.49,66.1,,16.39,percent of total billed charges,66.1% of total billed charges,25.73,83,,20.58,percent of total billed charges,83% of total,29.45,95,,23.56,percent of total billed charges ,95% of total billed charges,24.8,80,,19.84,percent of total billed charges,78% of total billed charges,24.18,78,,19.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,19.53,63,,15.62,percent of total billed charges,63% of total billed charges,26.35,85,,21.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.49,79,,19.59,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.53,450,
MOD SED ADDTL 15 MINS <5YRS,450099153,CDM,372,RC,99153,HCPCS,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
CRYOPRECIPITATE (POOLED 5unit),3900000506,CDM,390,RC,,,outpatient,,,311.15,217.81,,245.81,79,,196.65,percent of total billed charges,79% of total billed charges,280.04,90,,224.03,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.02,63,,156.82,percent of total billed charges,63% of total billed charges,240.27,77.22,,192.22,percent of total billed charges,77.22% of total billed charges,205.67,66.1,,164.54,percent of total billed charges,66.1% of total billed charges,258.25,83,,206.6,percent of total billed charges,83% of total,295.59,95,,236.47,percent of total billed charges ,95% of total billed charges,248.92,80,,199.14,percent of total billed charges,78% of total billed charges,242.7,78,,194.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,196.02,63,,156.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,280.04,90,,224.03,percent of total billed charges,90% of total billed charges,248.92,80,,199.14,percent of total billed charges,80% of total billed charges,196.02,63,,156.82,percent of total billed charges,63% of total billed charges,264.48,85,,211.584,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,245.81,79,,196.65,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,196.02,450,
PREWARM X-M BILL ONLY,390000190,CDM,390,RC,,,outpatient,,,142,99.4,,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,127.8,90,,102.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,109.65,77.22,,87.72,percent of total billed charges,77.22% of total billed charges,93.86,66.1,,75.09,percent of total billed charges,66.1% of total billed charges,117.86,83,,94.29,percent of total billed charges,83% of total,134.9,95,,107.92,percent of total billed charges ,95% of total billed charges,113.6,80,,90.88,percent of total billed charges,78% of total billed charges,110.76,78,,88.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,89.46,63,,71.57,percent of total billed charges,63% of total billed charges,120.7,85,,96.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,112.18,79,,89.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.46,450,
RED BLOOD CELLS UNIT,390000501,CDM,390,RC,P9021,HCPCS,outpatient,,,542,379.4,,428.18,79,,342.54,percent of total billed charges,79% of total billed charges,487.8,90,,390.24,percent of total billed charges,90% of total billed charges,136.51,100,,,Fee Schedule,100% of CMS OPPS rate,218.41,160,,,Fee Schedule,160% of CMS OPPS rate,177.46,130,,,Fee Schedule,130% of CMS OPPS rate,341.46,63,,273.17,percent of total billed charges,63% of total billed charges,418.53,77.22,,334.82,percent of total billed charges,77.22% of total billed charges,358.26,66.1,,286.61,percent of total billed charges,66.1% of total billed charges,449.86,83,,359.89,percent of total billed charges,83% of total,514.9,95,,411.92,percent of total billed charges ,95% of total billed charges,433.6,80,,346.88,percent of total billed charges,78% of total billed charges,422.76,78,,338.208,percent of total billed charges,78% of total billed charges,136.51,100,,,Fee Schedule,100% of CMS OPPS rate,341.46,63,,273.17,percent of total billed charges,63% of total billed charges,136.51,100,,,Fee Schedule,100% of CMS OPPS rate,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,341.46,63,,273.17,percent of total billed charges,63% of total billed charges,460.7,85,,368.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,126.95,93,,,fee schedule,93% of CMS OPPS rate,428.18,79,,342.54,percent of total billed charges,79% of total billed charges,136.51,100,,,Fee Schedule,100% of CMS OPPS rate,136.51,100,,,Fee Schedule,100% of CMS OPPS rate,126.95,514.9,
CRYOPRECIPITATE (PER UNIT),390000504,CDM,390,RC,P9012,HCPCS,outpatient,,,54.87,38.41,,43.35,79,,34.68,percent of total billed charges,79% of total billed charges,49.38,90,,39.5,percent of total billed charges,90% of total billed charges,59.87,100,,,Fee Schedule,100% of CMS OPPS rate,95.79,160,,,Fee Schedule,160% of CMS OPPS rate,77.83,130,,,Fee Schedule,130% of CMS OPPS rate,34.57,63,,27.66,percent of total billed charges,63% of total billed charges,42.37,77.22,,33.9,percent of total billed charges,77.22% of total billed charges,36.27,66.1,,29.02,percent of total billed charges,66.1% of total billed charges,45.54,83,,36.43,percent of total billed charges,83% of total,52.13,95,,41.7,percent of total billed charges ,95% of total billed charges,43.9,80,,35.12,percent of total billed charges,78% of total billed charges,42.8,78,,34.24,percent of total billed charges,78% of total billed charges,59.87,100,,,Fee Schedule,100% of CMS OPPS rate,34.57,63,,27.66,percent of total billed charges,63% of total billed charges,59.87,100,,,Fee Schedule,100% of CMS OPPS rate,49.38,90,,39.5,percent of total billed charges,90% of total billed charges,43.9,80,,35.12,percent of total billed charges,80% of total billed charges,34.57,63,,27.66,percent of total billed charges,63% of total billed charges,46.64,85,,37.312,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,55.67,93,,,fee schedule,93% of CMS OPPS rate,43.35,79,,34.68,percent of total billed charges,79% of total billed charges,59.87,100,,,Fee Schedule,100% of CMS OPPS rate,59.87,100,,,Fee Schedule,100% of CMS OPPS rate,34.57,450,
PLASMA (FRESH FROZEN),390000505,CDM,390,RC,P9017,HCPCS,outpatient,,,61.14,42.8,,48.3,79,,38.64,percent of total billed charges,79% of total billed charges,55.03,90,,44.02,percent of total billed charges,90% of total billed charges,79.95,100,,,Fee Schedule,100% of CMS OPPS rate,127.93,160,,,Fee Schedule,160% of CMS OPPS rate,103.94,130,,,Fee Schedule,130% of CMS OPPS rate,38.52,63,,30.82,percent of total billed charges,63% of total billed charges,47.21,77.22,,37.77,percent of total billed charges,77.22% of total billed charges,40.41,66.1,,32.33,percent of total billed charges,66.1% of total billed charges,50.75,83,,40.6,percent of total billed charges,83% of total,58.08,95,,46.46,percent of total billed charges ,95% of total billed charges,48.91,80,,39.13,percent of total billed charges,78% of total billed charges,47.69,78,,38.152,percent of total billed charges,78% of total billed charges,79.95,100,,,Fee Schedule,100% of CMS OPPS rate,38.52,63,,30.82,percent of total billed charges,63% of total billed charges,79.95,100,,,Fee Schedule,100% of CMS OPPS rate,55.03,90,,44.02,percent of total billed charges,90% of total billed charges,48.91,80,,39.13,percent of total billed charges,80% of total billed charges,38.52,63,,30.82,percent of total billed charges,63% of total billed charges,51.97,85,,41.576,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,74.36,93,,,fee schedule,93% of CMS OPPS rate,48.3,79,,38.64,percent of total billed charges,79% of total billed charges,79.95,100,,,Fee Schedule,100% of CMS OPPS rate,79.95,100,,,Fee Schedule,100% of CMS OPPS rate,38.52,450,
PLATELET CONCENTRATE,390000506,CDM,390,RC,P9019,HCPCS,outpatient,,,278,194.6,,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,250.2,90,,200.16,percent of total billed charges,90% of total billed charges,65.04,100,,,Fee Schedule,100% of CMS OPPS rate,104.06,160,,,Fee Schedule,160% of CMS OPPS rate,84.55,130,,,Fee Schedule,130% of CMS OPPS rate,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,214.67,77.22,,171.74,percent of total billed charges,77.22% of total billed charges,183.76,66.1,,147.01,percent of total billed charges,66.1% of total billed charges,230.74,83,,184.59,percent of total billed charges,83% of total,264.1,95,,211.28,percent of total billed charges ,95% of total billed charges,222.4,80,,177.92,percent of total billed charges,78% of total billed charges,216.84,78,,173.472,percent of total billed charges,78% of total billed charges,65.04,100,,,Fee Schedule,100% of CMS OPPS rate,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,65.04,100,,,Fee Schedule,100% of CMS OPPS rate,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,175.14,63,,140.11,percent of total billed charges,63% of total billed charges,236.3,85,,189.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,60.48,93,,,fee schedule,93% of CMS OPPS rate,219.62,79,,175.7,percent of total billed charges,79% of total billed charges,65.04,100,,,Fee Schedule,100% of CMS OPPS rate,65.04,100,,,Fee Schedule,100% of CMS OPPS rate,60.48,450,
WASHED CELLS,390000507,CDM,390,RC,P9022,HCPCS,outpatient,,,873,611.1,,689.67,79,,551.74,percent of total billed charges,79% of total billed charges,785.7,90,,628.56,percent of total billed charges,90% of total billed charges,397.12,100,,,Fee Schedule,100% of CMS OPPS rate,635.39,160,,,Fee Schedule,160% of CMS OPPS rate,516.25,130,,,Fee Schedule,130% of CMS OPPS rate,549.99,63,,439.99,percent of total billed charges,63% of total billed charges,674.13,77.22,,539.3,percent of total billed charges,77.22% of total billed charges,577.05,66.1,,461.64,percent of total billed charges,66.1% of total billed charges,724.59,83,,579.67,percent of total billed charges,83% of total,829.35,95,,663.48,percent of total billed charges ,95% of total billed charges,698.4,80,,558.72,percent of total billed charges,78% of total billed charges,680.94,78,,544.752,percent of total billed charges,78% of total billed charges,397.12,100,,,Fee Schedule,100% of CMS OPPS rate,549.99,63,,439.99,percent of total billed charges,63% of total billed charges,397.12,100,,,Fee Schedule,100% of CMS OPPS rate,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,549.99,63,,439.99,percent of total billed charges,63% of total billed charges,742.05,85,,593.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,369.32,93,,,fee schedule,93% of CMS OPPS rate,689.67,79,,551.74,percent of total billed charges,79% of total billed charges,397.12,100,,,Fee Schedule,100% of CMS OPPS rate,397.12,100,,,Fee Schedule,100% of CMS OPPS rate,369.32,829.35,
RED BLOOD CELLS IRRADIATED,390000510,CDM,390,RC,P9038,HCPCS,outpatient,,,392,274.4,,309.68,79,,247.74,percent of total billed charges,79% of total billed charges,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,216.72,100,,,Fee Schedule,100% of CMS OPPS rate,346.75,160,,,Fee Schedule,160% of CMS OPPS rate,281.73,130,,,Fee Schedule,130% of CMS OPPS rate,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,302.7,77.22,,242.16,percent of total billed charges,77.22% of total billed charges,259.11,66.1,,207.29,percent of total billed charges,66.1% of total billed charges,325.36,83,,260.29,percent of total billed charges,83% of total,372.4,95,,297.92,percent of total billed charges ,95% of total billed charges,313.6,80,,250.88,percent of total billed charges,78% of total billed charges,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,216.72,100,,,Fee Schedule,100% of CMS OPPS rate,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,216.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,201.54,93,,,fee schedule,93% of CMS OPPS rate,309.68,79,,247.74,percent of total billed charges,79% of total billed charges,216.72,100,,,Fee Schedule,100% of CMS OPPS rate,216.72,100,,,Fee Schedule,100% of CMS OPPS rate,201.54,450,
LEUKOCYTE REDUCED RBC,390000511,CDM,390,RC,P9016,HCPCS,outpatient,,,217.81,152.47,,172.07,79,,137.66,percent of total billed charges,79% of total billed charges,196.03,90,,156.82,percent of total billed charges,90% of total billed charges,180.82,100,,,Fee Schedule,100% of CMS OPPS rate,289.31,160,,,Fee Schedule,160% of CMS OPPS rate,235.06,130,,,Fee Schedule,130% of CMS OPPS rate,137.22,63,,109.78,percent of total billed charges,63% of total billed charges,168.19,77.22,,134.55,percent of total billed charges,77.22% of total billed charges,143.97,66.1,,115.18,percent of total billed charges,66.1% of total billed charges,180.78,83,,144.62,percent of total billed charges,83% of total,206.92,95,,165.54,percent of total billed charges ,95% of total billed charges,174.25,80,,139.4,percent of total billed charges,78% of total billed charges,169.89,78,,135.912,percent of total billed charges,78% of total billed charges,180.82,100,,,Fee Schedule,100% of CMS OPPS rate,137.22,63,,109.78,percent of total billed charges,63% of total billed charges,180.82,100,,,Fee Schedule,100% of CMS OPPS rate,196.03,90,,156.82,percent of total billed charges,90% of total billed charges,174.25,80,,139.4,percent of total billed charges,80% of total billed charges,137.22,63,,109.78,percent of total billed charges,63% of total billed charges,185.14,85,,148.112,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,168.16,93,,,fee schedule,93% of CMS OPPS rate,172.07,79,,137.66,percent of total billed charges,79% of total billed charges,180.82,100,,,Fee Schedule,100% of CMS OPPS rate,180.82,100,,,Fee Schedule,100% of CMS OPPS rate,137.22,450,
LEUKOCYTE REDUCED IRRIATED RBC,390000512,CDM,390,RC,P9056,HCPCS,outpatient,,,774,541.8,,611.46,79,,489.17,percent of total billed charges,79% of total billed charges,696.6,90,,557.28,percent of total billed charges,90% of total billed charges,91.99,100,,,Fee Schedule,100% of CMS OPPS rate,147.18,160,,,Fee Schedule,160% of CMS OPPS rate,119.58,130,,,Fee Schedule,130% of CMS OPPS rate,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,597.68,77.22,,478.14,percent of total billed charges,77.22% of total billed charges,511.61,66.1,,409.29,percent of total billed charges,66.1% of total billed charges,642.42,83,,513.94,percent of total billed charges,83% of total,735.3,95,,588.24,percent of total billed charges ,95% of total billed charges,619.2,80,,495.36,percent of total billed charges,78% of total billed charges,603.72,78,,482.976,percent of total billed charges,78% of total billed charges,91.99,100,,,Fee Schedule,100% of CMS OPPS rate,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,91.99,100,,,Fee Schedule,100% of CMS OPPS rate,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,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.55,93,,,fee schedule,93% of CMS OPPS rate,611.46,79,,489.17,percent of total billed charges,79% of total billed charges,91.99,100,,,Fee Schedule,100% of CMS OPPS rate,91.99,100,,,Fee Schedule,100% of CMS OPPS rate,85.55,735.3,
APHERESIS PLATELET,390000514,CDM,390,RC,P9034,HCPCS,outpatient,,,1568,1097.6,,1238.72,79,,990.98,percent of total billed charges,79% of total billed charges,1411.2,90,,1128.96,percent of total billed charges,90% of total billed charges,321.86,100,,,Fee Schedule,100% of CMS OPPS rate,514.97,160,,,Fee Schedule,160% of CMS OPPS rate,418.41,130,,,Fee Schedule,130% of CMS OPPS rate,987.84,63,,790.27,percent of total billed charges,63% of total billed charges,1210.81,77.22,,968.65,percent of total billed charges,77.22% of total billed charges,1036.45,66.1,,829.16,percent of total billed charges,66.1% of total billed charges,1301.44,83,,1041.15,percent of total billed charges,83% of total,1489.6,95,,1191.68,percent of total billed charges ,95% of total billed charges,1254.4,80,,1003.52,percent of total billed charges,78% of total billed charges,1223.04,78,,978.432,percent of total billed charges,78% of total billed charges,321.86,100,,,Fee Schedule,100% of CMS OPPS rate,987.84,63,,790.27,percent of total billed charges,63% of total billed charges,321.86,100,,,Fee Schedule,100% of CMS OPPS rate,1411.2,90,,1128.96,percent of total billed charges,90% of total billed charges,1254.4,80,,1003.52,percent of total billed charges,80% of total billed charges,987.84,63,,790.27,percent of total billed charges,63% of total billed charges,1332.8,85,,1066.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.32,93,,,fee schedule,93% of CMS OPPS rate,1238.72,79,,990.98,percent of total billed charges,79% of total billed charges,321.86,100,,,Fee Schedule,100% of CMS OPPS rate,321.86,100,,,Fee Schedule,100% of CMS OPPS rate,299.32,1489.6,
AUTOLOGOUS UNIT,390000527,CDM,390,RC,,,outpatient,,,410,287,,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,369,90,,295.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,316.6,77.22,,253.28,percent of total billed charges,77.22% of total billed charges,271.01,66.1,,216.81,percent of total billed charges,66.1% of total billed charges,340.3,83,,272.24,percent of total billed charges,83% of total,389.5,95,,311.6,percent of total billed charges ,95% of total billed charges,328,80,,262.4,percent of total billed charges,78% of total billed charges,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,348.5,85,,278.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,450,
DEGLYCEROLIZE RED BLOOD CELLS,390000530,CDM,390,RC,P9039,HCPCS,outpatient,,,426,298.2,,336.54,79,,269.23,percent of total billed charges,79% of total billed charges,383.4,90,,306.72,percent of total billed charges,90% of total billed charges,311.11,100,,,Fee Schedule,100% of CMS OPPS rate,497.77,160,,,Fee Schedule,160% of CMS OPPS rate,404.44,130,,,Fee Schedule,130% of CMS OPPS rate,268.38,63,,214.7,percent of total billed charges,63% of total billed charges,328.96,77.22,,263.17,percent of total billed charges,77.22% of total billed charges,281.59,66.1,,225.27,percent of total billed charges,66.1% of total billed charges,353.58,83,,282.86,percent of total billed charges,83% of total,404.7,95,,323.76,percent of total billed charges ,95% of total billed charges,340.8,80,,272.64,percent of total billed charges,78% of total billed charges,332.28,78,,265.824,percent of total billed charges,78% of total billed charges,311.11,100,,,Fee Schedule,100% of CMS OPPS rate,268.38,63,,214.7,percent of total billed charges,63% of total billed charges,311.11,100,,,Fee Schedule,100% of CMS OPPS rate,383.4,90,,306.72,percent of total billed charges,90% of total billed charges,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,268.38,63,,214.7,percent of total billed charges,63% of total billed charges,362.1,85,,289.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,289.33,93,,,fee schedule,93% of CMS OPPS rate,336.54,79,,269.23,percent of total billed charges,79% of total billed charges,311.11,100,,,Fee Schedule,100% of CMS OPPS rate,311.11,100,,,Fee Schedule,100% of CMS OPPS rate,268.38,497.77,
INDIRECT COOMBS,390008370,CDM,390,RC,,,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.58,450,
SDC TRANSFUSION BLOOD/COMPONEN,360036430,CDM,391,RC,36430,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,641.25,
BLOOD TRANSFUSION/COMPONENT,391001000,CDM,391,RC,36430,HCPCS,outpatient,,,780,546,,616.2,79,,492.96,percent of total billed charges,79% of total billed charges,702,90,,561.6,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,491.4,63,,393.12,percent of total billed charges,63% of total billed charges,602.32,77.22,,481.86,percent of total billed charges,77.22% of total billed charges,515.58,66.1,,412.46,percent of total billed charges,66.1% of total billed charges,647.4,83,,517.92,percent of total billed charges,83% of total,741,95,,592.8,percent of total billed charges ,95% of total billed charges,624,80,,499.2,percent of total billed charges,78% of total billed charges,608.4,78,,486.72,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,491.4,63,,393.12,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,491.4,63,,393.12,percent of total billed charges,63% of total billed charges,663,85,,530.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,616.2,79,,492.96,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,741,
ER BLOOD TRANSFUSION SERVICE,450036430,CDM,391,RC,36430,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,641.25,
SDC BLOOD TRANSFUSION SERVICES,490036430,CDM,391,RC,36430,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,641.25,
OB BLOOD TRANSFUSION 1 UNIT,760036430,CDM,391,RC,36430,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,641.25,
OB BLOOD TRANSFUSION 2+ UNITS,760136430,CDM,391,RC,36430,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,641.25,
TR BLOOD TRANSFUSION SERVICE,761036430,CDM,391,RC,36430,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,641.25,
BLOOD TRANSFUSION SERVICE,762036430,CDM,391,RC,36430,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,580.76,160,,,Fee Schedule,160% of CMS OPPS rate,471.87,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,337.56,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,362.98,100,,,Fee Schedule,100% of CMS OPPS rate,337.56,641.25,
MAMMO POST BIOPSY L CLIP PLACE,320000075,CDM,401,RC,19281,HCPCS,outpatient,,,2399,1679.3,,1895.21,79,,1516.17,percent of total billed charges,79% of total billed charges,2159.1,90,,1727.28,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1511.37,63,,1209.1,percent of total billed charges,63% of total billed charges,1852.51,77.22,,1482.01,percent of total billed charges,77.22% of total billed charges,1585.74,66.1,,1268.59,percent of total billed charges,66.1% of total billed charges,1991.17,83,,1592.94,percent of total billed charges,83% of total,2279.05,95,,1823.24,percent of total billed charges ,95% of total billed charges,1919.2,80,,1535.36,percent of total billed charges,78% of total billed charges,1871.22,78,,1496.976,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1511.37,63,,1209.1,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2159.1,90,,1727.28,percent of total billed charges,90% of total billed charges,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,1511.37,63,,1209.1,percent of total billed charges,63% of total billed charges,2039.15,85,,1631.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1895.21,79,,1516.17,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2279.05,
MAMMO POST BIOPSY R CLIP PLACE,320000076,CDM,401,RC,19281,HCPCS,outpatient,,,2399,1679.3,,1895.21,79,,1516.17,percent of total billed charges,79% of total billed charges,2159.1,90,,1727.28,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1511.37,63,,1209.1,percent of total billed charges,63% of total billed charges,1852.51,77.22,,1482.01,percent of total billed charges,77.22% of total billed charges,1585.74,66.1,,1268.59,percent of total billed charges,66.1% of total billed charges,1991.17,83,,1592.94,percent of total billed charges,83% of total,2279.05,95,,1823.24,percent of total billed charges ,95% of total billed charges,1919.2,80,,1535.36,percent of total billed charges,78% of total billed charges,1871.22,78,,1496.976,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1511.37,63,,1209.1,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2159.1,90,,1727.28,percent of total billed charges,90% of total billed charges,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,1511.37,63,,1209.1,percent of total billed charges,63% of total billed charges,2039.15,85,,1631.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1895.21,79,,1516.17,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2279.05,
MAMMO GUIDED LT BREAST BIOPSY,320000141,CDM,401,RC,19081,HCPCS,outpatient,,,2814,1969.8,,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2172.97,77.22,,1738.38,percent of total billed charges,77.22% of total billed charges,1860.05,66.1,,1488.04,percent of total billed charges,66.1% of total billed charges,2335.62,83,,1868.5,percent of total billed charges,83% of total,2673.3,95,,2138.64,percent of total billed charges ,95% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,78% of total billed charges,2194.92,78,,1755.936,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,80% of total billed charges,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2391.9,85,,1913.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2673.3,
MAMMO GUIDED RT BREAST BIOPSY,320000145,CDM,401,RC,19081,HCPCS,outpatient,,,2814,1969.8,,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2172.97,77.22,,1738.38,percent of total billed charges,77.22% of total billed charges,1860.05,66.1,,1488.04,percent of total billed charges,66.1% of total billed charges,2335.62,83,,1868.5,percent of total billed charges,83% of total,2673.3,95,,2138.64,percent of total billed charges ,95% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,78% of total billed charges,2194.92,78,,1755.936,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,80% of total billed charges,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2391.9,85,,1913.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2673.3,
BX BREAST ADDL LESION STRTCTC,320000146,CDM,401,RC,19082,HCPCS,outpatient,,,2814,1969.8,,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2172.97,77.22,,1738.38,percent of total billed charges,77.22% of total billed charges,1860.05,66.1,,1488.04,percent of total billed charges,66.1% of total billed charges,2335.62,83,,1868.5,percent of total billed charges,83% of total,2673.3,95,,2138.64,percent of total billed charges ,95% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,78% of total billed charges,2194.92,78,,1755.936,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,80% of total billed charges,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2391.9,85,,1913.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2673.3,
DIAG DIG BRST TOMO UNI OR BILA,401000279,CDM,401,RC,G0279,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,17,100,,,fee schedule,100% of CMS fee schedule,27.2,160,,,fee schedule,160% of CMS fee schedule,22.1,130,,,fee schedule,130% of CMS fee schedule,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,17,100,,,fee schedule,100% of CMS fee schedule,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,17,100,,,fee schedule ,100% of CMS 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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,15.81,93,,,fee schedule,93% of CMS fee schedule,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,17,100,,,fee schedule,100% of CMS fee schedule,17,100,,,fee schedule,100% of CMS fee schedule,15.81,450,
DIAG MAMMO UNILATERAL 3D RT CP,401000771,CDM,401,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DIAG MAMMO BILATERAL 3D CP,401000772,CDM,401,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DIAG MAMMO UNILATERAL 3D LT CP,401000773,CDM,401,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NEEDLE LOC BREAST EA ADDL LES,401001818,CDM,401,RC,19084,HCPCS,outpatient,,,974,681.8,,769.46,79,,615.57,percent of total billed charges,79% of total billed charges,876.6,90,,701.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,613.62,63,,490.9,percent of total billed charges,63% of total billed charges,752.12,77.22,,601.7,percent of total billed charges,77.22% of total billed charges,643.81,66.1,,515.05,percent of total billed charges,66.1% of total billed charges,808.42,83,,646.74,percent of total billed charges,83% of total,925.3,95,,740.24,percent of total billed charges ,95% of total billed charges,779.2,80,,623.36,percent of total billed charges,78% of total billed charges,759.72,78,,607.776,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,613.62,63,,490.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,876.6,90,,701.28,percent of total billed charges,90% of total billed charges,779.2,80,,623.36,percent of total billed charges,80% of total billed charges,613.62,63,,490.9,percent of total billed charges,63% of total billed charges,827.9,85,,662.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,769.46,79,,615.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,925.3,
MAMMOGRAPHIC LOCALIZE MASS LT,401001877,CDM,401,RC,19281,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1254.05,77.22,,1003.24,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
PLACEMENT OF NEEDLE LOCAL RT,401001897,CDM,401,RC,19281,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1254.05,77.22,,1003.24,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
MAMMO DIAGNOSTIC RIGHT BREAST,401077064,CDM,401,RC,77065,HCPCS,outpatient,,,446,312.2,,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,122.99,160,,,fee schedule,160% of CMS fee schedule,99.93,130,,,fee schedule,130% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,344.4,77.22,,275.52,percent of total billed charges,77.22% of total billed charges,294.81,66.1,,235.85,percent of total billed charges,66.1% of total billed charges,370.18,83,,296.14,percent of total billed charges,83% of total,423.7,95,,338.96,percent of total billed charges ,95% of total billed charges,356.8,80,,285.44,percent of total billed charges,78% of total billed charges,347.88,78,,278.304,percent of total billed charges,78% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,76.87,100,,,fee schedule ,100% of CMS 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,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,71.49,93,,,fee schedule,93% of CMS fee schedule,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,76.87,100,,,fee schedule,100% of CMS fee schedule,71.49,450,
MAMMO DIAGNOSTIC LEFT BREAST,401077065,CDM,401,RC,77065,HCPCS,outpatient,,,446,312.2,,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,122.99,160,,,fee schedule,160% of CMS fee schedule,99.93,130,,,fee schedule,130% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,344.4,77.22,,275.52,percent of total billed charges,77.22% of total billed charges,294.81,66.1,,235.85,percent of total billed charges,66.1% of total billed charges,370.18,83,,296.14,percent of total billed charges,83% of total,423.7,95,,338.96,percent of total billed charges ,95% of total billed charges,356.8,80,,285.44,percent of total billed charges,78% of total billed charges,347.88,78,,278.304,percent of total billed charges,78% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,76.87,100,,,fee schedule ,100% of CMS 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,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,71.49,93,,,fee schedule,93% of CMS fee schedule,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,76.87,100,,,fee schedule,100% of CMS fee schedule,71.49,450,
MAMMO DIAGNOSTIC BILATERAL,401077066,CDM,401,RC,77066,HCPCS,outpatient,,,556,389.2,,439.24,79,,351.39,percent of total billed charges,79% of total billed charges,500.4,90,,400.32,percent of total billed charges,90% of total billed charges,98.62,100,,,fee schedule,100% of CMS fee schedule,157.79,160,,,fee schedule,160% of CMS fee schedule,128.21,130,,,fee schedule,130% of CMS fee schedule,350.28,63,,280.22,percent of total billed charges,63% of total billed charges,429.34,77.22,,343.47,percent of total billed charges,77.22% of total billed charges,367.52,66.1,,294.02,percent of total billed charges,66.1% of total billed charges,461.48,83,,369.18,percent of total billed charges,83% of total,528.2,95,,422.56,percent of total billed charges ,95% of total billed charges,444.8,80,,355.84,percent of total billed charges,78% of total billed charges,433.68,78,,346.944,percent of total billed charges,78% of total billed charges,98.62,100,,,fee schedule,100% of CMS fee schedule,350.28,63,,280.22,percent of total billed charges,63% of total billed charges,98.62,100,,,fee schedule ,100% of CMS 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,350.28,63,,280.22,percent of total billed charges,63% of total billed charges,472.6,85,,378.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,91.72,93,,,fee schedule,93% of CMS fee schedule,439.24,79,,351.39,percent of total billed charges,79% of total billed charges,98.62,100,,,fee schedule,100% of CMS fee schedule,98.62,100,,,fee schedule,100% of CMS fee schedule,91.72,528.2,
MAMMOGRAPHIC LOCAL MASS  LT CP,401080504,CDM,401,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MAMMOGRAPHIC LOCAL MASS RT CP,401080506,CDM,401,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MAMO NEEDLE LOC ADD LESI RT CP,401080515,CDM,401,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BREAST SPECIMEN CP,401081510,CDM,401,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NEEDLE LOC BREAST 1ST LESION,402001818,CDM,401,RC,19083,HCPCS,outpatient,,,4381,3066.7,,3460.99,79,,2768.79,percent of total billed charges,79% of total billed charges,3942.9,90,,3154.32,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2760.03,63,,2208.02,percent of total billed charges,63% of total billed charges,3383.01,77.22,,2706.41,percent of total billed charges,77.22% of total billed charges,2895.84,66.1,,2316.67,percent of total billed charges,66.1% of total billed charges,3636.23,83,,2908.98,percent of total billed charges,83% of total,4161.95,95,,3329.56,percent of total billed charges ,95% of total billed charges,3504.8,80,,2803.84,percent of total billed charges,78% of total billed charges,3417.18,78,,2733.744,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2760.03,63,,2208.02,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,2760.03,63,,2208.02,percent of total billed charges,63% of total billed charges,3723.85,85,,2979.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3460.99,79,,2768.79,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,4161.95,
PLACE NEEDL LOC 1ST LES BREAST,402001825,CDM,401,RC,19281,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1254.05,77.22,,1003.24,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
PLAC NEEDL LOC EA AD LES BREST,402001853,CDM,401,RC,19282,HCPCS,outpatient,,,501,350.7,,395.79,79,,316.63,percent of total billed charges,79% of total billed charges,450.9,90,,360.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.63,63,,252.5,percent of total billed charges,63% of total billed charges,386.87,77.22,,309.5,percent of total billed charges,77.22% of total billed charges,331.16,66.1,,264.93,percent of total billed charges,66.1% of total billed charges,415.83,83,,332.66,percent of total billed charges,83% of total,475.95,95,,380.76,percent of total billed charges ,95% of total billed charges,400.8,80,,320.64,percent of total billed charges,78% of total billed charges,390.78,78,,312.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,315.63,63,,252.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,315.63,63,,252.5,percent of total billed charges,63% of total billed charges,425.85,85,,340.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,395.79,79,,316.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,315.63,475.95,
DIAG MAMMO CAD UNILAT LEFT,403007065,CDM,401,RC,77065,HCPCS,outpatient,,,446,312.2,,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,122.99,160,,,fee schedule,160% of CMS fee schedule,99.93,130,,,fee schedule,130% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,344.4,77.22,,275.52,percent of total billed charges,77.22% of total billed charges,294.81,66.1,,235.85,percent of total billed charges,66.1% of total billed charges,370.18,83,,296.14,percent of total billed charges,83% of total,423.7,95,,338.96,percent of total billed charges ,95% of total billed charges,356.8,80,,285.44,percent of total billed charges,78% of total billed charges,347.88,78,,278.304,percent of total billed charges,78% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,76.87,100,,,fee schedule ,100% of CMS 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,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,71.49,93,,,fee schedule,93% of CMS fee schedule,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,76.87,100,,,fee schedule,100% of CMS fee schedule,71.49,450,
DIAG MAMMO CAD UNILAT RIGHT,403077065,CDM,401,RC,77065,HCPCS,outpatient,,,446,312.2,,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,122.99,160,,,fee schedule,160% of CMS fee schedule,99.93,130,,,fee schedule,130% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,344.4,77.22,,275.52,percent of total billed charges,77.22% of total billed charges,294.81,66.1,,235.85,percent of total billed charges,66.1% of total billed charges,370.18,83,,296.14,percent of total billed charges,83% of total,423.7,95,,338.96,percent of total billed charges ,95% of total billed charges,356.8,80,,285.44,percent of total billed charges,78% of total billed charges,347.88,78,,278.304,percent of total billed charges,78% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,76.87,100,,,fee schedule ,100% of CMS 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,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,71.49,93,,,fee schedule,93% of CMS fee schedule,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,76.87,100,,,fee schedule,100% of CMS fee schedule,76.87,100,,,fee schedule,100% of CMS fee schedule,71.49,450,
US PELVIC (NON-OB) COMPLETE,402001312,CDM,402,RC,76856,HCPCS,outpatient,,,434,303.8,,342.86,79,,274.29,percent of total billed charges,79% of total billed charges,390.6,90,,312.48,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,335.13,77.22,,268.1,percent of total billed charges,77.22% of total billed charges,286.87,66.1,,229.5,percent of total billed charges,66.1% of total billed charges,360.22,83,,288.18,percent of total billed charges,83% of total,412.3,95,,329.84,percent of total billed charges ,95% of total billed charges,347.2,80,,277.76,percent of total billed charges,78% of total billed charges,338.52,78,,270.816,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,368.9,85,,295.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,342.86,79,,274.29,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
COMPLETE ABDOMEN SONOGRAM,402001601,CDM,402,RC,76700,HCPCS,outpatient,,,1136,795.2,,897.44,79,,717.95,percent of total billed charges,79% of total billed charges,1022.4,90,,817.92,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,715.68,63,,572.54,percent of total billed charges,63% of total billed charges,877.22,77.22,,701.78,percent of total billed charges,77.22% of total billed charges,750.9,66.1,,600.72,percent of total billed charges,66.1% of total billed charges,942.88,83,,754.3,percent of total billed charges,83% of total,1079.2,95,,863.36,percent of total billed charges ,95% of total billed charges,908.8,80,,727.04,percent of total billed charges,78% of total billed charges,886.08,78,,708.864,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,715.68,63,,572.54,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,1022.4,90,,817.92,percent of total billed charges,90% of total billed charges,908.8,80,,727.04,percent of total billed charges,80% of total billed charges,715.68,63,,572.54,percent of total billed charges,63% of total billed charges,965.6,85,,772.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,897.44,79,,717.95,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,1079.2,
THYROID SONOGRAM,402001603,CDM,402,RC,76536,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,641.25,
RENAL RETROPERITONEAL COMPLETE,402001605,CDM,402,RC,76770,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,641.25,
RENAL W BLADDER SONOGRAM CMPL,402001607,CDM,402,RC,76770,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,641.25,
OB SONOGRAM LIMITED,402001610,CDM,402,RC,76815,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,493.05,
URINARY BLADDER SONOGRAM LMTD,402001611,CDM,402,RC,76775,HCPCS,outpatient,,,360,252,,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,277.99,77.22,,222.39,percent of total billed charges,77.22% of total billed charges,237.96,66.1,,190.37,percent of total billed charges,66.1% of total billed charges,298.8,83,,239.04,percent of total billed charges,83% of total,342,95,,273.6,percent of total billed charges ,95% of total billed charges,288,80,,230.4,percent of total billed charges,78% of total billed charges,280.8,78,,224.64,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
PELVIS SONOGRAM COMPLETE,402001612,CDM,402,RC,76856,HCPCS,outpatient,,,434,303.8,,342.86,79,,274.29,percent of total billed charges,79% of total billed charges,390.6,90,,312.48,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,335.13,77.22,,268.1,percent of total billed charges,77.22% of total billed charges,286.87,66.1,,229.5,percent of total billed charges,66.1% of total billed charges,360.22,83,,288.18,percent of total billed charges,83% of total,412.3,95,,329.84,percent of total billed charges ,95% of total billed charges,347.2,80,,277.76,percent of total billed charges,78% of total billed charges,338.52,78,,270.816,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,368.9,85,,295.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,342.86,79,,274.29,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
ABDOMEN-SUPERFICIAL LIMITED,402001613,CDM,402,RC,76705,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,641.25,
AMNIOCENTESIS SONOGRAM,402001615,CDM,402,RC,76946,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
TESTICULAR SONOGRAM,402001616,CDM,402,RC,76870,HCPCS,outpatient,,,1061,742.7,,838.19,79,,670.55,percent of total billed charges,79% of total billed charges,954.9,90,,763.92,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,668.43,63,,534.74,percent of total billed charges,63% of total billed charges,819.3,77.22,,655.44,percent of total billed charges,77.22% of total billed charges,701.32,66.1,,561.06,percent of total billed charges,66.1% of total billed charges,880.63,83,,704.5,percent of total billed charges,83% of total,1007.95,95,,806.36,percent of total billed charges ,95% of total billed charges,848.8,80,,679.04,percent of total billed charges,78% of total billed charges,827.58,78,,662.064,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,668.43,63,,534.74,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,954.9,90,,763.92,percent of total billed charges,90% of total billed charges,848.8,80,,679.04,percent of total billed charges,80% of total billed charges,668.43,63,,534.74,percent of total billed charges,63% of total billed charges,901.85,85,,721.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,838.19,79,,670.55,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,1007.95,
US OB GROWTH FOLL-UP 1ST FETUS,402001617,CDM,402,RC,76816,HCPCS,outpatient,,,288,201.6,,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,222.39,77.22,,177.91,percent of total billed charges,77.22% of total billed charges,190.37,66.1,,152.3,percent of total billed charges,66.1% of total billed charges,239.04,83,,191.23,percent of total billed charges,83% of total,273.6,95,,218.88,percent of total billed charges ,95% of total billed charges,230.4,80,,184.32,percent of total billed charges,78% of total billed charges,224.64,78,,179.712,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
US OB GROWTH FOLL-UP 2ND FETUS,402001620,CDM,402,RC,76816,HCPCS,outpatient,,,288,201.6,,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,222.39,77.22,,177.91,percent of total billed charges,77.22% of total billed charges,190.37,66.1,,152.3,percent of total billed charges,66.1% of total billed charges,239.04,83,,191.23,percent of total billed charges,83% of total,273.6,95,,218.88,percent of total billed charges ,95% of total billed charges,230.4,80,,184.32,percent of total billed charges,78% of total billed charges,224.64,78,,179.712,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
U/S GUIDE/ASPIR/CYST/ANY SITE,402001622,CDM,402,RC,76942,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,423.94,77.22,,339.15,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,345.87,521.55,
ULTRASOUND GUIDANCE/CYST ANY S,402001623,CDM,402,RC,76942,HCPCS,outpatient,,,1308,915.6,,1033.32,79,,826.66,percent of total billed charges,79% of total billed charges,1177.2,90,,941.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,824.04,63,,659.23,percent of total billed charges,63% of total billed charges,1010.04,77.22,,808.03,percent of total billed charges,77.22% of total billed charges,864.59,66.1,,691.67,percent of total billed charges,66.1% of total billed charges,1085.64,83,,868.51,percent of total billed charges,83% of total,1242.6,95,,994.08,percent of total billed charges ,95% of total billed charges,1046.4,80,,837.12,percent of total billed charges,78% of total billed charges,1020.24,78,,816.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,824.04,63,,659.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1177.2,90,,941.76,percent of total billed charges,90% of total billed charges,1046.4,80,,837.12,percent of total billed charges,80% of total billed charges,824.04,63,,659.23,percent of total billed charges,63% of total billed charges,1111.8,85,,889.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1033.32,79,,826.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1242.6,
POPLITEAL NON-VASCU US COMPLET,402001625,CDM,402,RC,76881,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,406.98,63,,325.58,percent of total billed charges,63% of total billed charges,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,427.01,66.1,,341.61,percent of total billed charges,66.1% of total billed charges,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,406.98,63,,325.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,406.98,63,,325.58,percent of total billed charges,63% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,613.7,
NECK ULTRASOUND,402001626,CDM,402,RC,76536,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,641.25,
SPINE ECHOGRAPHY SPINAL CANAL,402001629,CDM,402,RC,76800,HCPCS,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
US TRANSVAGINAL,402001632,CDM,402,RC,76830,HCPCS,outpatient,,,434,303.8,,342.86,79,,274.29,percent of total billed charges,79% of total billed charges,390.6,90,,312.48,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,335.13,77.22,,268.1,percent of total billed charges,77.22% of total billed charges,286.87,66.1,,229.5,percent of total billed charges,66.1% of total billed charges,360.22,83,,288.18,percent of total billed charges,83% of total,412.3,95,,329.84,percent of total billed charges ,95% of total billed charges,347.2,80,,277.76,percent of total billed charges,78% of total billed charges,338.52,78,,270.816,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,273.42,63,,218.74,percent of total billed charges,63% of total billed charges,368.9,85,,295.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,342.86,79,,274.29,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
INGUINAL-GROIN ULTRASOUND,402001633,CDM,402,RC,76857,HCPCS,outpatient,,,424,296.8,,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,381.6,90,,305.28,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,327.41,77.22,,261.93,percent of total billed charges,77.22% of total billed charges,280.26,66.1,,224.21,percent of total billed charges,66.1% of total billed charges,351.92,83,,281.54,percent of total billed charges,83% of total,402.8,95,,322.24,percent of total billed charges ,95% of total billed charges,339.2,80,,271.36,percent of total billed charges,78% of total billed charges,330.72,78,,264.576,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
ECHOGRAPHY NONVASCULAR EXT LTD,402001634,CDM,402,RC,76882,HCPCS,outpatient,,,397,277.9,,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,306.56,77.22,,245.25,percent of total billed charges,77.22% of total billed charges,262.42,66.1,,209.94,percent of total billed charges,66.1% of total billed charges,329.51,83,,263.61,percent of total billed charges,83% of total,377.15,95,,301.72,percent of total billed charges ,95% of total billed charges,317.6,80,,254.08,percent of total billed charges,78% of total billed charges,309.66,78,,247.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
ECHO EXAM OF CHEST,402001635,CDM,402,RC,76604,HCPCS,outpatient,,,408,285.6,,322.32,79,,257.86,percent of total billed charges,79% of total billed charges,367.2,90,,293.76,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,257.04,63,,205.63,percent of total billed charges,63% of total billed charges,315.06,77.22,,252.05,percent of total billed charges,77.22% of total billed charges,269.69,66.1,,215.75,percent of total billed charges,66.1% of total billed charges,338.64,83,,270.91,percent of total billed charges,83% of total,387.6,95,,310.08,percent of total billed charges ,95% of total billed charges,326.4,80,,261.12,percent of total billed charges,78% of total billed charges,318.24,78,,254.592,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,257.04,63,,205.63,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,367.2,90,,293.76,percent of total billed charges,90% of total billed charges,326.4,80,,261.12,percent of total billed charges,80% of total billed charges,257.04,63,,205.63,percent of total billed charges,63% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,322.32,79,,257.86,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
LIMITED SINGLE QUADRANT,402001636,CDM,402,RC,76705,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,641.25,
RENAL SCAN,402001638,CDM,402,RC,76770,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,641.25,
BREAST US BILATERAL COMPLETE,402001642,CDM,402,RC,76641,HCPCS,outpatient,,,387,270.9,,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,298.84,77.22,,239.07,percent of total billed charges,77.22% of total billed charges,255.81,66.1,,204.65,percent of total billed charges,66.1% of total billed charges,321.21,83,,256.97,percent of total billed charges,83% of total,367.65,95,,294.12,percent of total billed charges ,95% of total billed charges,309.6,80,,247.68,percent of total billed charges,78% of total billed charges,301.86,78,,241.488,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BREAST US BILATERIAL LIMITED,402001643,CDM,402,RC,76642,HCPCS,outpatient,,,404,282.8,,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,363.6,90,,290.88,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,311.97,77.22,,249.58,percent of total billed charges,77.22% of total billed charges,267.04,66.1,,213.63,percent of total billed charges,66.1% of total billed charges,335.32,83,,268.26,percent of total billed charges,83% of total,383.8,95,,307.04,percent of total billed charges ,95% of total billed charges,323.2,80,,258.56,percent of total billed charges,78% of total billed charges,315.12,78,,252.096,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BREAST ULTRASOUND COMPLETE LT,402001644,CDM,402,RC,76641,HCPCS,outpatient,,,387,270.9,,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,298.84,77.22,,239.07,percent of total billed charges,77.22% of total billed charges,255.81,66.1,,204.65,percent of total billed charges,66.1% of total billed charges,321.21,83,,256.97,percent of total billed charges,83% of total,367.65,95,,294.12,percent of total billed charges ,95% of total billed charges,309.6,80,,247.68,percent of total billed charges,78% of total billed charges,301.86,78,,241.488,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BREAST ULTRASOUND COMPLETE RT,402001645,CDM,402,RC,76641,HCPCS,outpatient,,,387,270.9,,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,298.84,77.22,,239.07,percent of total billed charges,77.22% of total billed charges,255.81,66.1,,204.65,percent of total billed charges,66.1% of total billed charges,321.21,83,,256.97,percent of total billed charges,83% of total,367.65,95,,294.12,percent of total billed charges ,95% of total billed charges,309.6,80,,247.68,percent of total billed charges,78% of total billed charges,301.86,78,,241.488,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
BREAST ULTRASOUND LIMITED RT,402001646,CDM,402,RC,76642,HCPCS,outpatient,,,404,282.8,,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,363.6,90,,290.88,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,311.97,77.22,,249.58,percent of total billed charges,77.22% of total billed charges,267.04,66.1,,213.63,percent of total billed charges,66.1% of total billed charges,335.32,83,,268.26,percent of total billed charges,83% of total,383.8,95,,307.04,percent of total billed charges ,95% of total billed charges,323.2,80,,258.56,percent of total billed charges,78% of total billed charges,315.12,78,,252.096,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
BREAST ULTRASOUND LIMITED LT,402001647,CDM,402,RC,76642,HCPCS,outpatient,,,404,282.8,,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,363.6,90,,290.88,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,311.97,77.22,,249.58,percent of total billed charges,77.22% of total billed charges,267.04,66.1,,213.63,percent of total billed charges,66.1% of total billed charges,335.32,83,,268.26,percent of total billed charges,83% of total,383.8,95,,307.04,percent of total billed charges ,95% of total billed charges,323.2,80,,258.56,percent of total billed charges,78% of total billed charges,315.12,78,,252.096,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,254.52,63,,203.62,percent of total billed charges,63% of total billed charges,343.4,85,,274.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,319.16,79,,255.33,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
US BILATERAL BREAST,402001732,CDM,402,RC,76641,HCPCS,outpatient,,,387,270.9,,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,298.84,77.22,,239.07,percent of total billed charges,77.22% of total billed charges,255.81,66.1,,204.65,percent of total billed charges,66.1% of total billed charges,321.21,83,,256.97,percent of total billed charges,83% of total,367.65,95,,294.12,percent of total billed charges ,95% of total billed charges,309.6,80,,247.68,percent of total billed charges,78% of total billed charges,301.86,78,,241.488,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
ABDOMEN LIMITED,402001803,CDM,402,RC,76705,HCPCS,outpatient,,,675,472.5,,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,607.5,90,,486,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,521.24,77.22,,416.99,percent of total billed charges,77.22% of total billed charges,446.18,66.1,,356.94,percent of total billed charges,66.1% of total billed charges,560.25,83,,448.2,percent of total billed charges,83% of total,641.25,95,,513,percent of total billed charges ,95% of total billed charges,540,80,,432,percent of total billed charges,78% of total billed charges,526.5,78,,421.2,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,425.25,63,,340.2,percent of total billed charges,63% of total billed charges,573.75,85,,459,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,533.25,79,,426.6,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,641.25,
US PELVIS LIMITED (NON OB),402001804,CDM,402,RC,76857,HCPCS,outpatient,,,424,296.8,,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,381.6,90,,305.28,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,327.41,77.22,,261.93,percent of total billed charges,77.22% of total billed charges,280.26,66.1,,224.21,percent of total billed charges,66.1% of total billed charges,351.92,83,,281.54,percent of total billed charges,83% of total,402.8,95,,322.24,percent of total billed charges ,95% of total billed charges,339.2,80,,271.36,percent of total billed charges,78% of total billed charges,330.72,78,,264.576,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US OB TRANSVAGINAL < 14 WEEKS,402001805,CDM,402,RC,76817,HCPCS,outpatient,,,449,314.3,,354.71,79,,283.77,percent of total billed charges,79% of total billed charges,404.1,90,,323.28,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,282.87,63,,226.3,percent of total billed charges,63% of total billed charges,346.72,77.22,,277.38,percent of total billed charges,77.22% of total billed charges,296.79,66.1,,237.43,percent of total billed charges,66.1% of total billed charges,372.67,83,,298.14,percent of total billed charges,83% of total,426.55,95,,341.24,percent of total billed charges ,95% of total billed charges,359.2,80,,287.36,percent of total billed charges,78% of total billed charges,350.22,78,,280.176,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,282.87,63,,226.3,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,282.87,63,,226.3,percent of total billed charges,63% of total billed charges,381.65,85,,305.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,354.71,79,,283.77,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
US OB 1ST TRI TRANABD <14 WKS,402001806,CDM,402,RC,76801,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,493.05,
US OB ADD FETUS 1ST TRI <14 WK,402001807,CDM,402,RC,76802,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179.55,450,
US OB COMPLETE,402001808,CDM,402,RC,76811,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,493.05,
US OB COMPLETE 2ND FETUS EA AD,402001809,CDM,402,RC,76812,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.53,63,,166.82,percent of total billed charges,63% of total billed charges,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,218.79,66.1,,175.03,percent of total billed charges,66.1% of total billed charges,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,208.53,63,,166.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,208.53,63,,166.82,percent of total billed charges,63% of total billed charges,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,208.53,450,
US OB 2-3RD TANSABD >14WKS,402001810,CDM,402,RC,76805,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,493.05,
US OB GEST LTD 2-3 TRI EA ADDL,402001811,CDM,402,RC,76810,HCPCS,outpatient,,,331,231.7,,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,297.9,90,,238.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.53,63,,166.82,percent of total billed charges,63% of total billed charges,255.6,77.22,,204.48,percent of total billed charges,77.22% of total billed charges,218.79,66.1,,175.03,percent of total billed charges,66.1% of total billed charges,274.73,83,,219.78,percent of total billed charges,83% of total,314.45,95,,251.56,percent of total billed charges ,95% of total billed charges,264.8,80,,211.84,percent of total billed charges,78% of total billed charges,258.18,78,,206.544,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,208.53,63,,166.82,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,208.53,63,,166.82,percent of total billed charges,63% of total billed charges,281.35,85,,225.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,261.49,79,,209.19,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,208.53,450,
US OB LTD 1 OR MORE,402001812,CDM,402,RC,76815,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,493.05,
RENAL SONOGRAM LIMITED,402001816,CDM,402,RC,76775,HCPCS,outpatient,,,360,252,,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,277.99,77.22,,222.39,percent of total billed charges,77.22% of total billed charges,237.96,66.1,,190.37,percent of total billed charges,66.1% of total billed charges,298.8,83,,239.04,percent of total billed charges,83% of total,342,95,,273.6,percent of total billed charges ,95% of total billed charges,288,80,,230.4,percent of total billed charges,78% of total billed charges,280.8,78,,224.64,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
US NEEDLE LOCALIZATION LT,402001817,CDM,402,RC,76942,HCPCS,outpatient,,,898,628.6,,709.42,79,,567.54,percent of total billed charges,79% of total billed charges,808.2,90,,646.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,693.44,77.22,,554.75,percent of total billed charges,77.22% of total billed charges,593.58,66.1,,474.86,percent of total billed charges,66.1% of total billed charges,745.34,83,,596.27,percent of total billed charges,83% of total,853.1,95,,682.48,percent of total billed charges ,95% of total billed charges,718.4,80,,574.72,percent of total billed charges,78% of total billed charges,700.44,78,,560.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,808.2,90,,646.56,percent of total billed charges,90% of total billed charges,718.4,80,,574.72,percent of total billed charges,80% of total billed charges,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,763.3,85,,610.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,709.42,79,,567.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,853.1,
US NEEDLE LOCALIZATION RT,402001819,CDM,402,RC,76942,HCPCS,outpatient,,,898,628.6,,709.42,79,,567.54,percent of total billed charges,79% of total billed charges,808.2,90,,646.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,693.44,77.22,,554.75,percent of total billed charges,77.22% of total billed charges,593.58,66.1,,474.86,percent of total billed charges,66.1% of total billed charges,745.34,83,,596.27,percent of total billed charges,83% of total,853.1,95,,682.48,percent of total billed charges ,95% of total billed charges,718.4,80,,574.72,percent of total billed charges,78% of total billed charges,700.44,78,,560.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,808.2,90,,646.56,percent of total billed charges,90% of total billed charges,718.4,80,,574.72,percent of total billed charges,80% of total billed charges,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,763.3,85,,610.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,709.42,79,,567.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,853.1,
US THORACENTE W IMAGE CATH/NEE,402001822,CDM,402,RC,32555,HCPCS,outpatient,,,1908,1335.6,,1507.32,79,,1205.86,percent of total billed charges,79% of total billed charges,1717.2,90,,1373.76,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,1202.04,63,,961.63,percent of total billed charges,63% of total billed charges,1473.36,77.22,,1178.69,percent of total billed charges,77.22% of total billed charges,1261.19,66.1,,1008.95,percent of total billed charges,66.1% of total billed charges,1583.64,83,,1266.91,percent of total billed charges,83% of total,1812.6,95,,1450.08,percent of total billed charges ,95% of total billed charges,1526.4,80,,1221.12,percent of total billed charges,78% of total billed charges,1488.24,78,,1190.592,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,1202.04,63,,961.63,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,1717.2,90,,1373.76,percent of total billed charges,90% of total billed charges,1526.4,80,,1221.12,percent of total billed charges,80% of total billed charges,1202.04,63,,961.63,percent of total billed charges,63% of total billed charges,1621.8,85,,1297.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,1507.32,79,,1205.86,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1812.6,
US PARACENTE W/ IMAGING ABDOMI,402001823,CDM,402,RC,49083,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
ULTRASOUND CHEST SUPERFICIAL,402001829,CDM,402,RC,76604,HCPCS,outpatient,,,408,285.6,,322.32,79,,257.86,percent of total billed charges,79% of total billed charges,367.2,90,,293.76,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,257.04,63,,205.63,percent of total billed charges,63% of total billed charges,315.06,77.22,,252.05,percent of total billed charges,77.22% of total billed charges,269.69,66.1,,215.75,percent of total billed charges,66.1% of total billed charges,338.64,83,,270.91,percent of total billed charges,83% of total,387.6,95,,310.08,percent of total billed charges ,95% of total billed charges,326.4,80,,261.12,percent of total billed charges,78% of total billed charges,318.24,78,,254.592,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,257.04,63,,205.63,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,367.2,90,,293.76,percent of total billed charges,90% of total billed charges,326.4,80,,261.12,percent of total billed charges,80% of total billed charges,257.04,63,,205.63,percent of total billed charges,63% of total billed charges,346.8,85,,277.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,322.32,79,,257.86,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
ULTRASOUND UNLISTED PROC DIAG,402001830,CDM,402,RC,76999,HCPCS,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,450,
ULTRASOUND SPINAL CANAL,402001831,CDM,402,RC,76800,HCPCS,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
US GUIDANCE ADDTION CYST,402001832,CDM,402,RC,76942,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,423.94,77.22,,339.15,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,345.87,521.55,
UPPER EXTREM BILATERAL INFANT,402001834,CDM,402,RC,76885,HCPCS,outpatient,,,716,501.2,,565.64,79,,452.51,percent of total billed charges,79% of total billed charges,644.4,90,,515.52,percent of total billed charges,90% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,121.57,160,,,Fee Schedule,160% of CMS OPPS rate,98.77,130,,,Fee Schedule,130% of CMS OPPS rate,451.08,63,,360.86,percent of total billed charges,63% of total billed charges,552.9,77.22,,442.32,percent of total billed charges,77.22% of total billed charges,473.28,66.1,,378.62,percent of total billed charges,66.1% of total billed charges,594.28,83,,475.42,percent of total billed charges,83% of total,680.2,95,,544.16,percent of total billed charges ,95% of total billed charges,572.8,80,,458.24,percent of total billed charges,78% of total billed charges,558.48,78,,446.784,percent of total billed charges,78% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,451.08,63,,360.86,percent of total billed charges,63% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,644.4,90,,515.52,percent of total billed charges,90% of total billed charges,572.8,80,,458.24,percent of total billed charges,80% of total billed charges,451.08,63,,360.86,percent of total billed charges,63% of total billed charges,608.6,85,,486.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,70.66,93,,,fee schedule,93% of CMS OPPS rate,565.64,79,,452.51,percent of total billed charges,79% of total billed charges,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,75.98,100,,,Fee Schedule,100% of CMS OPPS rate,70.66,680.2,
ECHOGRAPHY NONVASCULAR COMP,402001835,CDM,402,RC,76881,HCPCS,outpatient,,,646,452.2,,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,581.4,90,,465.12,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,406.98,63,,325.58,percent of total billed charges,63% of total billed charges,498.84,77.22,,399.07,percent of total billed charges,77.22% of total billed charges,427.01,66.1,,341.61,percent of total billed charges,66.1% of total billed charges,536.18,83,,428.94,percent of total billed charges,83% of total,613.7,95,,490.96,percent of total billed charges ,95% of total billed charges,516.8,80,,413.44,percent of total billed charges,78% of total billed charges,503.88,78,,403.104,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,406.98,63,,325.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,406.98,63,,325.58,percent of total billed charges,63% of total billed charges,549.1,85,,439.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,510.34,79,,408.27,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,613.7,
ULTRASOUND GUIDANCE,402001837,CDM,402,RC,76942,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,423.94,77.22,,339.15,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,345.87,521.55,
ULTRASOUND GUIDANCE ASPIRATION,402001838,CDM,402,RC,76942,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,423.94,77.22,,339.15,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,345.87,521.55,
US NEEDLE LOCALIZATION  BILAT,402001839,CDM,402,RC,76942,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,423.94,77.22,,339.15,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,345.87,521.55,
US BUTTOCK-SUPERFICIAL,402001840,CDM,402,RC,76857,HCPCS,outpatient,,,424,296.8,,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,381.6,90,,305.28,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,327.41,77.22,,261.93,percent of total billed charges,77.22% of total billed charges,280.26,66.1,,224.21,percent of total billed charges,66.1% of total billed charges,351.92,83,,281.54,percent of total billed charges,83% of total,402.8,95,,322.24,percent of total billed charges ,95% of total billed charges,339.2,80,,271.36,percent of total billed charges,78% of total billed charges,330.72,78,,264.576,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,267.12,63,,213.7,percent of total billed charges,63% of total billed charges,360.4,85,,288.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,334.96,79,,267.97,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US TRANSRECTAL ULTRASOUND,402001842,CDM,402,RC,76872,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,493.05,
US BIOPHYS PROF WO NONSTRESS T,402001849,CDM,402,RC,76819,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,493.05,
PLAC BRST LOC DEV LT 1ST LESIO,402001850,CDM,402,RC,19285,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,941.29,160,,,Fee Schedule,160% of CMS OPPS rate,764.8,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1254.05,77.22,,1003.24,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,450,1542.8,
PLAC BRST LOC DEV RT 1ST LESIO,402001851,CDM,402,RC,19285,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,941.29,160,,,Fee Schedule,160% of CMS OPPS rate,764.8,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1254.05,77.22,,1003.24,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,450,1542.8,
PLACE BRST LOC DEVI BI 1STLES,402001852,CDM,402,RC,19285,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,941.29,160,,,Fee Schedule,160% of CMS OPPS rate,764.8,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1254.05,77.22,,1003.24,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,588.3,100,,,Fee Schedule,100% of CMS OPPS rate,450,1542.8,
US 2ND FETAL BIOPHY PRF WO NST,402001856,CDM,402,RC,76819,HCPCS,outpatient,,,288,201.6,,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,259.2,90,,207.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,222.39,77.22,,177.91,percent of total billed charges,77.22% of total billed charges,190.37,66.1,,152.3,percent of total billed charges,66.1% of total billed charges,239.04,83,,191.23,percent of total billed charges,83% of total,273.6,95,,218.88,percent of total billed charges ,95% of total billed charges,230.4,80,,184.32,percent of total billed charges,78% of total billed charges,224.64,78,,179.712,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,181.44,63,,145.15,percent of total billed charges,63% of total billed charges,244.8,85,,195.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,227.52,79,,182.02,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US RETROPERITONEAL LTD,402001860,CDM,402,RC,76775,HCPCS,outpatient,,,360,252,,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,277.99,77.22,,222.39,percent of total billed charges,77.22% of total billed charges,237.96,66.1,,190.37,percent of total billed charges,66.1% of total billed charges,298.8,83,,239.04,percent of total billed charges,83% of total,342,95,,273.6,percent of total billed charges ,95% of total billed charges,288,80,,230.4,percent of total billed charges,78% of total billed charges,280.8,78,,224.64,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
US LYMPH NODE BIOPSY W GUID CP,402038505,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
US AAA SCREENING ABDOMINAL,402076706,CDM,402,RC,76706,HCPCS,outpatient,,,282,197.4,,222.78,79,,178.22,percent of total billed charges,79% of total billed charges,253.8,90,,203.04,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,177.66,63,,142.13,percent of total billed charges,63% of total billed charges,217.76,77.22,,174.21,percent of total billed charges,77.22% of total billed charges,186.4,66.1,,149.12,percent of total billed charges,66.1% of total billed charges,234.06,83,,187.25,percent of total billed charges,83% of total,267.9,95,,214.32,percent of total billed charges ,95% of total billed charges,225.6,80,,180.48,percent of total billed charges,78% of total billed charges,219.96,78,,175.968,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,177.66,63,,142.13,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,177.66,63,,142.13,percent of total billed charges,63% of total billed charges,239.7,85,,191.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,222.78,79,,178.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US EXTREM NON VASCULAR,402076882,CDM,402,RC,76882,HCPCS,outpatient,,,397,277.9,,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,306.56,77.22,,245.25,percent of total billed charges,77.22% of total billed charges,262.42,66.1,,209.94,percent of total billed charges,66.1% of total billed charges,329.51,83,,263.61,percent of total billed charges,83% of total,377.15,95,,301.72,percent of total billed charges ,95% of total billed charges,317.6,80,,254.08,percent of total billed charges,78% of total billed charges,309.66,78,,247.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
THYROID SONOGRAM CP,402080526,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CYST ASPIRATION CP,402080527,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
US NEEDLE LOCALIZA COMP LT CP,402080528,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
US NEEDLE LOC ADD LESIO LT CP,402080531,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
US NEEDLE LOC ADD LESI RT CP,402080532,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
US ADD FETUS 1ST TRIMESTER,402080533,CDM,402,RC,,,outpatient,,,628,439.6,,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,484.94,77.22,,387.95,percent of total billed charges,77.22% of total billed charges,415.11,66.1,,332.09,percent of total billed charges,66.1% of total billed charges,521.24,83,,416.99,percent of total billed charges,83% of total,596.6,95,,477.28,percent of total billed charges ,95% of total billed charges,502.4,80,,401.92,percent of total billed charges,78% of total billed charges,489.84,78,,391.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,565.2,90,,452.16,percent of total billed charges,90% of total billed charges,502.4,80,,401.92,percent of total billed charges,80% of total billed charges,395.64,63,,316.51,percent of total billed charges,63% of total billed charges,533.8,85,,427.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,496.12,79,,396.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,395.64,596.6,
ADD CYST GUIDANCE/ASPIRAT CP,402080534,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
US LIVER BIOPSY & GUIDANCE  CP,402080535,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ULTRASOUND GUIDANCE ASPIRA CP,402080537,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PLACM BREAST LOCAL DEVIC LT CP,402080539,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PLACM BREAST LOCAL DEVIC RT CP,402080540,CDM,402,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
US PL BRST DEV AD LES LT EA AD,402080542,CDM,402,RC,19286,HCPCS,outpatient,,,1348,943.6,,1064.92,79,,851.94,percent of total billed charges,79% of total billed charges,1213.2,90,,970.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.24,63,,679.39,percent of total billed charges,63% of total billed charges,1040.93,77.22,,832.74,percent of total billed charges,77.22% of total billed charges,891.03,66.1,,712.82,percent of total billed charges,66.1% of total billed charges,1118.84,83,,895.07,percent of total billed charges,83% of total,1280.6,95,,1024.48,percent of total billed charges ,95% of total billed charges,1078.4,80,,862.72,percent of total billed charges,78% of total billed charges,1051.44,78,,841.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,849.24,63,,679.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,849.24,63,,679.39,percent of total billed charges,63% of total billed charges,1145.8,85,,916.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1064.92,79,,851.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1280.6,
US PL BRST DEV AD LES RT EA/AD,402080543,CDM,402,RC,19286,HCPCS,outpatient,,,1348,943.6,,1064.92,79,,851.94,percent of total billed charges,79% of total billed charges,1213.2,90,,970.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.24,63,,679.39,percent of total billed charges,63% of total billed charges,1040.93,77.22,,832.74,percent of total billed charges,77.22% of total billed charges,891.03,66.1,,712.82,percent of total billed charges,66.1% of total billed charges,1118.84,83,,895.07,percent of total billed charges,83% of total,1280.6,95,,1024.48,percent of total billed charges ,95% of total billed charges,1078.4,80,,862.72,percent of total billed charges,78% of total billed charges,1051.44,78,,841.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,849.24,63,,679.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,849.24,63,,679.39,percent of total billed charges,63% of total billed charges,1145.8,85,,916.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1064.92,79,,851.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1280.6,
OB PORTABLE US LIMITED,402091812,CDM,402,RC,76815,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,493.05,
"OBS US EXAM,PG.UTERUS,COMPL",762076805,CDM,402,RC,76805,HCPCS,outpatient,,,519,363.3,,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,467.1,90,,373.68,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,400.77,77.22,,320.62,percent of total billed charges,77.22% of total billed charges,343.06,66.1,,274.45,percent of total billed charges,66.1% of total billed charges,430.77,83,,344.62,percent of total billed charges,83% of total,493.05,95,,394.44,percent of total billed charges ,95% of total billed charges,415.2,80,,332.16,percent of total billed charges,78% of total billed charges,404.82,78,,323.856,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.97,63,,261.58,percent of total billed charges,63% of total billed charges,441.15,85,,352.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,410.01,79,,328.01,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,493.05,
OBS ECHO GUIDE FOR BIOPSY,762076942,CDM,402,RC,76942,HCPCS,outpatient,,,1308,915.6,,1033.32,79,,826.66,percent of total billed charges,79% of total billed charges,1177.2,90,,941.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,824.04,63,,659.23,percent of total billed charges,63% of total billed charges,1010.04,77.22,,808.03,percent of total billed charges,77.22% of total billed charges,864.59,66.1,,691.67,percent of total billed charges,66.1% of total billed charges,1085.64,83,,868.51,percent of total billed charges,83% of total,1242.6,95,,994.08,percent of total billed charges ,95% of total billed charges,1046.4,80,,837.12,percent of total billed charges,78% of total billed charges,1020.24,78,,816.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,824.04,63,,659.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1177.2,90,,941.76,percent of total billed charges,90% of total billed charges,1046.4,80,,837.12,percent of total billed charges,80% of total billed charges,824.04,63,,659.23,percent of total billed charges,63% of total billed charges,1111.8,85,,889.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1033.32,79,,826.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1242.6,
SCREENING MAMMO W 3D BILAT CP,403000770,CDM,403,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SCREENING UNILATERAL RIGHT,403001895,CDM,403,RC,77061,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,194.04,450,
SCREENING UNILATERAL LEFT,403001896,CDM,403,RC,77061,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,194.04,450,
MAMMO SCREEN OCTOBER SPECIAL,403001897,CDM,403,RC,77067,HCPCS,outpatient,,,513,359.1,,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,461.7,90,,369.36,percent of total billed charges,90% of total billed charges,81.27,100,,,fee schedule,100% of CMS fee schedule,130.03,160,,,fee schedule,160% of CMS fee schedule,105.65,130,,,fee schedule,130% of CMS fee schedule,323.19,63,,258.55,percent of total billed charges,63% of total billed charges,396.14,77.22,,316.91,percent of total billed charges,77.22% of total billed charges,339.09,66.1,,271.27,percent of total billed charges,66.1% of total billed charges,425.79,83,,340.63,percent of total billed charges,83% of total,487.35,95,,389.88,percent of total billed charges ,95% of total billed charges,410.4,80,,328.32,percent of total billed charges,78% of total billed charges,400.14,78,,320.112,percent of total billed charges,78% of total billed charges,81.27,100,,,fee schedule,100% of CMS fee schedule,323.19,63,,258.55,percent of total billed charges,63% of total billed charges,81.27,100,,,fee schedule ,100% of CMS fee schedule,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,323.19,63,,258.55,percent of total billed charges,63% of total billed charges,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,75.58,93,,,fee schedule,93% of CMS fee schedule,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,81.27,100,,,fee schedule,100% of CMS fee schedule,81.27,100,,,fee schedule,100% of CMS fee schedule,75.58,487.35,
SCREENING DIG BREAST TOMO BILA,403077063,CDM,403,RC,77063,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,21.11,100,,,fee schedule,100% of CMS fee schedule,33.78,160,,,fee schedule,160% of CMS fee schedule,27.44,130,,,fee schedule,130% of CMS fee schedule,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,21.11,100,,,fee schedule,100% of CMS fee schedule,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,21.11,100,,,fee schedule ,100% of CMS 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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.63,93,,,fee schedule,93% of CMS fee schedule,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,21.11,100,,,fee schedule,100% of CMS fee schedule,21.11,100,,,fee schedule,100% of CMS fee schedule,19.63,450,
MAMMO SCREENING BILATERAL,403077067,CDM,403,RC,77067,HCPCS,outpatient,,,513,359.1,,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,461.7,90,,369.36,percent of total billed charges,90% of total billed charges,81.27,100,,,fee schedule,100% of CMS fee schedule,130.03,160,,,fee schedule,160% of CMS fee schedule,105.65,130,,,fee schedule,130% of CMS fee schedule,323.19,63,,258.55,percent of total billed charges,63% of total billed charges,396.14,77.22,,316.91,percent of total billed charges,77.22% of total billed charges,339.09,66.1,,271.27,percent of total billed charges,66.1% of total billed charges,425.79,83,,340.63,percent of total billed charges,83% of total,487.35,95,,389.88,percent of total billed charges ,95% of total billed charges,410.4,80,,328.32,percent of total billed charges,78% of total billed charges,400.14,78,,320.112,percent of total billed charges,78% of total billed charges,81.27,100,,,fee schedule,100% of CMS fee schedule,323.19,63,,258.55,percent of total billed charges,63% of total billed charges,81.27,100,,,fee schedule ,100% of CMS fee schedule,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,323.19,63,,258.55,percent of total billed charges,63% of total billed charges,436.05,85,,348.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,75.58,93,,,fee schedule,93% of CMS fee schedule,405.27,79,,324.22,percent of total billed charges,79% of total billed charges,81.27,100,,,fee schedule,100% of CMS fee schedule,81.27,100,,,fee schedule,100% of CMS fee schedule,75.58,487.35,
INHALATION SYST & MGMT INITIAL,410000612,CDM,410,RC,94002,HCPCS,outpatient,,,916,641.2,,723.64,79,,578.91,percent of total billed charges,79% of total billed charges,824.4,90,,659.52,percent of total billed charges,90% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,838.38,160,,,Fee Schedule,160% of CMS OPPS rate,681.19,130,,,Fee Schedule,130% of CMS OPPS rate,577.08,63,,461.66,percent of total billed charges,63% of total billed charges,707.34,77.22,,565.87,percent of total billed charges,77.22% of total billed charges,605.48,66.1,,484.38,percent of total billed charges,66.1% of total billed charges,760.28,83,,608.22,percent of total billed charges,83% of total,870.2,95,,696.16,percent of total billed charges ,95% of total billed charges,732.8,80,,586.24,percent of total billed charges,78% of total billed charges,714.48,78,,571.584,percent of total billed charges,78% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,577.08,63,,461.66,percent of total billed charges,63% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,824.4,90,,659.52,percent of total billed charges,90% of total billed charges,732.8,80,,586.24,percent of total billed charges,80% of total billed charges,577.08,63,,461.66,percent of total billed charges,63% of total billed charges,778.6,85,,622.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,487.31,93,,,fee schedule,93% of CMS OPPS rate,723.64,79,,578.91,percent of total billed charges,79% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,450,870.2,
SVN RX,410000620,CDM,410,RC,94640,HCPCS,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
IPPB INITIAL,410000621,CDM,410,RC,94640,HCPCS,outpatient,,,368,257.6,,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,284.17,77.22,,227.34,percent of total billed charges,77.22% of total billed charges,243.25,66.1,,194.6,percent of total billed charges,66.1% of total billed charges,305.44,83,,244.35,percent of total billed charges,83% of total,349.6,95,,279.68,percent of total billed charges ,95% of total billed charges,294.4,80,,235.52,percent of total billed charges,78% of total billed charges,287.04,78,,229.632,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
IPPB SUBSEQUENT,410000622,CDM,410,RC,94640,HCPCS,outpatient,,,368,257.6,,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,284.17,77.22,,227.34,percent of total billed charges,77.22% of total billed charges,243.25,66.1,,194.6,percent of total billed charges,66.1% of total billed charges,305.44,83,,244.35,percent of total billed charges,83% of total,349.6,95,,279.68,percent of total billed charges ,95% of total billed charges,294.4,80,,235.52,percent of total billed charges,78% of total billed charges,287.04,78,,229.632,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
NEBULIZER/SVN NON-BILL,410000623,CDM,410,RC,94640,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS 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,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
MANIPULATE CHEST WALL INITIAL,410000625,CDM,410,RC,94667,HCPCS,outpatient,,,400,280,,316,79,,252.8,percent of total billed charges,79% of total billed charges,360,90,,288,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,252,63,,201.6,percent of total billed charges,63% of total billed charges,308.88,77.22,,247.1,percent of total billed charges,77.22% of total billed charges,264.4,66.1,,211.52,percent of total billed charges,66.1% of total billed charges,332,83,,265.6,percent of total billed charges,83% of total,380,95,,304,percent of total billed charges ,95% of total billed charges,320,80,,256,percent of total billed charges,78% of total billed charges,312,78,,249.6,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,252,63,,201.6,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,252,63,,201.6,percent of total billed charges,63% of total billed charges,340,85,,272,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,316,79,,252.8,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
MDI TX,410000629,CDM,410,RC,94640,HCPCS,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
ABG PUNCTURE,410000643,CDM,410,RC,36600,HCPCS,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,145.95,77.22,,116.76,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
PULSE OX SAT MULT NON-BILL,410000674,CDM,410,RC,94761,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ABG DETERMINATION COMP CHG CP,410000681,CDM,410,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MDI SUBSEQUENT TREATMENT,410000682,CDM,410,RC,94640,HCPCS,outpatient,,,368,257.6,,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,284.17,77.22,,227.34,percent of total billed charges,77.22% of total billed charges,243.25,66.1,,194.6,percent of total billed charges,66.1% of total billed charges,305.44,83,,244.35,percent of total billed charges,83% of total,349.6,95,,279.68,percent of total billed charges ,95% of total billed charges,294.4,80,,235.52,percent of total billed charges,78% of total billed charges,287.04,78,,229.632,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
BIPAP CPAP HFT AVAP INIT/MGMT,410000690,CDM,410,RC,94660,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,355.21,77.22,,284.17,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.85,93,,,fee schedule,93% of CMS OPPS rate,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.85,450,
INHALATION SYS & MGMT SUBSEQNT,410000691,CDM,410,RC,94003,HCPCS,outpatient,,,1377,963.9,,1087.83,79,,870.26,percent of total billed charges,79% of total billed charges,1239.3,90,,991.44,percent of total billed charges,90% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,838.38,160,,,Fee Schedule,160% of CMS OPPS rate,681.19,130,,,Fee Schedule,130% of CMS OPPS rate,867.51,63,,694.01,percent of total billed charges,63% of total billed charges,1063.32,77.22,,850.66,percent of total billed charges,77.22% of total billed charges,910.2,66.1,,728.16,percent of total billed charges,66.1% of total billed charges,1142.91,83,,914.33,percent of total billed charges,83% of total,1308.15,95,,1046.52,percent of total billed charges ,95% of total billed charges,1101.6,80,,881.28,percent of total billed charges,78% of total billed charges,1074.06,78,,859.248,percent of total billed charges,78% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,867.51,63,,694.01,percent of total billed charges,63% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,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,867.51,63,,694.01,percent of total billed charges,63% of total billed charges,1170.45,85,,936.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,487.31,93,,,fee schedule,93% of CMS OPPS rate,1087.83,79,,870.26,percent of total billed charges,79% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,450,1308.15,
BIPAP SUBSEQUENT,410000692,CDM,410,RC,94662,HCPCS,outpatient,,,1059,741.3,,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,838.38,160,,,Fee Schedule,160% of CMS OPPS rate,681.19,130,,,Fee Schedule,130% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,817.76,77.22,,654.21,percent of total billed charges,77.22% of total billed charges,700,66.1,,560,percent of total billed charges,66.1% of total billed charges,878.97,83,,703.18,percent of total billed charges,83% of total,1006.05,95,,804.84,percent of total billed charges ,95% of total billed charges,847.2,80,,677.76,percent of total billed charges,78% of total billed charges,826.02,78,,660.816,percent of total billed charges,78% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,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,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,487.31,93,,,fee schedule,93% of CMS OPPS rate,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,450,1006.05,
NON-BILLABLE CHARGE RT,410005555,CDM,410,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CONTINUOUS NEB TREATMENT,410006602,CDM,410,RC,94644,HCPCS,outpatient,,,202,141.4,,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,181.8,90,,145.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,155.98,77.22,,124.78,percent of total billed charges,77.22% of total billed charges,133.52,66.1,,106.82,percent of total billed charges,66.1% of total billed charges,167.66,83,,134.13,percent of total billed charges,83% of total,191.9,95,,153.52,percent of total billed charges ,95% of total billed charges,161.6,80,,129.28,percent of total billed charges,78% of total billed charges,157.56,78,,126.048,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,127.26,63,,101.81,percent of total billed charges,63% of total billed charges,171.7,85,,137.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,159.58,79,,127.66,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
CONTINUOUS NEB >1 HOUR,410006603,CDM,410,RC,94645,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.44,63,,94.75,percent of total billed charges,63% of total billed charges,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,124.27,66.1,,99.42,percent of total billed charges,66.1% of total billed charges,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,118.44,63,,94.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,118.44,63,,94.75,percent of total billed charges,63% of total billed charges,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,118.44,450,
CONTINUOUS NEB TX NON-BILL,410006604,CDM,410,RC,94640,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS 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,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
EZ PAP TX NON-BILL,410006608,CDM,410,RC,94640,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS 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,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
EZ PAP TX,410006609,CDM,410,RC,94640,HCPCS,outpatient,,,368,257.6,,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,284.17,77.22,,227.34,percent of total billed charges,77.22% of total billed charges,243.25,66.1,,194.6,percent of total billed charges,66.1% of total billed charges,305.44,83,,244.35,percent of total billed charges,83% of total,349.6,95,,279.68,percent of total billed charges ,95% of total billed charges,294.4,80,,235.52,percent of total billed charges,78% of total billed charges,287.04,78,,229.632,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
CHANGE OF WINDPIPE AIRWAY,410031502,CDM,410,RC,31502,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,314.29,77.22,,251.43,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,450,
COMPLETE PFT  COMP CHG CP,410060000,CDM,410,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INITIAL SVN TX CP,410060001,CDM,410,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INITIAL EZ PAP TX,410060009,CDM,410,RC,94640,HCPCS,outpatient,,,368,257.6,,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,284.17,77.22,,227.34,percent of total billed charges,77.22% of total billed charges,243.25,66.1,,194.6,percent of total billed charges,66.1% of total billed charges,305.44,83,,244.35,percent of total billed charges,83% of total,349.6,95,,279.68,percent of total billed charges ,95% of total billed charges,294.4,80,,235.52,percent of total billed charges,78% of total billed charges,287.04,78,,229.632,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,231.84,63,,185.47,percent of total billed charges,63% of total billed charges,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
INITIAL EZ PAP TX/KIT CP,410060011,CDM,410,RC,94640,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS 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,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,165.86,450,
MDI TX & AEROCHAMBER CP,410060072,CDM,410,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
EXTERNAL TRANSPORT INITIAL DA,410060077,CDM,410,RC,94002,HCPCS,outpatient,,,916,641.2,,723.64,79,,578.91,percent of total billed charges,79% of total billed charges,824.4,90,,659.52,percent of total billed charges,90% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,838.38,160,,,Fee Schedule,160% of CMS OPPS rate,681.19,130,,,Fee Schedule,130% of CMS OPPS rate,577.08,63,,461.66,percent of total billed charges,63% of total billed charges,707.34,77.22,,565.87,percent of total billed charges,77.22% of total billed charges,605.48,66.1,,484.38,percent of total billed charges,66.1% of total billed charges,760.28,83,,608.22,percent of total billed charges,83% of total,870.2,95,,696.16,percent of total billed charges ,95% of total billed charges,732.8,80,,586.24,percent of total billed charges,78% of total billed charges,714.48,78,,571.584,percent of total billed charges,78% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,577.08,63,,461.66,percent of total billed charges,63% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,824.4,90,,659.52,percent of total billed charges,90% of total billed charges,732.8,80,,586.24,percent of total billed charges,80% of total billed charges,577.08,63,,461.66,percent of total billed charges,63% of total billed charges,778.6,85,,622.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,487.31,93,,,fee schedule,93% of CMS OPPS rate,723.64,79,,578.91,percent of total billed charges,79% of total billed charges,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,523.99,100,,,Fee Schedule,100% of CMS OPPS rate,450,870.2,
PHY QHP OP PULM RHB W/O MNTR,410094625,CDM,410,RC,94625,HCPCS,outpatient,,,303,212.1,,239.37,79,,191.5,percent of total billed charges,79% of total billed charges,272.7,90,,218.16,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.81,160,,,Fee Schedule,160% of CMS OPPS rate,66.48,130,,,Fee Schedule,130% of CMS OPPS rate,190.89,63,,152.71,percent of total billed charges,63% of total billed charges,233.98,77.22,,187.18,percent of total billed charges,77.22% of total billed charges,200.28,66.1,,160.22,percent of total billed charges,66.1% of total billed charges,251.49,83,,201.19,percent of total billed charges,83% of total,287.85,95,,230.28,percent of total billed charges ,95% of total billed charges,242.4,80,,193.92,percent of total billed charges,78% of total billed charges,236.34,78,,189.072,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,190.89,63,,152.71,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,190.89,63,,152.71,percent of total billed charges,63% of total billed charges,257.55,85,,206.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,239.37,79,,191.5,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
PHY QHP OP PULM RHB W MNTR,410094626,CDM,410,RC,94626,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.81,160,,,Fee Schedule,160% of CMS OPPS rate,66.48,130,,,Fee Schedule,130% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
"CHEST WALL MANIPULATION,SUBSEQ",410094667,CDM,410,RC,94668,HCPCS,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,187.64,77.22,,150.11,percent of total billed charges,77.22% of total billed charges,160.62,66.1,,128.5,percent of total billed charges,66.1% of total billed charges,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
BIPAP INITIAL CP,410094800,CDM,410,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HIGH FLOW THERAPY CP,410094900,CDM,410,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NEBULIZER TX,94640,CDM,410,RC,94640,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,37.8,450,
INHALATION TX FOR ACUTE AIRWAY,450094640,CDM,412,RC,94640,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,285.35,160,,,Fee Schedule,160% of CMS OPPS rate,231.84,130,,,Fee Schedule,130% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,168.34,77.22,,134.67,percent of total billed charges,77.22% of total billed charges,144.1,66.1,,115.28,percent of total billed charges,66.1% of total billed charges,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,165.86,93,,,fee schedule,93% of CMS OPPS rate,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,178.34,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,450,
APPLY UNNABOOT,29580P,CDM,420,RC,29580,HCPCS,outpatient,,,66,46.2,,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,59.4,90,,47.52,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,50.97,77.22,,40.78,percent of total billed charges,77.22% of total billed charges,43.63,66.1,,34.9,percent of total billed charges,66.1% of total billed charges,54.78,83,,43.82,percent of total billed charges,83% of total,62.7,95,,50.16,percent of total billed charges ,95% of total billed charges,52.8,80,,42.24,percent of total billed charges,78% of total billed charges,51.48,78,,41.184,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,41.58,63,,33.26,percent of total billed charges,63% of total billed charges,56.1,85,,44.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,52.14,79,,41.71,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,41.58,450,
APPLY UNNABOOT,29580T,CDM,420,RC,29580,HCPCS,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,65.44,66.1,,52.35,percent of total billed charges,66.1% of total billed charges,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,62.37,450,
PHYSICAL THERAPHY CONSULT,420000001,CDM,420,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NON-BILLABLE CHARGE PT,420005555,CDM,420,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CRYOTHERAPY,420020010,CDM,420,RC,97010,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,9.36,160,,,fee schedule,160% of CMS fee schedule,7.61,130,,,fee schedule,130% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,5.85,100,,,fee schedule ,100% of CMS 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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.44,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,5.85,100,,,fee schedule,100% of CMS fee schedule,5.44,450,
DIATHERMY,420020020,CDM,420,RC,97024,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,6.73,100,,,fee schedule,100% of CMS fee schedule,10.77,160,,,fee schedule,160% of CMS fee schedule,8.75,130,,,fee schedule,130% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,6.73,100,,,fee schedule,100% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,6.73,100,,,fee schedule ,100% of CMS 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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.26,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,6.73,100,,,fee schedule,100% of CMS fee schedule,6.73,100,,,fee schedule,100% of CMS fee schedule,6.26,450,
"AQUATIC THERPHY, EA 15 MINS",420020025,CDM,420,RC,97113,HCPCS,outpatient,,,211,147.7,,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,34.2,100,,,fee schedule,100% of CMS fee schedule,54.72,160,,,fee schedule,160% of CMS fee schedule,44.46,130,,,fee schedule,130% of CMS fee schedule,132.93,63,,106.34,percent of total billed charges,63% of total billed charges,162.93,77.22,,130.34,percent of total billed charges,77.22% of total billed charges,139.47,66.1,,111.58,percent of total billed charges,66.1% of total billed charges,175.13,83,,140.1,percent of total billed charges,83% of total,200.45,95,,160.36,percent of total billed charges ,95% of total billed charges,168.8,80,,135.04,percent of total billed charges,78% of total billed charges,164.58,78,,131.664,percent of total billed charges,78% of total billed charges,34.2,100,,,fee schedule,100% of CMS fee schedule,132.93,63,,106.34,percent of total billed charges,63% of total billed charges,34.2,100,,,fee schedule ,100% of CMS 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,132.93,63,,106.34,percent of total billed charges,63% of total billed charges,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.81,93,,,fee schedule,93% of CMS fee schedule,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,34.2,100,,,fee schedule,100% of CMS fee schedule,34.2,100,,,fee schedule,100% of CMS fee schedule,31.81,450,
"E-STIM, UNATTENDED",420020030,CDM,420,RC,97014,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.34,450,
MECHANICAL LUMB TRACTION,420020039,CDM,420,RC,97012,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,13.35,100,,,fee schedule,100% of CMS fee schedule,21.36,160,,,fee schedule,160% of CMS fee schedule,17.36,130,,,fee schedule,130% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,13.35,100,,,fee schedule,100% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,13.35,100,,,fee schedule ,100% of CMS 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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.42,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,13.35,100,,,fee schedule,100% of CMS fee schedule,13.35,100,,,fee schedule,100% of CMS fee schedule,12.42,450,
MECHANICAL CERVICAL TRACTION,420020040,CDM,420,RC,97012,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,13.35,100,,,fee schedule,100% of CMS fee schedule,21.36,160,,,fee schedule,160% of CMS fee schedule,17.36,130,,,fee schedule,130% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,13.35,100,,,fee schedule,100% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,13.35,100,,,fee schedule ,100% of CMS 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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.42,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,13.35,100,,,fee schedule,100% of CMS fee schedule,13.35,100,,,fee schedule,100% of CMS fee schedule,12.42,450,
MOIST HEAT PACKS,420020060,CDM,420,RC,97010,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,9.36,160,,,fee schedule,160% of CMS fee schedule,7.61,130,,,fee schedule,130% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,5.85,100,,,fee schedule ,100% of CMS 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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.44,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,5.85,100,,,fee schedule,100% of CMS fee schedule,5.44,450,
PARAFFIN BATH,420020070,CDM,420,RC,97018,HCPCS,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,5.26,100,,,fee schedule,100% of CMS fee schedule,8.42,160,,,fee schedule,160% of CMS fee schedule,6.84,130,,,fee schedule,130% of CMS fee schedule,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,5.26,100,,,fee schedule,100% of CMS fee schedule,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,5.26,100,,,fee schedule ,100% of CMS 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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.89,93,,,fee schedule,93% of CMS fee schedule,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,5.26,100,,,fee schedule,100% of CMS fee schedule,5.26,100,,,fee schedule,100% of CMS fee schedule,4.89,450,
"ULTRASOUND W TOPICAL,EA 15 MIN",420020080,CDM,420,RC,97035,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,13.19,100,,,fee schedule ,100% of CMS 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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"IONTOPHORESIS, EA 15 MINS",420020090,CDM,420,RC,97033,HCPCS,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,18.08,100,,,fee schedule,100% of CMS fee schedule,28.93,160,,,fee schedule,160% of CMS fee schedule,23.5,130,,,fee schedule,130% of CMS fee schedule,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,18.08,100,,,fee schedule,100% of CMS fee schedule,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,18.08,100,,,fee schedule ,100% of CMS 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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.81,93,,,fee schedule,93% of CMS fee schedule,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,18.08,100,,,fee schedule,100% of CMS fee schedule,18.08,100,,,fee schedule,100% of CMS fee schedule,16.81,450,
"ULTRASOUND THERAPY, EA 15 MINS",420020100,CDM,420,RC,97035,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,13.19,100,,,fee schedule ,100% of CMS 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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
VASOPNEUMATIC DEVICE,420020140,CDM,420,RC,97016,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,11.02,100,,,fee schedule,100% of CMS fee schedule,17.63,160,,,fee schedule,160% of CMS fee schedule,14.33,130,,,fee schedule,130% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,11.02,100,,,fee schedule,100% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,11.02,100,,,fee schedule ,100% of CMS 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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.25,93,,,fee schedule,93% of CMS fee schedule,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,11.02,100,,,fee schedule,100% of CMS fee schedule,11.02,100,,,fee schedule,100% of CMS fee schedule,10.25,450,
BIOFEEDBACK,420020150,CDM,420,RC,90901,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,18.42,100,,,fee schedule,100% of CMS fee schedule,29.47,160,,,fee schedule,160% of CMS fee schedule,23.95,130,,,fee schedule,130% of CMS fee schedule,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,104.44,66.1,,83.55,percent of total billed charges,66.1% of total billed charges,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,18.42,100,,,fee schedule,100% of CMS fee schedule,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,18.42,100,,,fee schedule ,100% of CMS 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,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.13,93,,,fee schedule,93% of CMS fee schedule,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,18.42,100,,,fee schedule,100% of CMS fee schedule,18.42,100,,,fee schedule,100% of CMS fee schedule,17.13,450,
"SENSORY INTEGRATION,EA 15 MINS",420020345,CDM,420,RC,97533,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,56.78,100,,,fee schedule,100% of CMS fee schedule,90.85,160,,,fee schedule,160% of CMS fee schedule,73.81,130,,,fee schedule,130% of CMS fee schedule,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,56.78,100,,,fee schedule,100% of CMS fee schedule,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,56.78,100,,,fee schedule ,100% of CMS 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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,52.81,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,56.78,100,,,fee schedule,100% of CMS fee schedule,56.78,100,,,fee schedule,100% of CMS fee schedule,52.81,450,
"E-STIM, MANUAL, EA 15 MINS",420020450,CDM,420,RC,97032,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,13.64,100,,,fee schedule,100% of CMS fee schedule,21.82,160,,,fee schedule,160% of CMS fee schedule,17.73,130,,,fee schedule,130% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,13.64,100,,,fee schedule,100% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,13.64,100,,,fee schedule ,100% of CMS 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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.69,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,13.64,100,,,fee schedule,100% of CMS fee schedule,13.64,100,,,fee schedule,100% of CMS fee schedule,12.69,450,
PT NEEDLE INSERT 1-2 MUSCLES,420020560,CDM,420,RC,20560,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,23.15,450,
PT NEEDLE INSERT 3 OR > MUSCLE,420020561,CDM,420,RC,20561,HCPCS,outpatient,,,60,42,,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,54,90,,43.2,percent of total billed charges,90% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,39.83,160,,,Fee Schedule,160% of CMS OPPS rate,32.36,130,,,Fee Schedule,130% of CMS OPPS rate,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,46.33,77.22,,37.06,percent of total billed charges,77.22% of total billed charges,39.66,66.1,,31.73,percent of total billed charges,66.1% of total billed charges,49.8,83,,39.84,percent of total billed charges,83% of total,57,95,,45.6,percent of total billed charges ,95% of total billed charges,48,80,,38.4,percent of total billed charges,78% of total billed charges,46.8,78,,37.44,percent of total billed charges,78% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,37.8,63,,30.24,percent of total billed charges,63% of total billed charges,51,85,,40.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.15,93,,,fee schedule,93% of CMS OPPS rate,47.4,79,,37.92,percent of total billed charges,79% of total billed charges,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,24.89,100,,,Fee Schedule,100% of CMS OPPS rate,23.15,450,
"MANUAL THERAPY, EA 15 MINS",420020686,CDM,420,RC,97140,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,25.5,100,,,fee schedule,100% of CMS fee schedule,40.8,160,,,fee schedule,160% of CMS fee schedule,33.15,130,,,fee schedule,130% of CMS fee schedule,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,97.83,66.1,,78.26,percent of total billed charges,66.1% of total billed charges,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,25.5,100,,,fee schedule,100% of CMS fee schedule,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,25.5,100,,,fee schedule ,100% of CMS 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,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.72,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,25.5,100,,,fee schedule,100% of CMS fee schedule,25.5,100,,,fee schedule,100% of CMS fee schedule,23.72,450,
ROM MEASUREMENT EXTREMITY/SPIN,420020795,CDM,420,RC,95851,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,7.42,100,,,fee schedule,100% of CMS fee schedule,11.87,160,,,fee schedule,160% of CMS fee schedule,9.65,130,,,fee schedule,130% of CMS fee schedule,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,7.42,100,,,fee schedule,100% of CMS fee schedule,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,7.42,100,,,fee schedule ,100% of CMS 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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.9,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,7.42,100,,,fee schedule,100% of CMS fee schedule,7.42,100,,,fee schedule,100% of CMS fee schedule,6.9,450,
ROM MEASUREMENT HAND,420020796,CDM,420,RC,95852,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,8.27,160,,,fee schedule,160% of CMS fee schedule,6.72,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,5.17,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.81,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,5.17,100,,,fee schedule,100% of CMS fee schedule,4.81,450,
TAPING/STRAPPING ELBOW/WRIST,420020810,CDM,420,RC,29260,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
TAPING/STRAPPING LOW BACK,420020820,CDM,420,RC,29799,HCPCS,outpatient,,,267,186.9,,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,206.18,77.22,,164.94,percent of total billed charges,77.22% of total billed charges,176.49,66.1,,141.19,percent of total billed charges,66.1% of total billed charges,221.61,83,,177.29,percent of total billed charges,83% of total,253.65,95,,202.92,percent of total billed charges ,95% of total billed charges,213.6,80,,170.88,percent of total billed charges,78% of total billed charges,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
TAPING/STRAPPING SHOULDER,420020830,CDM,420,RC,29240,HCPCS,outpatient,,,227,158.9,,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,175.29,77.22,,140.23,percent of total billed charges,77.22% of total billed charges,150.05,66.1,,120.04,percent of total billed charges,66.1% of total billed charges,188.41,83,,150.73,percent of total billed charges,83% of total,215.65,95,,172.52,percent of total billed charges ,95% of total billed charges,181.6,80,,145.28,percent of total billed charges,78% of total billed charges,177.06,78,,141.648,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
TAPING/STRAPPIN HAND/FINGER,420020840,CDM,420,RC,29280,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
TAPING/STRAPPING HIP,420020850,CDM,420,RC,29520,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,87.91,66.1,,70.33,percent of total billed charges,66.1% of total billed charges,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,83.79,450,
TAPING/STRAPPING KNEE,420020860,CDM,420,RC,29530,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,168.34,77.22,,134.67,percent of total billed charges,77.22% of total billed charges,144.1,66.1,,115.28,percent of total billed charges,66.1% of total billed charges,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
TAPING/STRAPPING ANKLE,420020870,CDM,420,RC,29540,HCPCS,outpatient,,,267,186.9,,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,206.18,77.22,,164.94,percent of total billed charges,77.22% of total billed charges,176.49,66.1,,141.19,percent of total billed charges,66.1% of total billed charges,221.61,83,,177.29,percent of total billed charges,83% of total,253.65,95,,202.92,percent of total billed charges ,95% of total billed charges,213.6,80,,170.88,percent of total billed charges,78% of total billed charges,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
UNNA BOOT,420020881,CDM,420,RC,29580,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
APPLICATION SHORT ARM SPLINT,420020890,CDM,420,RC,29125,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
APPLICATION SHORT LEG SPLINT,420020893,CDM,420,RC,29515,HCPCS,outpatient,,,428,299.6,,338.12,79,,270.5,percent of total billed charges,79% of total billed charges,385.2,90,,308.16,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,330.5,77.22,,264.4,percent of total billed charges,77.22% of total billed charges,282.91,66.1,,226.33,percent of total billed charges,66.1% of total billed charges,355.24,83,,284.19,percent of total billed charges,83% of total,406.6,95,,325.28,percent of total billed charges ,95% of total billed charges,342.4,80,,273.92,percent of total billed charges,78% of total billed charges,333.84,78,,267.072,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,363.8,85,,291.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,338.12,79,,270.5,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
"WHEELCHAIR TRAINING,EA 15 MINS",420020965,CDM,420,RC,97542,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,47.68,160,,,fee schedule,160% of CMS fee schedule,38.74,130,,,fee schedule,130% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,29.8,100,,,fee schedule ,100% of CMS 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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.71,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,29.8,100,,,fee schedule,100% of CMS fee schedule,27.71,450,
WHEELCHAIR ASSESSMENT EA 15 MI,420020968,CDM,420,RC,97542,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,47.68,160,,,fee schedule,160% of CMS fee schedule,38.74,130,,,fee schedule,130% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,29.8,100,,,fee schedule ,100% of CMS 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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.71,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,29.8,100,,,fee schedule,100% of CMS fee schedule,27.71,450,
"THEREX, EACH 15 MINS",420021015,CDM,420,RC,97110,HCPCS,outpatient,,,165,115.5,,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,44.21,160,,,fee schedule,160% of CMS fee schedule,35.92,130,,,fee schedule,130% of CMS fee schedule,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,127.41,77.22,,101.93,percent of total billed charges,77.22% of total billed charges,109.07,66.1,,87.26,percent of total billed charges,66.1% of total billed charges,136.95,83,,109.56,percent of total billed charges,83% of total,156.75,95,,125.4,percent of total billed charges ,95% of total billed charges,132,80,,105.6,percent of total billed charges,78% of total billed charges,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,27.63,100,,,fee schedule ,100% of CMS 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,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.7,93,,,fee schedule,93% of CMS fee schedule,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,27.63,100,,,fee schedule,100% of CMS fee schedule,25.7,450,
"NEUROMUSCU REEDUCATION,15 MINS",420021067,CDM,420,RC,97112,HCPCS,outpatient,,,112,78.4,,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,31.64,100,,,fee schedule,100% of CMS fee schedule,50.62,160,,,fee schedule,160% of CMS fee schedule,41.13,130,,,fee schedule,130% of CMS fee schedule,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,86.49,77.22,,69.19,percent of total billed charges,77.22% of total billed charges,74.03,66.1,,59.22,percent of total billed charges,66.1% of total billed charges,92.96,83,,74.37,percent of total billed charges,83% of total,106.4,95,,85.12,percent of total billed charges ,95% of total billed charges,89.6,80,,71.68,percent of total billed charges,78% of total billed charges,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,31.64,100,,,fee schedule,100% of CMS fee schedule,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,31.64,100,,,fee schedule ,100% of CMS fee schedule,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.43,93,,,fee schedule,93% of CMS fee schedule,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,31.64,100,,,fee schedule,100% of CMS fee schedule,31.64,100,,,fee schedule,100% of CMS fee schedule,29.43,450,
"WORK HARDENING,INITIAL 2 HRS",420021080,CDM,420,RC,97545,HCPCS,outpatient,,,279,195.3,,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,251.1,90,,200.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,215.44,77.22,,172.35,percent of total billed charges,77.22% of total billed charges,184.42,66.1,,147.54,percent of total billed charges,66.1% of total billed charges,231.57,83,,185.26,percent of total billed charges,83% of total,265.05,95,,212.04,percent of total billed charges ,95% of total billed charges,223.2,80,,178.56,percent of total billed charges,78% of total billed charges,217.62,78,,174.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,175.77,63,,140.62,percent of total billed charges,63% of total billed charges,237.15,85,,189.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,220.41,79,,176.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,175.77,450,
"WORK HARDENING,EA HR >2 HRS",420021081,CDM,420,RC,97546,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.38,450,
"GAIT TRAINING, EA 15 MINS",420021115,CDM,420,RC,97116,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,44.21,160,,,fee schedule,160% of CMS fee schedule,35.92,130,,,fee schedule,130% of CMS fee schedule,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,27.63,100,,,fee schedule ,100% of CMS 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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.7,93,,,fee schedule,93% of CMS fee schedule,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,27.63,100,,,fee schedule,100% of CMS fee schedule,25.7,450,
"WOUND CARE, NON-SELECTIVE",420021252,CDM,420,RC,97602,HCPCS,outpatient,,,673,471.1,,531.67,79,,425.34,percent of total billed charges,79% of total billed charges,605.7,90,,484.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,519.69,77.22,,415.75,percent of total billed charges,77.22% of total billed charges,444.85,66.1,,355.88,percent of total billed charges,66.1% of total billed charges,558.59,83,,446.87,percent of total billed charges,83% of total,639.35,95,,511.48,percent of total billed charges ,95% of total billed charges,538.4,80,,430.72,percent of total billed charges,78% of total billed charges,524.94,78,,419.952,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,605.7,90,,484.56,percent of total billed charges,90% of total billed charges,538.4,80,,430.72,percent of total billed charges,80% of total billed charges,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,572.05,85,,457.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,531.67,79,,425.34,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,639.35,
SUBSEQ ORTHOTIC/PROS EA 15 MIN,420021267,CDM,420,RC,97763,HCPCS,outpatient,,,96,67.2,,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,47.98,100,,,fee schedule,100% of CMS fee schedule,76.77,160,,,fee schedule,160% of CMS fee schedule,62.37,130,,,fee schedule,130% of CMS fee schedule,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,74.13,77.22,,59.3,percent of total billed charges,77.22% of total billed charges,63.46,66.1,,50.77,percent of total billed charges,66.1% of total billed charges,79.68,83,,63.74,percent of total billed charges,83% of total,91.2,95,,72.96,percent of total billed charges ,95% of total billed charges,76.8,80,,61.44,percent of total billed charges,78% of total billed charges,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,47.98,100,,,fee schedule,100% of CMS fee schedule,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,47.98,100,,,fee schedule ,100% of CMS 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,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,44.62,93,,,fee schedule,93% of CMS fee schedule,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,47.98,100,,,fee schedule,100% of CMS fee schedule,47.98,100,,,fee schedule,100% of CMS fee schedule,44.62,450,
DEB/DSG SMALL BURN W/O ANESTH,420021270,CDM,420,RC,16020,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,461,77.22,,368.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,567.15,
DEB/DSG MEDIUM BURN W/O ANESTH,420021271,CDM,420,RC,16025,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
DEB/DSG LARGE BURN W/O ANESTH,420021272,CDM,420,RC,16030,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
ACTIVE WOUND CARE PT < 20CM,420021280,CDM,420,RC,97597,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
"ACTIVE WOUND CARE,EA ADD 20CM",420021281,CDM,420,RC,97598,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
PT SELF CARE TRAINING EA 15 MN,420021600,CDM,420,RC,97535,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,48.9,160,,,fee schedule,160% of CMS fee schedule,39.73,130,,,fee schedule,130% of CMS fee schedule,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,88.57,66.1,,70.86,percent of total billed charges,66.1% of total billed charges,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,30.56,100,,,fee schedule ,100% of CMS 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,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,28.42,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,30.56,100,,,fee schedule,100% of CMS fee schedule,28.42,450,
"THERAPEUTIC ACTIVITY,EA 15 MIN",420021616,CDM,420,RC,97530,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,34.04,100,,,fee schedule,100% of CMS fee schedule,54.46,160,,,fee schedule,160% of CMS fee schedule,44.25,130,,,fee schedule,130% of CMS fee schedule,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,87.91,66.1,,70.33,percent of total billed charges,66.1% of total billed charges,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,34.04,100,,,fee schedule,100% of CMS fee schedule,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,34.04,100,,,fee schedule ,100% of CMS 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,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.66,93,,,fee schedule,93% of CMS fee schedule,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,34.04,100,,,fee schedule,100% of CMS fee schedule,34.04,100,,,fee schedule,100% of CMS fee schedule,31.66,450,
ORTHOTIC FIT INIT TRAIN 15 MIN,420021705,CDM,420,RC,97760,HCPCS,outpatient,,,144,100.8,,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,43.96,100,,,fee schedule,100% of CMS fee schedule,70.34,160,,,fee schedule,160% of CMS fee schedule,57.15,130,,,fee schedule,130% of CMS fee schedule,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,111.2,77.22,,88.96,percent of total billed charges,77.22% of total billed charges,95.18,66.1,,76.14,percent of total billed charges,66.1% of total billed charges,119.52,83,,95.62,percent of total billed charges,83% of total,136.8,95,,109.44,percent of total billed charges ,95% of total billed charges,115.2,80,,92.16,percent of total billed charges,78% of total billed charges,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,43.96,100,,,fee schedule,100% of CMS fee schedule,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,43.96,100,,,fee schedule ,100% of CMS 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,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.88,93,,,fee schedule,93% of CMS fee schedule,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,43.96,100,,,fee schedule,100% of CMS fee schedule,43.96,100,,,fee schedule,100% of CMS fee schedule,40.88,450,
"PROSTHETIC TRAINING,EA 15 MINS",420021800,CDM,420,RC,97761,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,38.68,100,,,fee schedule,100% of CMS fee schedule,61.89,160,,,fee schedule,160% of CMS fee schedule,50.28,130,,,fee schedule,130% of CMS fee schedule,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,38.68,100,,,fee schedule,100% of CMS fee schedule,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,38.68,100,,,fee schedule ,100% of CMS 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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.97,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,38.68,100,,,fee schedule,100% of CMS fee schedule,38.68,100,,,fee schedule,100% of CMS fee schedule,35.97,450,
WHIRLPOOL EXTREMITY,420022020,CDM,420,RC,97022,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,25.07,160,,,fee schedule,160% of CMS fee schedule,20.37,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,15.67,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.57,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,15.67,100,,,fee schedule,100% of CMS fee schedule,14.57,450,
"WHIRLPOOL, FULLBODY",420022120,CDM,420,RC,97022,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,25.07,160,,,fee schedule,160% of CMS fee schedule,20.37,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,15.67,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.57,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,15.67,100,,,fee schedule,100% of CMS fee schedule,14.57,450,
"CONTRAST BATH, EA 15 MINS",420022900,CDM,420,RC,97034,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,13.19,100,,,fee schedule ,100% of CMS 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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"ASSISTIVE TECH ASMT,EA 15 MINS",420023820,CDM,420,RC,97755,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,36.27,100,,,fee schedule,100% of CMS fee schedule,58.03,160,,,fee schedule,160% of CMS fee schedule,47.15,130,,,fee schedule,130% of CMS fee schedule,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,74.69,66.1,,59.75,percent of total billed charges,66.1% of total billed charges,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,36.27,100,,,fee schedule,100% of CMS fee schedule,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,36.27,100,,,fee schedule ,100% of CMS 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,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,33.73,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,36.27,100,,,fee schedule,100% of CMS fee schedule,36.27,100,,,fee schedule,100% of CMS fee schedule,33.73,450,
"COMM/WORK REINTEGRATION,15 MIN",420024035,CDM,420,RC,97537,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,47.68,160,,,fee schedule,160% of CMS fee schedule,38.74,130,,,fee schedule,130% of CMS fee schedule,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,29.8,100,,,fee schedule ,100% of CMS 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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.71,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,29.8,100,,,fee schedule,100% of CMS fee schedule,27.71,450,
APP ML VENOUS WOUND COMPRESS,420024036,CDM,420,RC,29581,HCPCS,outpatient,,,342,239.4,,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,307.8,90,,246.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,264.09,77.22,,211.27,percent of total billed charges,77.22% of total billed charges,226.06,66.1,,180.85,percent of total billed charges,66.1% of total billed charges,283.86,83,,227.09,percent of total billed charges,83% of total,324.9,95,,259.92,percent of total billed charges ,95% of total billed charges,273.6,80,,218.88,percent of total billed charges,78% of total billed charges,266.76,78,,213.408,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,215.46,63,,172.37,percent of total billed charges,63% of total billed charges,290.7,85,,232.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,270.18,79,,216.14,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
NEG PRES WND THER < 50CM WND,420024910,CDM,420,RC,97605,HCPCS,outpatient,,,715,500.5,,564.85,79,,451.88,percent of total billed charges,79% of total billed charges,643.5,90,,514.8,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,552.12,77.22,,441.7,percent of total billed charges,77.22% of total billed charges,472.62,66.1,,378.1,percent of total billed charges,66.1% of total billed charges,593.45,83,,474.76,percent of total billed charges,83% of total,679.25,95,,543.4,percent of total billed charges ,95% of total billed charges,572,80,,457.6,percent of total billed charges,78% of total billed charges,557.7,78,,446.16,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,643.5,90,,514.8,percent of total billed charges,90% of total billed charges,572,80,,457.6,percent of total billed charges,80% of total billed charges,450.45,63,,360.36,percent of total billed charges,63% of total billed charges,607.75,85,,486.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,564.85,79,,451.88,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,679.25,
NEG PRESS WND THER > 50 CM WND,420024911,CDM,420,RC,97606,HCPCS,outpatient,,,1059,741.3,,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,817.76,77.22,,654.21,percent of total billed charges,77.22% of total billed charges,700,66.1,,560,percent of total billed charges,66.1% of total billed charges,878.97,83,,703.18,percent of total billed charges,83% of total,1006.05,95,,804.84,percent of total billed charges ,95% of total billed charges,847.2,80,,677.76,percent of total billed charges,78% of total billed charges,826.02,78,,660.816,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,1006.05,
PT BIOFEEDBACK TRG INIT 15 MIN,420090912,CDM,420,RC,90912,HCPCS,outpatient,,,102,71.4,,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,40.73,100,,,fee schedule,100% of CMS fee schedule,65.17,160,,,fee schedule,160% of CMS fee schedule,52.95,130,,,fee schedule,130% of CMS fee schedule,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,78.76,77.22,,63.01,percent of total billed charges,77.22% of total billed charges,67.42,66.1,,53.94,percent of total billed charges,66.1% of total billed charges,84.66,83,,67.73,percent of total billed charges,83% of total,96.9,95,,77.52,percent of total billed charges ,95% of total billed charges,81.6,80,,65.28,percent of total billed charges,78% of total billed charges,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,40.73,100,,,fee schedule,100% of CMS fee schedule,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,40.73,100,,,fee schedule ,100% of CMS 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,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,37.88,93,,,fee schedule,93% of CMS fee schedule,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,40.73,100,,,fee schedule,100% of CMS fee schedule,40.73,100,,,fee schedule,100% of CMS fee schedule,37.88,450,
PT BIOFEEDBACK TRG EA ADL15 MI,420090913,CDM,420,RC,90913,HCPCS,outpatient,,,102,71.4,,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,91.8,90,,73.44,percent of total billed charges,90% of total billed charges,22.93,100,,,fee schedule,100% of CMS fee schedule,36.69,160,,,fee schedule,160% of CMS fee schedule,29.81,130,,,fee schedule,130% of CMS fee schedule,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,78.76,77.22,,63.01,percent of total billed charges,77.22% of total billed charges,67.42,66.1,,53.94,percent of total billed charges,66.1% of total billed charges,84.66,83,,67.73,percent of total billed charges,83% of total,96.9,95,,77.52,percent of total billed charges ,95% of total billed charges,81.6,80,,65.28,percent of total billed charges,78% of total billed charges,79.56,78,,63.648,percent of total billed charges,78% of total billed charges,22.93,100,,,fee schedule,100% of CMS fee schedule,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,22.93,100,,,fee schedule ,100% of CMS 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,64.26,63,,51.41,percent of total billed charges,63% of total billed charges,86.7,85,,69.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.32,93,,,fee schedule,93% of CMS fee schedule,80.58,79,,64.46,percent of total billed charges,79% of total billed charges,22.93,100,,,fee schedule,100% of CMS fee schedule,22.93,100,,,fee schedule,100% of CMS fee schedule,21.32,450,
LOW-LEVEL LASER THER 1> AREAS,420097037,CDM,420,RC,97037,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,53.64,160,,,Fee Schedule,160% of CMS OPPS rate,43.59,130,,,Fee Schedule,130% of CMS OPPS rate,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.18,93,,,fee schedule,93% of CMS OPPS rate,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.18,450,
PT COGNITIVE TRAIN INIT 15 MIN,420097129,CDM,420,RC,97129,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,21.38,100,,,fee schedule,100% of CMS fee schedule,34.21,160,,,fee schedule,160% of CMS fee schedule,27.79,130,,,fee schedule,130% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,21.38,100,,,fee schedule,100% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,21.38,100,,,fee schedule ,100% of CMS 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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.88,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,21.38,100,,,fee schedule,100% of CMS fee schedule,21.38,100,,,fee schedule,100% of CMS fee schedule,19.88,450,
PT COGNITIVE TRG EA ADL 15 MIN,420097130,CDM,420,RC,97130,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,20.42,100,,,fee schedule,100% of CMS fee schedule,32.67,160,,,fee schedule,160% of CMS fee schedule,26.55,130,,,fee schedule,130% of CMS fee schedule,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,68.74,66.1,,54.99,percent of total billed charges,66.1% of total billed charges,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,20.42,100,,,fee schedule,100% of CMS fee schedule,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,20.42,100,,,fee schedule ,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.99,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,20.42,100,,,fee schedule,100% of CMS fee schedule,20.42,100,,,fee schedule,100% of CMS fee schedule,18.99,450,
PT CAREGIVER TRNG INITIAL 30 M,420097550,CDM,420,RC,97550,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,70.35,160,,,fee schedule,160% of CMS fee schedule,57.16,130,,,fee schedule,130% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,43.97,100,,,fee schedule ,100% of CMS 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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.89,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,43.97,100,,,fee schedule,100% of CMS fee schedule,40.89,450,
PT CAREGIVER TRNG ADDL 15 MIN,420097551,CDM,420,RC,97551,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,37.74,160,,,fee schedule,160% of CMS fee schedule,30.67,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,23.59,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.94,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,23.59,100,,,fee schedule,100% of CMS fee schedule,21.94,450,
PT GROUP CAREGIVER TRAINING,420097552,CDM,420,RC,97552,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,16.54,160,,,fee schedule,160% of CMS fee schedule,13.44,130,,,fee schedule,130% of CMS fee schedule,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,10.34,100,,,fee schedule ,100% of CMS 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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.62,93,,,fee schedule,93% of CMS fee schedule,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,10.34,100,,,fee schedule,100% of CMS fee schedule,9.62,450,
PT CAREGIVER TRNG ADDL 15 MIN,420097554,CDM,420,RC,,,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.45,450,
PT REM THER MNTR 1ST SETUP&EDU,420098975,CDM,420,RC,98975,HCPCS,outpatient,,,333,233.1,,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,299.7,90,,239.76,percent of total billed charges,90% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,176.85,160,,,Fee Schedule,160% of CMS OPPS rate,143.69,130,,,Fee Schedule,130% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,257.14,77.22,,205.71,percent of total billed charges,77.22% of total billed charges,220.11,66.1,,176.09,percent of total billed charges,66.1% of total billed charges,276.39,83,,221.11,percent of total billed charges,83% of total,316.35,95,,253.08,percent of total billed charges ,95% of total billed charges,266.4,80,,213.12,percent of total billed charges,78% of total billed charges,259.74,78,,207.792,percent of total billed charges,78% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,102.79,93,,,fee schedule,93% of CMS OPPS rate,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,102.79,450,
PT REM THER MNTR DEV SPLY RESP,420098976,CDM,420,RC,98976,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,50.45,160,,,Fee Schedule,160% of CMS OPPS rate,40.99,130,,,Fee Schedule,130% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.32,93,,,fee schedule,93% of CMS OPPS rate,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,29.32,450,
PT REM THER MNTR DV SPY MSCSKL,420098977,CDM,420,RC,98977,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,50.45,160,,,Fee Schedule,160% of CMS OPPS rate,40.99,130,,,Fee Schedule,130% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.32,93,,,fee schedule,93% of CMS OPPS rate,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,29.32,450,
PT REM THER MNTR 1ST 20 MIN,420098980,CDM,420,RC,98980,HCPCS,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.98,450,
PT REM THER MNTR EA ADL 20 MIN,420098981,CDM,420,RC,98981,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
"FUNCT CAPACITY EVAL,EA 15 MINS",420021078,CDM,424,RC,97750,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,31.73,100,,,fee schedule,100% of CMS fee schedule,50.77,160,,,fee schedule,160% of CMS fee schedule,41.25,130,,,fee schedule,130% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,31.73,100,,,fee schedule,100% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,31.73,100,,,fee schedule ,100% of CMS 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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.51,93,,,fee schedule,93% of CMS fee schedule,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,31.73,100,,,fee schedule,100% of CMS fee schedule,31.73,100,,,fee schedule,100% of CMS fee schedule,29.51,450,
"PT EVAL, LOW COMPLEXITY",424097161,CDM,424,RC,97161,HCPCS,outpatient,,,196,137.2,,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,151.28,160,,,fee schedule,160% of CMS fee schedule,122.92,130,,,fee schedule,130% of CMS fee schedule,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,151.35,77.22,,121.08,percent of total billed charges,77.22% of total billed charges,129.56,66.1,,103.65,percent of total billed charges,66.1% of total billed charges,162.68,83,,130.14,percent of total billed charges,83% of total,186.2,95,,148.96,percent of total billed charges ,95% of total billed charges,156.8,80,,125.44,percent of total billed charges,78% of total billed charges,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,94.55,100,,,fee schedule ,100% of CMS 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,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,87.93,93,,,fee schedule,93% of CMS fee schedule,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,94.55,100,,,fee schedule,100% of CMS fee schedule,87.93,450,
"PT EVAL, MODERATE COMPLEXITY",424097162,CDM,424,RC,97162,HCPCS,outpatient,,,170,119,,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,153,90,,122.4,percent of total billed charges,90% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,151.28,160,,,fee schedule,160% of CMS fee schedule,122.92,130,,,fee schedule,130% of CMS fee schedule,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,131.27,77.22,,105.02,percent of total billed charges,77.22% of total billed charges,112.37,66.1,,89.9,percent of total billed charges,66.1% of total billed charges,141.1,83,,112.88,percent of total billed charges,83% of total,161.5,95,,129.2,percent of total billed charges ,95% of total billed charges,136,80,,108.8,percent of total billed charges,78% of total billed charges,132.6,78,,106.08,percent of total billed charges,78% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,94.55,100,,,fee schedule ,100% of CMS 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,107.1,63,,85.68,percent of total billed charges,63% of total billed charges,144.5,85,,115.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,87.93,93,,,fee schedule,93% of CMS fee schedule,134.3,79,,107.44,percent of total billed charges,79% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,94.55,100,,,fee schedule,100% of CMS fee schedule,87.93,450,
"PT EVAL, HIGH COMPLEXITY",424097163,CDM,424,RC,97163,HCPCS,outpatient,,,196,137.2,,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,151.28,160,,,fee schedule,160% of CMS fee schedule,122.92,130,,,fee schedule,130% of CMS fee schedule,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,151.35,77.22,,121.08,percent of total billed charges,77.22% of total billed charges,129.56,66.1,,103.65,percent of total billed charges,66.1% of total billed charges,162.68,83,,130.14,percent of total billed charges,83% of total,186.2,95,,148.96,percent of total billed charges ,95% of total billed charges,156.8,80,,125.44,percent of total billed charges,78% of total billed charges,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,94.55,100,,,fee schedule ,100% of CMS 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,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,87.93,93,,,fee schedule,93% of CMS fee schedule,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,94.55,100,,,fee schedule,100% of CMS fee schedule,94.55,100,,,fee schedule,100% of CMS fee schedule,87.93,450,
PT RE-EVALUATE PLAN OF CARE,424097164,CDM,424,RC,97164,HCPCS,outpatient,,,132,92.4,,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,118.8,90,,95.04,percent of total billed charges,90% of total billed charges,65.22,100,,,fee schedule,100% of CMS fee schedule,104.35,160,,,fee schedule,160% of CMS fee schedule,84.79,130,,,fee schedule,130% of CMS fee schedule,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,101.93,77.22,,81.54,percent of total billed charges,77.22% of total billed charges,87.25,66.1,,69.8,percent of total billed charges,66.1% of total billed charges,109.56,83,,87.65,percent of total billed charges,83% of total,125.4,95,,100.32,percent of total billed charges ,95% of total billed charges,105.6,80,,84.48,percent of total billed charges,78% of total billed charges,102.96,78,,82.368,percent of total billed charges,78% of total billed charges,65.22,100,,,fee schedule,100% of CMS fee schedule,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,65.22,100,,,fee schedule ,100% of CMS 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,83.16,63,,66.53,percent of total billed charges,63% of total billed charges,112.2,85,,89.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,60.65,93,,,fee schedule,93% of CMS fee schedule,104.28,79,,83.42,percent of total billed charges,79% of total billed charges,65.22,100,,,fee schedule,100% of CMS fee schedule,65.22,100,,,fee schedule,100% of CMS fee schedule,60.65,450,
OT OCCUPATIONAL THP CONSULT,430000000,CDM,430,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
"OT E-STIM, UNATTENDED",430000010,CDM,430,RC,97014,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.34,450,
PARAFFIN BATH,430000030,CDM,430,RC,97018,HCPCS,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,5.26,100,,,fee schedule,100% of CMS fee schedule,8.42,160,,,fee schedule,160% of CMS fee schedule,6.84,130,,,fee schedule,130% of CMS fee schedule,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,5.26,100,,,fee schedule,100% of CMS fee schedule,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,5.26,100,,,fee schedule ,100% of CMS 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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.89,93,,,fee schedule,93% of CMS fee schedule,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,5.26,100,,,fee schedule,100% of CMS fee schedule,5.26,100,,,fee schedule,100% of CMS fee schedule,4.89,450,
"U/S W TOPICAL, EA 15 MINS",430000040,CDM,430,RC,97035,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,13.19,100,,,fee schedule ,100% of CMS 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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"IONTOPHORESIS, EA 15 MINS",430000060,CDM,430,RC,97033,HCPCS,outpatient,,,117,81.9,,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,105.3,90,,84.24,percent of total billed charges,90% of total billed charges,18.08,100,,,fee schedule,100% of CMS fee schedule,28.93,160,,,fee schedule,160% of CMS fee schedule,23.5,130,,,fee schedule,130% of CMS fee schedule,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,90.35,77.22,,72.28,percent of total billed charges,77.22% of total billed charges,77.34,66.1,,61.87,percent of total billed charges,66.1% of total billed charges,97.11,83,,77.69,percent of total billed charges,83% of total,111.15,95,,88.92,percent of total billed charges ,95% of total billed charges,93.6,80,,74.88,percent of total billed charges,78% of total billed charges,91.26,78,,73.008,percent of total billed charges,78% of total billed charges,18.08,100,,,fee schedule,100% of CMS fee schedule,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,18.08,100,,,fee schedule ,100% of CMS 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,73.71,63,,58.97,percent of total billed charges,63% of total billed charges,99.45,85,,79.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,16.81,93,,,fee schedule,93% of CMS fee schedule,92.43,79,,73.94,percent of total billed charges,79% of total billed charges,18.08,100,,,fee schedule,100% of CMS fee schedule,18.08,100,,,fee schedule,100% of CMS fee schedule,16.81,450,
"ULTRASOUND THERAPY, EA 15 MINS",430000080,CDM,430,RC,97035,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,13.19,100,,,fee schedule ,100% of CMS 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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
OT CRYO THERAPY,430000090,CDM,430,RC,97010,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,9.36,160,,,fee schedule,160% of CMS fee schedule,7.61,130,,,fee schedule,130% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,5.85,100,,,fee schedule ,100% of CMS 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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.44,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,5.85,100,,,fee schedule,100% of CMS fee schedule,5.44,450,
OT HOT PACK,430000095,CDM,430,RC,97010,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,9.36,160,,,fee schedule,160% of CMS fee schedule,7.61,130,,,fee schedule,130% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,23.8,66.1,,19.04,percent of total billed charges,66.1% of total billed charges,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,5.85,100,,,fee schedule ,100% of CMS 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,22.68,63,,18.14,percent of total billed charges,63% of total billed charges,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.44,93,,,fee schedule,93% of CMS fee schedule,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,5.85,100,,,fee schedule,100% of CMS fee schedule,5.85,100,,,fee schedule,100% of CMS fee schedule,5.44,450,
BIOFEEDBACK,430000110,CDM,430,RC,90901,HCPCS,outpatient,,,158,110.6,,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,142.2,90,,113.76,percent of total billed charges,90% of total billed charges,18.42,100,,,fee schedule,100% of CMS fee schedule,29.47,160,,,fee schedule,160% of CMS fee schedule,23.95,130,,,fee schedule,130% of CMS fee schedule,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,122.01,77.22,,97.61,percent of total billed charges,77.22% of total billed charges,104.44,66.1,,83.55,percent of total billed charges,66.1% of total billed charges,131.14,83,,104.91,percent of total billed charges,83% of total,150.1,95,,120.08,percent of total billed charges ,95% of total billed charges,126.4,80,,101.12,percent of total billed charges,78% of total billed charges,123.24,78,,98.592,percent of total billed charges,78% of total billed charges,18.42,100,,,fee schedule,100% of CMS fee schedule,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,18.42,100,,,fee schedule ,100% of CMS 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,99.54,63,,79.63,percent of total billed charges,63% of total billed charges,134.3,85,,107.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,17.13,93,,,fee schedule,93% of CMS fee schedule,124.82,79,,99.86,percent of total billed charges,79% of total billed charges,18.42,100,,,fee schedule,100% of CMS fee schedule,18.42,100,,,fee schedule,100% of CMS fee schedule,17.13,450,
"SENSORY INTEGRATION, EA 15 MIN",430000130,CDM,430,RC,97533,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,56.78,100,,,fee schedule,100% of CMS fee schedule,90.85,160,,,fee schedule,160% of CMS fee schedule,73.81,130,,,fee schedule,130% of CMS fee schedule,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,56.78,100,,,fee schedule,100% of CMS fee schedule,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,56.78,100,,,fee schedule ,100% of CMS 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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,52.81,93,,,fee schedule,93% of CMS fee schedule,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,56.78,100,,,fee schedule,100% of CMS fee schedule,56.78,100,,,fee schedule,100% of CMS fee schedule,52.81,450,
"E-STIM, MANUAL, EA 15 MINS",430000140,CDM,430,RC,97032,HCPCS,outpatient,,,111,77.7,,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,99.9,90,,79.92,percent of total billed charges,90% of total billed charges,13.64,100,,,fee schedule,100% of CMS fee schedule,21.82,160,,,fee schedule,160% of CMS fee schedule,17.73,130,,,fee schedule,130% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,85.71,77.22,,68.57,percent of total billed charges,77.22% of total billed charges,73.37,66.1,,58.7,percent of total billed charges,66.1% of total billed charges,92.13,83,,73.7,percent of total billed charges,83% of total,105.45,95,,84.36,percent of total billed charges ,95% of total billed charges,88.8,80,,71.04,percent of total billed charges,78% of total billed charges,86.58,78,,69.264,percent of total billed charges,78% of total billed charges,13.64,100,,,fee schedule,100% of CMS fee schedule,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,13.64,100,,,fee schedule ,100% of CMS 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,69.93,63,,55.94,percent of total billed charges,63% of total billed charges,94.35,85,,75.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.69,93,,,fee schedule,93% of CMS fee schedule,87.69,79,,70.15,percent of total billed charges,79% of total billed charges,13.64,100,,,fee schedule,100% of CMS fee schedule,13.64,100,,,fee schedule,100% of CMS fee schedule,12.69,450,
"MANUAL THERAPY, EA 15 MINS",430000170,CDM,430,RC,97140,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,25.5,100,,,fee schedule,100% of CMS fee schedule,40.8,160,,,fee schedule,160% of CMS fee schedule,33.15,130,,,fee schedule,130% of CMS fee schedule,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,97.83,66.1,,78.26,percent of total billed charges,66.1% of total billed charges,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,25.5,100,,,fee schedule,100% of CMS fee schedule,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,25.5,100,,,fee schedule ,100% of CMS 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,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.72,93,,,fee schedule,93% of CMS fee schedule,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,25.5,100,,,fee schedule,100% of CMS fee schedule,25.5,100,,,fee schedule,100% of CMS fee schedule,23.72,450,
ROM MEASUREMENT HAND W/REPORT,430000210,CDM,430,RC,95852,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,8.27,160,,,fee schedule,160% of CMS fee schedule,6.72,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,5.17,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,4.81,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,5.17,100,,,fee schedule,100% of CMS fee schedule,5.17,100,,,fee schedule,100% of CMS fee schedule,4.81,450,
ROM MEASUREMENT UP EXT W REPOR,430000211,CDM,430,RC,95851,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,7.42,100,,,fee schedule,100% of CMS fee schedule,11.87,160,,,fee schedule,160% of CMS fee schedule,9.65,130,,,fee schedule,130% of CMS fee schedule,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,7.42,100,,,fee schedule,100% of CMS fee schedule,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,7.42,100,,,fee schedule ,100% of CMS 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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6.9,93,,,fee schedule,93% of CMS fee schedule,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,7.42,100,,,fee schedule,100% of CMS fee schedule,7.42,100,,,fee schedule,100% of CMS fee schedule,6.9,450,
TAPING/STRAPPING ELBOW/WRIST,430000220,CDM,430,RC,29260,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
TAPING/STRAPPING SHOULDER,430000230,CDM,430,RC,29240,HCPCS,outpatient,,,227,158.9,,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,175.29,77.22,,140.23,percent of total billed charges,77.22% of total billed charges,150.05,66.1,,120.04,percent of total billed charges,66.1% of total billed charges,188.41,83,,150.73,percent of total billed charges,83% of total,215.65,95,,172.52,percent of total billed charges ,95% of total billed charges,181.6,80,,145.28,percent of total billed charges,78% of total billed charges,177.06,78,,141.648,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
TAPING/STRAPPIN HAND/FINGER,430000240,CDM,430,RC,29280,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,141.31,77.22,,113.05,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
"WHEELCHAIR MGMT, EA 15 MINS",430000250,CDM,430,RC,97542,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,47.68,160,,,fee schedule,160% of CMS fee schedule,38.74,130,,,fee schedule,130% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,29.8,100,,,fee schedule ,100% of CMS 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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.71,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,29.8,100,,,fee schedule,100% of CMS fee schedule,27.71,450,
"THEREX, EA 15 MINS",430000260,CDM,430,RC,97110,HCPCS,outpatient,,,165,115.5,,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,44.21,160,,,fee schedule,160% of CMS fee schedule,35.92,130,,,fee schedule,130% of CMS fee schedule,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,127.41,77.22,,101.93,percent of total billed charges,77.22% of total billed charges,109.07,66.1,,87.26,percent of total billed charges,66.1% of total billed charges,136.95,83,,109.56,percent of total billed charges,83% of total,156.75,95,,125.4,percent of total billed charges ,95% of total billed charges,132,80,,105.6,percent of total billed charges,78% of total billed charges,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,27.63,100,,,fee schedule ,100% of CMS 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,103.95,63,,83.16,percent of total billed charges,63% of total billed charges,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.7,93,,,fee schedule,93% of CMS fee schedule,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,27.63,100,,,fee schedule,100% of CMS fee schedule,27.63,100,,,fee schedule,100% of CMS fee schedule,25.7,450,
"AQUATIC THERAPY, EA 15 MINS",430000265,CDM,430,RC,97113,HCPCS,outpatient,,,211,147.7,,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,189.9,90,,151.92,percent of total billed charges,90% of total billed charges,34.2,100,,,fee schedule,100% of CMS fee schedule,54.72,160,,,fee schedule,160% of CMS fee schedule,44.46,130,,,fee schedule,130% of CMS fee schedule,132.93,63,,106.34,percent of total billed charges,63% of total billed charges,162.93,77.22,,130.34,percent of total billed charges,77.22% of total billed charges,139.47,66.1,,111.58,percent of total billed charges,66.1% of total billed charges,175.13,83,,140.1,percent of total billed charges,83% of total,200.45,95,,160.36,percent of total billed charges ,95% of total billed charges,168.8,80,,135.04,percent of total billed charges,78% of total billed charges,164.58,78,,131.664,percent of total billed charges,78% of total billed charges,34.2,100,,,fee schedule,100% of CMS fee schedule,132.93,63,,106.34,percent of total billed charges,63% of total billed charges,34.2,100,,,fee schedule ,100% of CMS 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,132.93,63,,106.34,percent of total billed charges,63% of total billed charges,179.35,85,,143.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.81,93,,,fee schedule,93% of CMS fee schedule,166.69,79,,133.35,percent of total billed charges,79% of total billed charges,34.2,100,,,fee schedule,100% of CMS fee schedule,34.2,100,,,fee schedule,100% of CMS fee schedule,31.81,450,
"NEUROMUSCU REEDUCATION,15 MINS",430000280,CDM,430,RC,97112,HCPCS,outpatient,,,112,78.4,,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,31.64,100,,,fee schedule,100% of CMS fee schedule,50.62,160,,,fee schedule,160% of CMS fee schedule,41.13,130,,,fee schedule,130% of CMS fee schedule,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,86.49,77.22,,69.19,percent of total billed charges,77.22% of total billed charges,74.03,66.1,,59.22,percent of total billed charges,66.1% of total billed charges,92.96,83,,74.37,percent of total billed charges,83% of total,106.4,95,,85.12,percent of total billed charges ,95% of total billed charges,89.6,80,,71.68,percent of total billed charges,78% of total billed charges,87.36,78,,69.888,percent of total billed charges,78% of total billed charges,31.64,100,,,fee schedule,100% of CMS fee schedule,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,31.64,100,,,fee schedule ,100% of CMS fee schedule,100.8,90,,80.64,percent of total billed charges,90% of total billed charges,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,70.56,63,,56.45,percent of total billed charges,63% of total billed charges,95.2,85,,76.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.43,93,,,fee schedule,93% of CMS fee schedule,88.48,79,,70.78,percent of total billed charges,79% of total billed charges,31.64,100,,,fee schedule,100% of CMS fee schedule,31.64,100,,,fee schedule,100% of CMS fee schedule,29.43,450,
"COMM/WORK INTEGRATION, 15 MINS",430000295,CDM,430,RC,97537,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,47.68,160,,,fee schedule,160% of CMS fee schedule,38.74,130,,,fee schedule,130% of CMS fee schedule,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,29.8,100,,,fee schedule ,100% of CMS 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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.71,93,,,fee schedule,93% of CMS fee schedule,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,29.8,100,,,fee schedule,100% of CMS fee schedule,29.8,100,,,fee schedule,100% of CMS fee schedule,27.71,450,
SUBSEQ ORTHOTIC/PROS EA 15 MIN,430000300,CDM,430,RC,97763,HCPCS,outpatient,,,96,67.2,,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,86.4,90,,69.12,percent of total billed charges,90% of total billed charges,47.98,100,,,fee schedule,100% of CMS fee schedule,76.77,160,,,fee schedule,160% of CMS fee schedule,62.37,130,,,fee schedule,130% of CMS fee schedule,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,74.13,77.22,,59.3,percent of total billed charges,77.22% of total billed charges,63.46,66.1,,50.77,percent of total billed charges,66.1% of total billed charges,79.68,83,,63.74,percent of total billed charges,83% of total,91.2,95,,72.96,percent of total billed charges ,95% of total billed charges,76.8,80,,61.44,percent of total billed charges,78% of total billed charges,74.88,78,,59.904,percent of total billed charges,78% of total billed charges,47.98,100,,,fee schedule,100% of CMS fee schedule,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,47.98,100,,,fee schedule ,100% of CMS 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,60.48,63,,48.38,percent of total billed charges,63% of total billed charges,81.6,85,,65.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,44.62,93,,,fee schedule,93% of CMS fee schedule,75.84,79,,60.67,percent of total billed charges,79% of total billed charges,47.98,100,,,fee schedule,100% of CMS fee schedule,47.98,100,,,fee schedule,100% of CMS fee schedule,44.62,450,
OT SELF CARE TRAINING EA 15 MN,430000310,CDM,430,RC,97535,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,48.9,160,,,fee schedule,160% of CMS fee schedule,39.73,130,,,fee schedule,130% of CMS fee schedule,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,88.57,66.1,,70.86,percent of total billed charges,66.1% of total billed charges,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,30.56,100,,,fee schedule ,100% of CMS 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,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,28.42,93,,,fee schedule,93% of CMS fee schedule,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,30.56,100,,,fee schedule,100% of CMS fee schedule,30.56,100,,,fee schedule,100% of CMS fee schedule,28.42,450,
"THERAPEUTIC ACTIVITY,EA 15 MIN",430000320,CDM,430,RC,97530,HCPCS,outpatient,,,133,93.1,,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,119.7,90,,95.76,percent of total billed charges,90% of total billed charges,34.04,100,,,fee schedule,100% of CMS fee schedule,54.46,160,,,fee schedule,160% of CMS fee schedule,44.25,130,,,fee schedule,130% of CMS fee schedule,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,102.7,77.22,,82.16,percent of total billed charges,77.22% of total billed charges,87.91,66.1,,70.33,percent of total billed charges,66.1% of total billed charges,110.39,83,,88.31,percent of total billed charges,83% of total,126.35,95,,101.08,percent of total billed charges ,95% of total billed charges,106.4,80,,85.12,percent of total billed charges,78% of total billed charges,103.74,78,,82.992,percent of total billed charges,78% of total billed charges,34.04,100,,,fee schedule,100% of CMS fee schedule,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,34.04,100,,,fee schedule ,100% of CMS 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,83.79,63,,67.03,percent of total billed charges,63% of total billed charges,113.05,85,,90.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.66,93,,,fee schedule,93% of CMS fee schedule,105.07,79,,84.06,percent of total billed charges,79% of total billed charges,34.04,100,,,fee schedule,100% of CMS fee schedule,34.04,100,,,fee schedule,100% of CMS fee schedule,31.66,450,
ORTHOTIC FIT INIT TRAIN 15 MIN,430000330,CDM,430,RC,97760,HCPCS,outpatient,,,144,100.8,,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,43.96,100,,,fee schedule,100% of CMS fee schedule,70.34,160,,,fee schedule,160% of CMS fee schedule,57.15,130,,,fee schedule,130% of CMS fee schedule,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,111.2,77.22,,88.96,percent of total billed charges,77.22% of total billed charges,95.18,66.1,,76.14,percent of total billed charges,66.1% of total billed charges,119.52,83,,95.62,percent of total billed charges,83% of total,136.8,95,,109.44,percent of total billed charges ,95% of total billed charges,115.2,80,,92.16,percent of total billed charges,78% of total billed charges,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,43.96,100,,,fee schedule,100% of CMS fee schedule,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,43.96,100,,,fee schedule ,100% of CMS 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,90.72,63,,72.58,percent of total billed charges,63% of total billed charges,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.88,93,,,fee schedule,93% of CMS fee schedule,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,43.96,100,,,fee schedule,100% of CMS fee schedule,43.96,100,,,fee schedule,100% of CMS fee schedule,40.88,450,
"PROSTHETIC TRAINING,EA 15 MINS",430000340,CDM,430,RC,97761,HCPCS,outpatient,,,126,88.2,,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,38.68,100,,,fee schedule,100% of CMS fee schedule,61.89,160,,,fee schedule,160% of CMS fee schedule,50.28,130,,,fee schedule,130% of CMS fee schedule,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,38.68,100,,,fee schedule,100% of CMS fee schedule,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,38.68,100,,,fee schedule ,100% of CMS 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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,35.97,93,,,fee schedule,93% of CMS fee schedule,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,38.68,100,,,fee schedule,100% of CMS fee schedule,38.68,100,,,fee schedule,100% of CMS fee schedule,35.97,450,
"CONTRAST BATH, EA 15 MINS",430000350,CDM,430,RC,97034,HCPCS,outpatient,,,73,51.1,,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,65.7,90,,52.56,percent of total billed charges,90% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,21.1,160,,,fee schedule,160% of CMS fee schedule,17.15,130,,,fee schedule,130% of CMS fee schedule,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,56.37,77.22,,45.1,percent of total billed charges,77.22% of total billed charges,48.25,66.1,,38.6,percent of total billed charges,66.1% of total billed charges,60.59,83,,48.47,percent of total billed charges,83% of total,69.35,95,,55.48,percent of total billed charges ,95% of total billed charges,58.4,80,,46.72,percent of total billed charges,78% of total billed charges,56.94,78,,45.552,percent of total billed charges,78% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,13.19,100,,,fee schedule ,100% of CMS 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,45.99,63,,36.79,percent of total billed charges,63% of total billed charges,62.05,85,,49.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.27,93,,,fee schedule,93% of CMS fee schedule,57.67,79,,46.14,percent of total billed charges,79% of total billed charges,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,12.27,450,
"ASSIST TECH ASMT,EA 15 MIN",430000365,CDM,430,RC,97755,HCPCS,outpatient,,,113,79.1,,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,101.7,90,,81.36,percent of total billed charges,90% of total billed charges,36.27,100,,,fee schedule,100% of CMS fee schedule,58.03,160,,,fee schedule,160% of CMS fee schedule,47.15,130,,,fee schedule,130% of CMS fee schedule,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,87.26,77.22,,69.81,percent of total billed charges,77.22% of total billed charges,74.69,66.1,,59.75,percent of total billed charges,66.1% of total billed charges,93.79,83,,75.03,percent of total billed charges,83% of total,107.35,95,,85.88,percent of total billed charges ,95% of total billed charges,90.4,80,,72.32,percent of total billed charges,78% of total billed charges,88.14,78,,70.512,percent of total billed charges,78% of total billed charges,36.27,100,,,fee schedule,100% of CMS fee schedule,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,36.27,100,,,fee schedule ,100% of CMS 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,71.19,63,,56.95,percent of total billed charges,63% of total billed charges,96.05,85,,76.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,33.73,93,,,fee schedule,93% of CMS fee schedule,89.27,79,,71.42,percent of total billed charges,79% of total billed charges,36.27,100,,,fee schedule,100% of CMS fee schedule,36.27,100,,,fee schedule,100% of CMS fee schedule,33.73,450,
OT APPL FINGER SPLINT DYNAMIC,430000370,CDM,430,RC,29131,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
OT APPL FINGER SPLINT STATIC,430000380,CDM,430,RC,29130,HCPCS,outpatient,,,230,161,,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,177.61,77.22,,142.09,percent of total billed charges,77.22% of total billed charges,152.03,66.1,,121.62,percent of total billed charges,66.1% of total billed charges,190.9,83,,152.72,percent of total billed charges,83% of total,218.5,95,,174.8,percent of total billed charges ,95% of total billed charges,184,80,,147.2,percent of total billed charges,78% of total billed charges,179.4,78,,143.52,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
OT APPLI LONG ARM SPLINT,430000390,CDM,430,RC,29105,HCPCS,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
OT APPL LONG LEG SPLINT,430000400,CDM,430,RC,29505,HCPCS,outpatient,,,467,326.9,,368.93,79,,295.14,percent of total billed charges,79% of total billed charges,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,294.21,63,,235.37,percent of total billed charges,63% of total billed charges,360.62,77.22,,288.5,percent of total billed charges,77.22% of total billed charges,308.69,66.1,,246.95,percent of total billed charges,66.1% of total billed charges,387.61,83,,310.09,percent of total billed charges,83% of total,443.65,95,,354.92,percent of total billed charges ,95% of total billed charges,373.6,80,,298.88,percent of total billed charges,78% of total billed charges,364.26,78,,291.408,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,294.21,63,,235.37,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,294.21,63,,235.37,percent of total billed charges,63% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,368.93,79,,295.14,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
OT APPL SHORT ARM SPLT DYNAMIC,430000410,CDM,430,RC,29126,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,210.04,77.22,,168.03,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
OT APPL SHORT ARM SPLT STATIC,430000420,CDM,430,RC,29125,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
OT APPL PL FIG 8 ELBOW TO FING,430000440,CDM,430,RC,29075,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,355.21,77.22,,284.17,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,208.83,450,
OT APPL PL FIG 8 HAND/L FOREAR,430000450,CDM,430,RC,29085,HCPCS,outpatient,,,267,186.9,,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,206.18,77.22,,164.94,percent of total billed charges,77.22% of total billed charges,176.49,66.1,,141.19,percent of total billed charges,66.1% of total billed charges,221.61,83,,177.29,percent of total billed charges,83% of total,253.65,95,,202.92,percent of total billed charges ,95% of total billed charges,213.6,80,,170.88,percent of total billed charges,78% of total billed charges,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
OT APPL PL FIG 8 SHOULDER/HAND,430000460,CDM,430,RC,29065,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,355.21,77.22,,284.17,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,208.83,450,
VASOPNEUMATIC DEVICE,430020140,CDM,430,RC,97016,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,11.02,100,,,fee schedule,100% of CMS fee schedule,17.63,160,,,fee schedule,160% of CMS fee schedule,14.33,130,,,fee schedule,130% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,11.02,100,,,fee schedule,100% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,11.02,100,,,fee schedule ,100% of CMS 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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,10.25,93,,,fee schedule,93% of CMS fee schedule,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,11.02,100,,,fee schedule,100% of CMS fee schedule,11.02,100,,,fee schedule,100% of CMS fee schedule,10.25,450,
WND MGT NS DEB,430021252,CDM,430,RC,97602,HCPCS,outpatient,,,673,471.1,,531.67,79,,425.34,percent of total billed charges,79% of total billed charges,605.7,90,,484.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,519.69,77.22,,415.75,percent of total billed charges,77.22% of total billed charges,444.85,66.1,,355.88,percent of total billed charges,66.1% of total billed charges,558.59,83,,446.87,percent of total billed charges,83% of total,639.35,95,,511.48,percent of total billed charges ,95% of total billed charges,538.4,80,,430.72,percent of total billed charges,78% of total billed charges,524.94,78,,419.952,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,605.7,90,,484.56,percent of total billed charges,90% of total billed charges,538.4,80,,430.72,percent of total billed charges,80% of total billed charges,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,572.05,85,,457.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,531.67,79,,425.34,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,639.35,
ACTIVE WOUND CARE OT < 20CM,430021280,CDM,430,RC,97597,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
STERILE EXTREMITY WHIRLPOOL,430022020,CDM,430,RC,97022,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,25.07,160,,,fee schedule,160% of CMS fee schedule,20.37,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,15.67,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.57,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,15.67,100,,,fee schedule,100% of CMS fee schedule,14.57,450,
OT COGNITIVE TRNG INIT 15 MINS,430097129,CDM,430,RC,97129,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,21.38,100,,,fee schedule,100% of CMS fee schedule,34.21,160,,,fee schedule,160% of CMS fee schedule,27.79,130,,,fee schedule,130% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,21.38,100,,,fee schedule,100% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,21.38,100,,,fee schedule ,100% of CMS 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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,19.88,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,21.38,100,,,fee schedule,100% of CMS fee schedule,21.38,100,,,fee schedule,100% of CMS fee schedule,19.88,450,
OT COGNITIVE TRG EA ADL 15 MIN,430097130,CDM,430,RC,97130,HCPCS,outpatient,,,104,72.8,,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,20.42,100,,,fee schedule,100% of CMS fee schedule,32.67,160,,,fee schedule,160% of CMS fee schedule,26.55,130,,,fee schedule,130% of CMS fee schedule,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,80.31,77.22,,64.25,percent of total billed charges,77.22% of total billed charges,68.74,66.1,,54.99,percent of total billed charges,66.1% of total billed charges,86.32,83,,69.06,percent of total billed charges,83% of total,98.8,95,,79.04,percent of total billed charges ,95% of total billed charges,83.2,80,,66.56,percent of total billed charges,78% of total billed charges,81.12,78,,64.896,percent of total billed charges,78% of total billed charges,20.42,100,,,fee schedule,100% of CMS fee schedule,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,20.42,100,,,fee schedule ,100% of CMS fee schedule,93.6,90,,74.88,percent of total billed charges,90% of total billed charges,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,65.52,63,,52.42,percent of total billed charges,63% of total billed charges,88.4,85,,70.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,18.99,93,,,fee schedule,93% of CMS fee schedule,82.16,79,,65.73,percent of total billed charges,79% of total billed charges,20.42,100,,,fee schedule,100% of CMS fee schedule,20.42,100,,,fee schedule,100% of CMS fee schedule,18.99,450,
OT CAREGIVER TRNG INITIAL 30 M,430097550,CDM,430,RC,97550,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,70.35,160,,,fee schedule,160% of CMS fee schedule,57.16,130,,,fee schedule,130% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,43.97,100,,,fee schedule ,100% of CMS 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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.89,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,43.97,100,,,fee schedule,100% of CMS fee schedule,40.89,450,
OT CAREGIVER TRNG ADDL 15 MIN,430097551,CDM,430,RC,97551,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,37.74,160,,,fee schedule,160% of CMS fee schedule,30.67,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,23.59,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.94,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,23.59,100,,,fee schedule,100% of CMS fee schedule,21.94,450,
OT GROUP CAREGIVER TRAINING,430097552,CDM,430,RC,97552,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,16.54,160,,,fee schedule,160% of CMS fee schedule,13.44,130,,,fee schedule,130% of CMS fee schedule,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,10.34,100,,,fee schedule ,100% of CMS 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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.62,93,,,fee schedule,93% of CMS fee schedule,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,10.34,100,,,fee schedule,100% of CMS fee schedule,9.62,450,
OT CAREGIVER TRNG ADDL 15 MIN,430097554,CDM,430,RC,,,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.45,450,
OT REM THER MNTR 1ST SETUP&EDU,430098975,CDM,430,RC,98975,HCPCS,outpatient,,,333,233.1,,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,299.7,90,,239.76,percent of total billed charges,90% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,176.85,160,,,Fee Schedule,160% of CMS OPPS rate,143.69,130,,,Fee Schedule,130% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,257.14,77.22,,205.71,percent of total billed charges,77.22% of total billed charges,220.11,66.1,,176.09,percent of total billed charges,66.1% of total billed charges,276.39,83,,221.11,percent of total billed charges,83% of total,316.35,95,,253.08,percent of total billed charges ,95% of total billed charges,266.4,80,,213.12,percent of total billed charges,78% of total billed charges,259.74,78,,207.792,percent of total billed charges,78% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,209.79,63,,167.83,percent of total billed charges,63% of total billed charges,283.05,85,,226.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,102.79,93,,,fee schedule,93% of CMS OPPS rate,263.07,79,,210.46,percent of total billed charges,79% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,102.79,450,
OT REM THER MNTR DEV SPLY RESP,430098976,CDM,430,RC,98976,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,50.45,160,,,Fee Schedule,160% of CMS OPPS rate,40.99,130,,,Fee Schedule,130% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.32,93,,,fee schedule,93% of CMS OPPS rate,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,29.32,450,
OT REM THER MNTR DV SPL MSCSKL,430098977,CDM,430,RC,98977,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,50.45,160,,,Fee Schedule,160% of CMS OPPS rate,40.99,130,,,Fee Schedule,130% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.32,93,,,fee schedule,93% of CMS OPPS rate,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.53,100,,,Fee Schedule,100% of CMS OPPS rate,29.32,450,
OT REM THER MNTR 1ST 20 MIN,430098980,CDM,430,RC,98980,HCPCS,outpatient,,,146,102.2,,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,131.4,90,,105.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,112.74,77.22,,90.19,percent of total billed charges,77.22% of total billed charges,96.51,66.1,,77.21,percent of total billed charges,66.1% of total billed charges,121.18,83,,96.94,percent of total billed charges,83% of total,138.7,95,,110.96,percent of total billed charges ,95% of total billed charges,116.8,80,,93.44,percent of total billed charges,78% of total billed charges,113.88,78,,91.104,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,91.98,63,,73.58,percent of total billed charges,63% of total billed charges,124.1,85,,99.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,115.34,79,,92.27,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91.98,450,
OT REM THER MNTR EA ADL 20 MIN,430098981,CDM,430,RC,98981,HCPCS,outpatient,,,119,83.3,,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,107.1,90,,85.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,91.89,77.22,,73.51,percent of total billed charges,77.22% of total billed charges,78.66,66.1,,62.93,percent of total billed charges,66.1% of total billed charges,98.77,83,,79.02,percent of total billed charges,83% of total,113.05,95,,90.44,percent of total billed charges ,95% of total billed charges,95.2,80,,76.16,percent of total billed charges,78% of total billed charges,92.82,78,,74.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,74.97,63,,59.98,percent of total billed charges,63% of total billed charges,101.15,85,,80.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,94.01,79,,75.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,74.97,450,
"FUNCT CAPACITY EVAL,EA 15 MINS",430000290,CDM,434,RC,97750,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,31.73,100,,,fee schedule,100% of CMS fee schedule,50.77,160,,,fee schedule,160% of CMS fee schedule,41.25,130,,,fee schedule,130% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,88.03,77.22,,70.42,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,31.73,100,,,fee schedule,100% of CMS fee schedule,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,31.73,100,,,fee schedule ,100% of CMS 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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.51,93,,,fee schedule,93% of CMS fee schedule,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,31.73,100,,,fee schedule,100% of CMS fee schedule,31.73,100,,,fee schedule,100% of CMS fee schedule,29.51,450,
"OT EVAL, UE ORTHOTICS",434000971,CDM,434,RC,97165,HCPCS,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,152.69,160,,,fee schedule,160% of CMS fee schedule,124.06,130,,,fee schedule,130% of CMS fee schedule,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,95.43,100,,,fee schedule ,100% of CMS 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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,88.75,93,,,fee schedule,93% of CMS fee schedule,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,95.43,100,,,fee schedule,100% of CMS fee schedule,88.75,450,
"OT EVAL, LOW COMPLEXITY",434097165,CDM,434,RC,97165,HCPCS,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,152.69,160,,,fee schedule,160% of CMS fee schedule,124.06,130,,,fee schedule,130% of CMS fee schedule,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,95.43,100,,,fee schedule ,100% of CMS 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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,88.75,93,,,fee schedule,93% of CMS fee schedule,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,95.43,100,,,fee schedule,100% of CMS fee schedule,88.75,450,
"OT EVAL, MODERATE COMPLEXITY",434097166,CDM,434,RC,97166,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,152.69,160,,,fee schedule,160% of CMS fee schedule,124.06,130,,,fee schedule,130% of CMS fee schedule,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,95.43,100,,,fee schedule ,100% of CMS 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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,88.75,93,,,fee schedule,93% of CMS fee schedule,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,95.43,100,,,fee schedule,100% of CMS fee schedule,88.75,450,
"OT EVAL, HIGH COMPLEXITY",434097167,CDM,434,RC,97167,HCPCS,outpatient,,,190,133,,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,171,90,,136.8,percent of total billed charges,90% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,152.69,160,,,fee schedule,160% of CMS fee schedule,124.06,130,,,fee schedule,130% of CMS fee schedule,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,146.72,77.22,,117.38,percent of total billed charges,77.22% of total billed charges,125.59,66.1,,100.47,percent of total billed charges,66.1% of total billed charges,157.7,83,,126.16,percent of total billed charges,83% of total,180.5,95,,144.4,percent of total billed charges ,95% of total billed charges,152,80,,121.6,percent of total billed charges,78% of total billed charges,148.2,78,,118.56,percent of total billed charges,78% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,95.43,100,,,fee schedule ,100% of CMS 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,119.7,63,,95.76,percent of total billed charges,63% of total billed charges,161.5,85,,129.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,88.75,93,,,fee schedule,93% of CMS fee schedule,150.1,79,,120.08,percent of total billed charges,79% of total billed charges,95.43,100,,,fee schedule,100% of CMS fee schedule,95.43,100,,,fee schedule,100% of CMS fee schedule,88.75,450,
OT RE-EVALUATE PLAN OF CARE,434097168,CDM,434,RC,97168,HCPCS,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,65.52,100,,,fee schedule,100% of CMS fee schedule,104.83,160,,,fee schedule,160% of CMS fee schedule,85.18,130,,,fee schedule,130% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,65.52,100,,,fee schedule,100% of CMS fee schedule,78.75,63,,63,percent of total billed charges,63% of total billed charges,65.52,100,,,fee schedule ,100% of CMS 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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,60.93,93,,,fee schedule,93% of CMS fee schedule,98.75,79,,79,percent of total billed charges,79% of total billed charges,65.52,100,,,fee schedule,100% of CMS fee schedule,65.52,100,,,fee schedule,100% of CMS fee schedule,60.93,450,
ST CAREGIVER TRNG INITIAL 30 M,440097550,CDM,440,RC,97550,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,70.35,160,,,fee schedule,160% of CMS fee schedule,57.16,130,,,fee schedule,130% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,89.24,66.1,,71.39,percent of total billed charges,66.1% of total billed charges,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,43.97,100,,,fee schedule ,100% of CMS 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,85.05,63,,68.04,percent of total billed charges,63% of total billed charges,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.89,93,,,fee schedule,93% of CMS fee schedule,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,43.97,100,,,fee schedule,100% of CMS fee schedule,43.97,100,,,fee schedule,100% of CMS fee schedule,40.89,450,
ST CAREGIVER TRNG ADDL 15 MIN,440097551,CDM,440,RC,97551,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,37.74,160,,,fee schedule,160% of CMS fee schedule,30.67,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,23.59,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,21.94,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,23.59,100,,,fee schedule,100% of CMS fee schedule,23.59,100,,,fee schedule,100% of CMS fee schedule,21.94,450,
ST GROUP CAREGIVER TRAINING,440097552,CDM,440,RC,97552,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,16.54,160,,,fee schedule,160% of CMS fee schedule,13.44,130,,,fee schedule,130% of CMS fee schedule,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,10.34,100,,,fee schedule ,100% of CMS 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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.62,93,,,fee schedule,93% of CMS fee schedule,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,10.34,100,,,fee schedule,100% of CMS fee schedule,10.34,100,,,fee schedule,100% of CMS fee schedule,9.62,450,
ST CAREGIVER TRNG ADDL 15 MIN,440097554,CDM,440,RC,,,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72.45,450,
TREATMENT OF SPEECH,442700150,CDM,440,RC,92507,HCPCS,outpatient,,,265,185.5,,209.35,79,,167.48,percent of total billed charges,79% of total billed charges,238.5,90,,190.8,percent of total billed charges,90% of total billed charges,72.44,100,,,fee schedule,100% of CMS fee schedule,115.9,160,,,fee schedule,160% of CMS fee schedule,94.17,130,,,fee schedule,130% of CMS fee schedule,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,204.63,77.22,,163.7,percent of total billed charges,77.22% of total billed charges,175.17,66.1,,140.14,percent of total billed charges,66.1% of total billed charges,219.95,83,,175.96,percent of total billed charges,83% of total,251.75,95,,201.4,percent of total billed charges ,95% of total billed charges,212,80,,169.6,percent of total billed charges,78% of total billed charges,206.7,78,,165.36,percent of total billed charges,78% of total billed charges,72.44,100,,,fee schedule,100% of CMS fee schedule,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,72.44,100,,,fee schedule ,100% of CMS fee schedule,238.5,90,,190.8,percent of total billed charges,90% of total billed charges,212,80,,169.6,percent of total billed charges,80% of total billed charges,166.95,63,,133.56,percent of total billed charges,63% of total billed charges,225.25,85,,180.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,67.37,93,,,fee schedule,93% of CMS fee schedule,209.35,79,,167.48,percent of total billed charges,79% of total billed charges,72.44,100,,,fee schedule,100% of CMS fee schedule,72.44,100,,,fee schedule,100% of CMS fee schedule,67.37,450,
TREATMENT OF SWALLOWING,442700250,CDM,440,RC,92526,HCPCS,outpatient,,,287,200.9,,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,258.3,90,,206.64,percent of total billed charges,90% of total billed charges,79.93,100,,,fee schedule,100% of CMS fee schedule,127.89,160,,,fee schedule,160% of CMS fee schedule,103.91,130,,,fee schedule,130% of CMS fee schedule,180.81,63,,144.65,percent of total billed charges,63% of total billed charges,221.62,77.22,,177.3,percent of total billed charges,77.22% of total billed charges,189.71,66.1,,151.77,percent of total billed charges,66.1% of total billed charges,238.21,83,,190.57,percent of total billed charges,83% of total,272.65,95,,218.12,percent of total billed charges ,95% of total billed charges,229.6,80,,183.68,percent of total billed charges,78% of total billed charges,223.86,78,,179.088,percent of total billed charges,78% of total billed charges,79.93,100,,,fee schedule,100% of CMS fee schedule,180.81,63,,144.65,percent of total billed charges,63% of total billed charges,79.93,100,,,fee schedule ,100% of CMS 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,180.81,63,,144.65,percent of total billed charges,63% of total billed charges,243.95,85,,195.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,74.33,93,,,fee schedule,93% of CMS fee schedule,226.73,79,,181.38,percent of total billed charges,79% of total billed charges,79.93,100,,,fee schedule,100% of CMS fee schedule,79.93,100,,,fee schedule,100% of CMS fee schedule,74.33,450,
MODIFIED BARIUM SWALLOW STUDY,442700300,CDM,440,RC,92611,HCPCS,outpatient,,,417,291.9,,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,375.3,90,,300.24,percent of total billed charges,90% of total billed charges,86.56,100,,,fee schedule,100% of CMS fee schedule,138.5,160,,,fee schedule,160% of CMS fee schedule,112.53,130,,,fee schedule,130% of CMS fee schedule,262.71,63,,210.17,percent of total billed charges,63% of total billed charges,322.01,77.22,,257.61,percent of total billed charges,77.22% of total billed charges,275.64,66.1,,220.51,percent of total billed charges,66.1% of total billed charges,346.11,83,,276.89,percent of total billed charges,83% of total,396.15,95,,316.92,percent of total billed charges ,95% of total billed charges,333.6,80,,266.88,percent of total billed charges,78% of total billed charges,325.26,78,,260.208,percent of total billed charges,78% of total billed charges,86.56,100,,,fee schedule,100% of CMS fee schedule,262.71,63,,210.17,percent of total billed charges,63% of total billed charges,86.56,100,,,fee schedule ,100% of CMS fee schedule,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,262.71,63,,210.17,percent of total billed charges,63% of total billed charges,354.45,85,,283.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,80.5,93,,,fee schedule,93% of CMS fee schedule,329.43,79,,263.54,percent of total billed charges,79% of total billed charges,86.56,100,,,fee schedule,100% of CMS fee schedule,86.56,100,,,fee schedule,100% of CMS fee schedule,80.5,450,
SPEECH CONSULT,442700550,CDM,442,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SPEECH SOUND/LANGU COMPRE EVAL,442700100,CDM,444,RC,92523,HCPCS,outpatient,,,647,452.9,,511.13,79,,408.9,percent of total billed charges,79% of total billed charges,582.3,90,,465.84,percent of total billed charges,90% of total billed charges,216.24,100,,,fee schedule,100% of CMS fee schedule,345.98,160,,,fee schedule,160% of CMS fee schedule,281.11,130,,,fee schedule,130% of CMS fee schedule,407.61,63,,326.09,percent of total billed charges,63% of total billed charges,499.61,77.22,,399.69,percent of total billed charges,77.22% of total billed charges,427.67,66.1,,342.14,percent of total billed charges,66.1% of total billed charges,537.01,83,,429.61,percent of total billed charges,83% of total,614.65,95,,491.72,percent of total billed charges ,95% of total billed charges,517.6,80,,414.08,percent of total billed charges,78% of total billed charges,504.66,78,,403.728,percent of total billed charges,78% of total billed charges,216.24,100,,,fee schedule,100% of CMS fee schedule,407.61,63,,326.09,percent of total billed charges,63% of total billed charges,216.24,100,,,fee schedule ,100% of CMS fee schedule,582.3,90,,465.84,percent of total billed charges,90% of total billed charges,517.6,80,,414.08,percent of total billed charges,80% of total billed charges,407.61,63,,326.09,percent of total billed charges,63% of total billed charges,549.95,85,,439.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,201.1,93,,,fee schedule,93% of CMS fee schedule,511.13,79,,408.9,percent of total billed charges,79% of total billed charges,216.24,100,,,fee schedule,100% of CMS fee schedule,216.24,100,,,fee schedule,100% of CMS fee schedule,201.1,614.65,
EVALUATION OF SWALLOWING,442700200,CDM,444,RC,92610,HCPCS,outpatient,,,289,202.3,,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,260.1,90,,208.08,percent of total billed charges,90% of total billed charges,66.91,100,,,fee schedule,100% of CMS fee schedule,107.06,160,,,fee schedule,160% of CMS fee schedule,86.98,130,,,fee schedule,130% of CMS fee schedule,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,223.17,77.22,,178.54,percent of total billed charges,77.22% of total billed charges,191.03,66.1,,152.82,percent of total billed charges,66.1% of total billed charges,239.87,83,,191.9,percent of total billed charges,83% of total,274.55,95,,219.64,percent of total billed charges ,95% of total billed charges,231.2,80,,184.96,percent of total billed charges,78% of total billed charges,225.42,78,,180.336,percent of total billed charges,78% of total billed charges,66.91,100,,,fee schedule,100% of CMS fee schedule,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,66.91,100,,,fee schedule ,100% of CMS 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,182.07,63,,145.66,percent of total billed charges,63% of total billed charges,245.65,85,,196.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,62.23,93,,,fee schedule,93% of CMS fee schedule,228.31,79,,182.65,percent of total billed charges,79% of total billed charges,66.91,100,,,fee schedule,100% of CMS fee schedule,66.91,100,,,fee schedule,100% of CMS fee schedule,62.23,450,
FEMORAL ARTERARY REPAIR,360040180,CDM,450,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,881,
EGD FLX TRANSNASAL TUBE/CATH,450000654,CDM,450,RC,0654T,HCPCS,outpatient,,,3250,2275,,2567.5,79,,2054,percent of total billed charges,79% of total billed charges,2925,90,,2340,percent of total billed charges,90% of total billed charges,3202.32,100,,,Fee Schedule,100% of CMS OPPS rate,5123.72,160,,,Fee Schedule,160% of CMS OPPS rate,4163.01,130,,,Fee Schedule,130% of CMS OPPS rate,2047.5,63,,1638,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2148.25,66.1,,1718.6,percent of total billed charges,66.1% of total billed charges,2697.5,83,,2158,percent of total billed charges,83% of total,3087.5,95,,2470,percent of total billed charges ,95% of total billed charges,2600,80,,2080,percent of total billed charges,78% of total billed charges,2535,78,,2028,percent of total billed charges,78% of total billed charges,3202.32,100,,,Fee Schedule,100% of CMS OPPS rate,2047.5,63,,1638,percent of total billed charges,63% of total billed charges,3202.32,100,,,Fee Schedule,100% of CMS OPPS rate,2925,90,,2340,percent of total billed charges,90% of total billed charges,2600,80,,2080,percent of total billed charges,80% of total billed charges,2047.5,63,,1638,percent of total billed charges,63% of total billed charges,2762.5,85,,2210,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2978.16,93,,,fee schedule,93% of CMS OPPS rate,2567.5,79,,2054,percent of total billed charges,79% of total billed charges,3202.32,100,,,Fee Schedule,100% of CMS OPPS rate,3202.32,100,,,Fee Schedule,100% of CMS OPPS rate,450,5123.72,
EMPLOYMENT PHYSICAL,450001306,CDM,450,RC,,,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64.89,881,
ER LEFT WITHOUT BEING SEEN,450001307,CDM,450,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,881,
EMERGENCY ROOM MORGUE,450001308,CDM,450,RC,,,outpatient,,,392,274.4,,309.68,79,,247.74,percent of total billed charges,79% of total billed charges,352.8,90,,282.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,259.11,66.1,,207.29,percent of total billed charges,66.1% of total billed charges,325.36,83,,260.29,percent of total billed charges,83% of total,372.4,95,,297.92,percent of total billed charges ,95% of total billed charges,313.6,80,,250.88,percent of total billed charges,78% of total billed charges,305.76,78,,244.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,246.96,63,,197.57,percent of total billed charges,63% of total billed charges,333.2,85,,266.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,309.68,79,,247.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,246.96,881,
US PARACENTE W/ IMAGING ABDOMI,450001823,CDM,450,RC,49083,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
NON-BILLABLE CHARGE ER,450005555,CDM,450,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,881,
ABSCESS SKIN/SQ SMPL OR SINGLE,450010060,CDM,450,RC,10060,HCPCS,outpatient,,,377,263.9,,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,249.2,66.1,,199.36,percent of total billed charges,66.1% of total billed charges,312.91,83,,250.33,percent of total billed charges,83% of total,358.15,95,,286.52,percent of total billed charges ,95% of total billed charges,301.6,80,,241.28,percent of total billed charges,78% of total billed charges,294.06,78,,235.248,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
ABSCESS SKIN/SQ COMP OR MULT,450010061,CDM,450,RC,10061,HCPCS,outpatient,,,719,503.3,,568.01,79,,454.41,percent of total billed charges,79% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,475.26,66.1,,380.21,percent of total billed charges,66.1% of total billed charges,596.77,83,,477.42,percent of total billed charges,83% of total,683.05,95,,546.44,percent of total billed charges ,95% of total billed charges,575.2,80,,460.16,percent of total billed charges,78% of total billed charges,560.82,78,,448.656,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,568.01,79,,454.41,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
PILONIDAL CYST I&D SMPL,450010080,CDM,450,RC,10080,HCPCS,outpatient,,,1700,1190,,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,1530,90,,1224,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1123.7,66.1,,898.96,percent of total billed charges,66.1% of total billed charges,1411,83,,1128.8,percent of total billed charges,83% of total,1615,95,,1292,percent of total billed charges ,95% of total billed charges,1360,80,,1088,percent of total billed charges,78% of total billed charges,1326,78,,1060.8,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,1071,63,,856.8,percent of total billed charges,63% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1615,
PILONIDAL CYST I&D COMP,450010081,CDM,450,RC,10081,HCPCS,outpatient,,,1700,1190,,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,1530,90,,1224,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1123.7,66.1,,898.96,percent of total billed charges,66.1% of total billed charges,1411,83,,1128.8,percent of total billed charges,83% of total,1615,95,,1292,percent of total billed charges ,95% of total billed charges,1360,80,,1088,percent of total billed charges,78% of total billed charges,1326,78,,1060.8,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,1071,63,,856.8,percent of total billed charges,63% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1615,
FB REMOVAL SQ W/INC SMPL,450010120,CDM,450,RC,10120,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
FB REMOVAL SQ W/INC COMPL,450010121,CDM,450,RC,10121,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
HEMATOMA/SEROMA I&D,450010140,CDM,450,RC,10140,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
ASPIRATE ABSCESS/HEMATOMA/CYST,450010160,CDM,450,RC,10160,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
POSTOP WND INFECTION I&D,450010180,CDM,450,RC,10180,HCPCS,outpatient,,,6980,4886,,5514.2,79,,4411.36,percent of total billed charges,79% of total billed charges,6282,90,,5025.6,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,4397.4,63,,3517.92,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,4613.78,66.1,,3691.02,percent of total billed charges,66.1% of total billed charges,5793.4,83,,4634.72,percent of total billed charges,83% of total,6631,95,,5304.8,percent of total billed charges ,95% of total billed charges,5584,80,,4467.2,percent of total billed charges,78% of total billed charges,5444.4,78,,4355.52,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,4397.4,63,,3517.92,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,6282,90,,5025.6,percent of total billed charges,90% of total billed charges,5584,80,,4467.2,percent of total billed charges,80% of total billed charges,4397.4,63,,3517.92,percent of total billed charges,63% of total billed charges,5933,85,,4746.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,5514.2,79,,4411.36,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,6631,
DEBRIDE ECZEMA/INFECT SKIN<10%,450011000,CDM,450,RC,11000,HCPCS,outpatient,,,1449,1014.3,,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,1304.1,90,,1043.28,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,957.79,66.1,,766.23,percent of total billed charges,66.1% of total billed charges,1202.67,83,,962.14,percent of total billed charges,83% of total,1376.55,95,,1101.24,percent of total billed charges ,95% of total billed charges,1159.2,80,,927.36,percent of total billed charges,78% of total billed charges,1130.22,78,,904.176,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1376.55,
DEBRIDE FX/DISLOC SKIN/SQ,450011010,CDM,450,RC,11010,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
DEBRIDE FX/DISLOC MUSCLE,450011011,CDM,450,RC,11011,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
DEBRIDE FX/DISLOC TO BONE,450011012,CDM,450,RC,11012,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,3801.55,
"DEBRIBE SKIN, PARTIAL <20CM",450011040,CDM,450,RC,97597,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
"DEBRIDE SKIN,FULL <20CM",450011041,CDM,450,RC,97597,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
"DEBRIDE SQ,1ST 20 SQCM OR LESS",450011042,CDM,450,RC,11042,HCPCS,outpatient,,,798,558.6,,630.42,79,,504.34,percent of total billed charges,79% of total billed charges,718.2,90,,574.56,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,527.48,66.1,,421.98,percent of total billed charges,66.1% of total billed charges,662.34,83,,529.87,percent of total billed charges,83% of total,758.1,95,,606.48,percent of total billed charges ,95% of total billed charges,638.4,80,,510.72,percent of total billed charges,78% of total billed charges,622.44,78,,497.952,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,678.3,85,,542.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,630.42,79,,504.34,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
DEBRIDE MUSCLE 1ST20CM OR LESS,450011043,CDM,450,RC,11043,HCPCS,outpatient,,,1226,858.2,,968.54,79,,774.83,percent of total billed charges,79% of total billed charges,1103.4,90,,882.72,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,772.38,63,,617.9,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,810.39,66.1,,648.31,percent of total billed charges,66.1% of total billed charges,1017.58,83,,814.06,percent of total billed charges,83% of total,1164.7,95,,931.76,percent of total billed charges ,95% of total billed charges,980.8,80,,784.64,percent of total billed charges,78% of total billed charges,956.28,78,,765.024,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,772.38,63,,617.9,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,1103.4,90,,882.72,percent of total billed charges,90% of total billed charges,980.8,80,,784.64,percent of total billed charges,80% of total billed charges,772.38,63,,617.9,percent of total billed charges,63% of total billed charges,1042.1,85,,833.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,968.54,79,,774.83,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1164.7,
DEBRIDE BONE 1ST 20 CM OR LESS,450011044,CDM,450,RC,11044,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
SKIN LESION RMBL 1 LESION,450011055,CDM,450,RC,11055,HCPCS,outpatient,,,448,313.6,,353.92,79,,283.14,percent of total billed charges,79% of total billed charges,403.2,90,,322.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,282.24,63,,225.79,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,296.13,66.1,,236.9,percent of total billed charges,66.1% of total billed charges,371.84,83,,297.47,percent of total billed charges,83% of total,425.6,95,,340.48,percent of total billed charges ,95% of total billed charges,358.4,80,,286.72,percent of total billed charges,78% of total billed charges,349.44,78,,279.552,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,282.24,63,,225.79,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,282.24,63,,225.79,percent of total billed charges,63% of total billed charges,380.8,85,,304.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,353.92,79,,283.14,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
TANGNTL BX SKIN SINGLE LESION,450011102,CDM,450,RC,11102,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
TANGENTIAL BX SKIN EA SEP/ADDL,450011103,CDM,450,RC,11103,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,881,
PUNCH BX SKIN SINGLE LESION,450011104,CDM,450,RC,11104,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
PUNCH BX SKIN EA SEP/ADDL,450011105,CDM,450,RC,11105,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,881,
INCISIONAL BX SKIN SGL LESION,450011106,CDM,450,RC,11106,HCPCS,outpatient,,,310,217,,244.9,79,,195.92,percent of total billed charges,79% of total billed charges,279,90,,223.2,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,204.91,66.1,,163.93,percent of total billed charges,66.1% of total billed charges,257.3,83,,205.84,percent of total billed charges,83% of total,294.5,95,,235.6,percent of total billed charges ,95% of total billed charges,248,80,,198.4,percent of total billed charges,78% of total billed charges,241.8,78,,193.44,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,279,90,,223.2,percent of total billed charges,90% of total billed charges,248,80,,198.4,percent of total billed charges,80% of total billed charges,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,263.5,85,,210.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,244.9,79,,195.92,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,195.3,881,
INCISIONAL BX SKIN EA SEP/ADDL,450011107,CDM,450,RC,11107,HCPCS,outpatient,,,461,322.7,,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,414.9,90,,331.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,304.72,66.1,,243.78,percent of total billed charges,66.1% of total billed charges,382.63,83,,306.1,percent of total billed charges,83% of total,437.95,95,,350.36,percent of total billed charges ,95% of total billed charges,368.8,80,,295.04,percent of total billed charges,78% of total billed charges,359.58,78,,287.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,391.85,85,,313.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,290.43,881,
REMOVE SKIN TAG 1-15 LESIONS,450011200,CDM,450,RC,11200,HCPCS,outpatient,,,437,305.9,,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,288.86,66.1,,231.09,percent of total billed charges,66.1% of total billed charges,362.71,83,,290.17,percent of total billed charges,83% of total,415.15,95,,332.12,percent of total billed charges ,95% of total billed charges,349.6,80,,279.68,percent of total billed charges,78% of total billed charges,340.86,78,,272.688,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,349.6,80,,279.68,percent of total billed charges,80% of total billed charges,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,371.45,85,,297.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
SHAVE SKIN 1 LESION  .5CM OR <,450011305,CDM,450,RC,11305,HCPCS,outpatient,,,437,305.9,,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,288.86,66.1,,231.09,percent of total billed charges,66.1% of total billed charges,362.71,83,,290.17,percent of total billed charges,83% of total,415.15,95,,332.12,percent of total billed charges ,95% of total billed charges,349.6,80,,279.68,percent of total billed charges,78% of total billed charges,340.86,78,,272.688,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,393.3,90,,314.64,percent of total billed charges,90% of total billed charges,349.6,80,,279.68,percent of total billed charges,80% of total billed charges,275.31,63,,220.25,percent of total billed charges,63% of total billed charges,371.45,85,,297.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,345.23,79,,276.18,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
SHAVE SKIN 1 LESION 1.1-2.0 CM,450011307,CDM,450,RC,11307,HCPCS,outpatient,,,194,135.8,,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,174.6,90,,139.68,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,128.23,66.1,,102.58,percent of total billed charges,66.1% of total billed charges,161.02,83,,128.82,percent of total billed charges,83% of total,184.3,95,,147.44,percent of total billed charges ,95% of total billed charges,155.2,80,,124.16,percent of total billed charges,78% of total billed charges,151.32,78,,121.056,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,122.22,63,,97.78,percent of total billed charges,63% of total billed charges,164.9,85,,131.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,153.26,79,,122.61,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,122.22,881,
SHAVE SKIN 1 LESION >2.0 CM,450011308,CDM,450,RC,11308,HCPCS,outpatient,,,213,149.1,,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,191.7,90,,153.36,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,140.79,66.1,,112.63,percent of total billed charges,66.1% of total billed charges,176.79,83,,141.43,percent of total billed charges,83% of total,202.35,95,,161.88,percent of total billed charges ,95% of total billed charges,170.4,80,,136.32,percent of total billed charges,78% of total billed charges,166.14,78,,132.912,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,134.19,63,,107.35,percent of total billed charges,63% of total billed charges,181.05,85,,144.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,168.27,79,,134.62,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,134.19,881,
EXC SKIN TRNK/EXT 0.6-1.0 CM,450011401,CDM,450,RC,11401,HCPCS,outpatient,,,1236,865.2,,976.44,79,,781.15,percent of total billed charges,79% of total billed charges,1112.4,90,,889.92,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,778.68,63,,622.94,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,817,66.1,,653.6,percent of total billed charges,66.1% of total billed charges,1025.88,83,,820.7,percent of total billed charges,83% of total,1174.2,95,,939.36,percent of total billed charges ,95% of total billed charges,988.8,80,,791.04,percent of total billed charges,78% of total billed charges,964.08,78,,771.264,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,778.68,63,,622.94,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,778.68,63,,622.94,percent of total billed charges,63% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,976.44,79,,781.15,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,1174.2,
EXC SKIN TRNK/EXT 1.1-2.0 CM,450011402,CDM,450,RC,11402,HCPCS,outpatient,,,2224,1556.8,,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1470.06,66.1,,1176.05,percent of total billed charges,66.1% of total billed charges,1845.92,83,,1476.74,percent of total billed charges,83% of total,2112.8,95,,1690.24,percent of total billed charges ,95% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,78% of total billed charges,1734.72,78,,1387.776,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,80% of total billed charges,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,1890.4,85,,1512.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,2112.8,
EXC SKIN TRNK/EXT 2.1-3.0 CM,450011403,CDM,450,RC,11403,HCPCS,outpatient,,,2224,1556.8,,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1470.06,66.1,,1176.05,percent of total billed charges,66.1% of total billed charges,1845.92,83,,1476.74,percent of total billed charges,83% of total,2112.8,95,,1690.24,percent of total billed charges ,95% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,78% of total billed charges,1734.72,78,,1387.776,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,80% of total billed charges,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,1890.4,85,,1512.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,2112.8,
EXC SKIN TRNK/EXT 3.1-4.0 CM,450011404,CDM,450,RC,11404,HCPCS,outpatient,,,5029,3520.3,,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,3324.17,66.1,,2659.34,percent of total billed charges,66.1% of total billed charges,4174.07,83,,3339.26,percent of total billed charges,83% of total,4777.55,95,,3822.04,percent of total billed charges ,95% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,78% of total billed charges,3922.62,78,,3138.096,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,80% of total billed charges,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,4274.65,85,,3419.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,4777.55,
EXC SKIN SCLP/HND/FT .5CM OR <,450011420,CDM,450,RC,11420,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
EXC SKIN SCLP/HND/FT .6-1.0CM,450011421,CDM,450,RC,11421,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
EXC SKIN SCLP/HND/FT 1.1-2.0CM,450011422,CDM,450,RC,11422,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
EXC SKIN SCLP/HND/FT 2.1-3.0CM,450011423,CDM,450,RC,11423,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
EXC SKIN SCLP/HND/FT 3.1-4.0CM,450011424,CDM,450,RC,11424,HCPCS,outpatient,,,2408,1685.6,,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1591.69,66.1,,1273.35,percent of total billed charges,66.1% of total billed charges,1998.64,83,,1598.91,percent of total billed charges,83% of total,2287.6,95,,1830.08,percent of total billed charges ,95% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,78% of total billed charges,1878.24,78,,1502.592,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,80% of total billed charges,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,2046.8,85,,1637.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2287.6,
EXC SKIN SCLP/HND/FEET >4.0 CM,450011426,CDM,450,RC,11426,HCPCS,outpatient,,,3647,2552.9,,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2410.67,66.1,,1928.54,percent of total billed charges,66.1% of total billed charges,3027.01,83,,2421.61,percent of total billed charges,83% of total,3464.65,95,,2771.72,percent of total billed charges ,95% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,78% of total billed charges,2844.66,78,,2275.728,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,80% of total billed charges,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,3099.95,85,,2479.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,3801.55,
EXC SKIN FACE 0.5 CM OR <,450011440,CDM,450,RC,11440,HCPCS,outpatient,,,670,469,,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,603,90,,482.4,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,442.87,66.1,,354.3,percent of total billed charges,66.1% of total billed charges,556.1,83,,444.88,percent of total billed charges,83% of total,636.5,95,,509.2,percent of total billed charges ,95% of total billed charges,536,80,,428.8,percent of total billed charges,78% of total billed charges,522.6,78,,418.08,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,603,90,,482.4,percent of total billed charges,90% of total billed charges,536,80,,428.8,percent of total billed charges,80% of total billed charges,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,569.5,85,,455.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,941.28,
EXC SKIN FACE 0.6-1.0 CM,450011441,CDM,450,RC,11441,HCPCS,outpatient,,,670,469,,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,603,90,,482.4,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,442.87,66.1,,354.3,percent of total billed charges,66.1% of total billed charges,556.1,83,,444.88,percent of total billed charges,83% of total,636.5,95,,509.2,percent of total billed charges ,95% of total billed charges,536,80,,428.8,percent of total billed charges,78% of total billed charges,522.6,78,,418.08,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,603,90,,482.4,percent of total billed charges,90% of total billed charges,536,80,,428.8,percent of total billed charges,80% of total billed charges,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,569.5,85,,455.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,941.28,
EXC SKIN FACE 1.1-2.0 CM,450011442,CDM,450,RC,11442,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
EXC SKIN FACE 2.1-3.0 CM,450011443,CDM,450,RC,11443,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
EXC CA TRUNK/EXT 0.5 CM OR <,450011600,CDM,450,RC,11600,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
EXC CA TRUNK/EXT 0.6-1.0CM,450011601,CDM,450,RC,11601,HCPCS,outpatient,,,670,469,,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,603,90,,482.4,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,442.87,66.1,,354.3,percent of total billed charges,66.1% of total billed charges,556.1,83,,444.88,percent of total billed charges,83% of total,636.5,95,,509.2,percent of total billed charges ,95% of total billed charges,536,80,,428.8,percent of total billed charges,78% of total billed charges,522.6,78,,418.08,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,603,90,,482.4,percent of total billed charges,90% of total billed charges,536,80,,428.8,percent of total billed charges,80% of total billed charges,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,569.5,85,,455.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,941.28,
EXC CA TRUNK/EXT 1.1-2.0 CM,450011602,CDM,450,RC,11602,HCPCS,outpatient,,,670,469,,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,603,90,,482.4,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,442.87,66.1,,354.3,percent of total billed charges,66.1% of total billed charges,556.1,83,,444.88,percent of total billed charges,83% of total,636.5,95,,509.2,percent of total billed charges ,95% of total billed charges,536,80,,428.8,percent of total billed charges,78% of total billed charges,522.6,78,,418.08,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,603,90,,482.4,percent of total billed charges,90% of total billed charges,536,80,,428.8,percent of total billed charges,80% of total billed charges,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,569.5,85,,455.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
EXC CA TRUNK/EXT 2.1-3.0 CM,450011603,CDM,450,RC,11603,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
EXC CA TRUNK/EXT 3.1-4.0 CM,450011604,CDM,450,RC,11604,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
EXC CA FACE 3.1-4.0 CM,450011644,CDM,450,RC,11644,HCPCS,outpatient,,,2408,1685.6,,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1591.69,66.1,,1273.35,percent of total billed charges,66.1% of total billed charges,1998.64,83,,1598.91,percent of total billed charges,83% of total,2287.6,95,,1830.08,percent of total billed charges ,95% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,78% of total billed charges,1878.24,78,,1502.592,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,80% of total billed charges,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,2046.8,85,,1637.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2287.6,
EXC CA FACE OVER 4.0 CM,450011646,CDM,450,RC,11646,HCPCS,outpatient,,,4779,3345.3,,3775.41,79,,3020.33,percent of total billed charges,79% of total billed charges,4301.1,90,,3440.88,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,3010.77,63,,2408.62,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,3158.92,66.1,,2527.14,percent of total billed charges,66.1% of total billed charges,3966.57,83,,3173.26,percent of total billed charges,83% of total,4540.05,95,,3632.04,percent of total billed charges ,95% of total billed charges,3823.2,80,,3058.56,percent of total billed charges,78% of total billed charges,3727.62,78,,2982.096,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3010.77,63,,2408.62,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,4301.1,90,,3440.88,percent of total billed charges,90% of total billed charges,3823.2,80,,3058.56,percent of total billed charges,80% of total billed charges,3010.77,63,,2408.62,percent of total billed charges,63% of total billed charges,4062.15,85,,3249.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,3775.41,79,,3020.33,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,4540.05,
TRIM NAILS NONDYSTROPHIC,450011719,CDM,450,RC,11719,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
DEBRIDE NAIL(S) 1-5,450011720,CDM,450,RC,11720,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
AVULSE NAIL PLATE SINGLE,450011730,CDM,450,RC,11730,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
AVULSE NAIL PLATE EA ADDL NAIL,450011732,CDM,450,RC,11732,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,881,
EVACUATE SUBUNGUAL HEMATOMA,450011740,CDM,450,RC,11740,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,881,
EXC NAIL & MATRIX,450011750,CDM,450,RC,11750,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
EXC NAIL & MATRIX W/TUFT AMPUT,450011752,CDM,450,RC,11752,HCPCS,outpatient,,,3647,2552.9,,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2410.67,66.1,,1928.54,percent of total billed charges,66.1% of total billed charges,3027.01,83,,2421.61,percent of total billed charges,83% of total,3464.65,95,,2771.72,percent of total billed charges ,95% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,78% of total billed charges,2844.66,78,,2275.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,80% of total billed charges,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,3099.95,85,,2479.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3464.65,
REPAIR NAIL BED,450011760,CDM,450,RC,11760,HCPCS,outpatient,,,1449,1014.3,,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,1304.1,90,,1043.28,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,957.79,66.1,,766.23,percent of total billed charges,66.1% of total billed charges,1202.67,83,,962.14,percent of total billed charges,83% of total,1376.55,95,,1101.24,percent of total billed charges ,95% of total billed charges,1159.2,80,,927.36,percent of total billed charges,78% of total billed charges,1130.22,78,,904.176,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1376.55,
RECONSTRUCT NAIL BED W/GRAFT,450011762,CDM,450,RC,11762,HCPCS,outpatient,,,2880,2016,,2275.2,79,,1820.16,percent of total billed charges,79% of total billed charges,2592,90,,2073.6,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1903.68,66.1,,1522.94,percent of total billed charges,66.1% of total billed charges,2390.4,83,,1912.32,percent of total billed charges,83% of total,2736,95,,2188.8,percent of total billed charges ,95% of total billed charges,2304,80,,1843.2,percent of total billed charges,78% of total billed charges,2246.4,78,,1797.12,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2592,90,,2073.6,percent of total billed charges,90% of total billed charges,2304,80,,1843.2,percent of total billed charges,80% of total billed charges,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,2448,85,,1958.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,2275.2,79,,1820.16,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,2736,
EXC NAIL FOLD (INGROWN),450011765,CDM,450,RC,11765,HCPCS,outpatient,,,402,281.4,,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,361.8,90,,289.44,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,265.72,66.1,,212.58,percent of total billed charges,66.1% of total billed charges,333.66,83,,266.93,percent of total billed charges,83% of total,381.9,95,,305.52,percent of total billed charges ,95% of total billed charges,321.6,80,,257.28,percent of total billed charges,78% of total billed charges,313.56,78,,250.848,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,253.26,63,,202.61,percent of total billed charges,63% of total billed charges,341.7,85,,273.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,317.58,79,,254.06,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,253.26,881,
LAC SP SCLP/TRK/EXT 2.5CM OR<,450012001,CDM,450,RC,12001,HCPCS,outpatient,,,516,361.2,,407.64,79,,326.11,percent of total billed charges,79% of total billed charges,464.4,90,,371.52,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,341.08,66.1,,272.86,percent of total billed charges,66.1% of total billed charges,428.28,83,,342.62,percent of total billed charges,83% of total,490.2,95,,392.16,percent of total billed charges ,95% of total billed charges,412.8,80,,330.24,percent of total billed charges,78% of total billed charges,402.48,78,,321.984,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,464.4,90,,371.52,percent of total billed charges,90% of total billed charges,412.8,80,,330.24,percent of total billed charges,80% of total billed charges,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,438.6,85,,350.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,407.64,79,,326.11,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
LAC SP SCLP/TRK/EXT 2.6-7.5CM,450012002,CDM,450,RC,12002,HCPCS,outpatient,,,776,543.2,,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,512.94,66.1,,410.35,percent of total billed charges,66.1% of total billed charges,644.08,83,,515.26,percent of total billed charges,83% of total,737.2,95,,589.76,percent of total billed charges ,95% of total billed charges,620.8,80,,496.64,percent of total billed charges,78% of total billed charges,605.28,78,,484.224,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
LAC SP SCLP/TRK/EXT 7.6-12.5CM,450012004,CDM,450,RC,12004,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
LAC SP SCLP/TRK/EXT 12.6-20.CM,450012005,CDM,450,RC,12005,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC SP SCLP/TRK/EXT 20.1-30 CM,450012006,CDM,450,RC,12006,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,283.57,66.1,,226.86,percent of total billed charges,66.1% of total billed charges,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,270.27,881,
LAC SP SCLP/TRK/EXT > 30.0 CM,450012007,CDM,450,RC,12007,HCPCS,outpatient,,,473,331.1,,373.67,79,,298.94,percent of total billed charges,79% of total billed charges,425.7,90,,340.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,297.99,63,,238.39,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,312.65,66.1,,250.12,percent of total billed charges,66.1% of total billed charges,392.59,83,,314.07,percent of total billed charges,83% of total,449.35,95,,359.48,percent of total billed charges ,95% of total billed charges,378.4,80,,302.72,percent of total billed charges,78% of total billed charges,368.94,78,,295.152,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,297.99,63,,238.39,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,425.7,90,,340.56,percent of total billed charges,90% of total billed charges,378.4,80,,302.72,percent of total billed charges,80% of total billed charges,297.99,63,,238.39,percent of total billed charges,63% of total billed charges,402.05,85,,321.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,373.67,79,,298.94,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
LAC SMPL FACE 2.5CM OR <,450012011,CDM,450,RC,12011,HCPCS,outpatient,,,776,543.2,,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,512.94,66.1,,410.35,percent of total billed charges,66.1% of total billed charges,644.08,83,,515.26,percent of total billed charges,83% of total,737.2,95,,589.76,percent of total billed charges ,95% of total billed charges,620.8,80,,496.64,percent of total billed charges,78% of total billed charges,605.28,78,,484.224,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
LAC SMPL FACE 2.6-5.0 CM,450012013,CDM,450,RC,12013,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
LAC SMPL FACE 5.1-7.5 CM,450012014,CDM,450,RC,12014,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,881,
LAC SMPL FACE 7.6-12.5 CM,450012015,CDM,450,RC,12015,HCPCS,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
LAC SMPL FACE 12.6-20.0 CM,450012016,CDM,450,RC,12016,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,283.57,66.1,,226.86,percent of total billed charges,66.1% of total billed charges,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,270.27,881,
WOUND DEHISCENCE SMPL,450012020,CDM,450,RC,12020,HCPCS,outpatient,,,1449,1014.3,,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,1304.1,90,,1043.28,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,957.79,66.1,,766.23,percent of total billed charges,66.1% of total billed charges,1202.67,83,,962.14,percent of total billed charges,83% of total,1376.55,95,,1101.24,percent of total billed charges ,95% of total billed charges,1159.2,80,,927.36,percent of total billed charges,78% of total billed charges,1130.22,78,,904.176,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1376.55,
WOUND DEHISCENCE W/PACKING,450012021,CDM,450,RC,12021,HCPCS,outpatient,,,418,292.6,,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,276.3,66.1,,221.04,percent of total billed charges,66.1% of total billed charges,346.94,83,,277.55,percent of total billed charges,83% of total,397.1,95,,317.68,percent of total billed charges ,95% of total billed charges,334.4,80,,267.52,percent of total billed charges,78% of total billed charges,326.04,78,,260.832,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,263.34,881,
LAC INT SCLP/TNK/EXT 2.5CM OR<,450012031,CDM,450,RC,12031,HCPCS,outpatient,,,305,213.5,,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,201.61,66.1,,161.29,percent of total billed charges,66.1% of total billed charges,253.15,83,,202.52,percent of total billed charges,83% of total,289.75,95,,231.8,percent of total billed charges ,95% of total billed charges,244,80,,195.2,percent of total billed charges,78% of total billed charges,237.9,78,,190.32,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,192.15,881,
LAC INT SCLP/TNK/EXT 2.6-7.5CM,450012032,CDM,450,RC,12032,HCPCS,outpatient,,,847,592.9,,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,559.87,66.1,,447.9,percent of total billed charges,66.1% of total billed charges,703.01,83,,562.41,percent of total billed charges,83% of total,804.65,95,,643.72,percent of total billed charges ,95% of total billed charges,677.6,80,,542.08,percent of total billed charges,78% of total billed charges,660.66,78,,528.528,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,677.6,80,,542.08,percent of total billed charges,80% of total billed charges,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,719.95,85,,575.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC INT SCLP/TNK/EX 7.6-12.5CM,450012034,CDM,450,RC,12034,HCPCS,outpatient,,,1202,841.4,,949.58,79,,759.66,percent of total billed charges,79% of total billed charges,1081.8,90,,865.44,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,757.26,63,,605.81,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,794.52,66.1,,635.62,percent of total billed charges,66.1% of total billed charges,997.66,83,,798.13,percent of total billed charges,83% of total,1141.9,95,,913.52,percent of total billed charges ,95% of total billed charges,961.6,80,,769.28,percent of total billed charges,78% of total billed charges,937.56,78,,750.048,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,757.26,63,,605.81,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,1081.8,90,,865.44,percent of total billed charges,90% of total billed charges,961.6,80,,769.28,percent of total billed charges,80% of total billed charges,757.26,63,,605.81,percent of total billed charges,63% of total billed charges,1021.7,85,,817.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,949.58,79,,759.66,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,1141.9,
LAC INT SCLP/TNK/EX12.6-20.0CM,450012035,CDM,450,RC,12035,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,227.38,66.1,,181.9,percent of total billed charges,66.1% of total billed charges,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,216.72,881,
LAC INTERM S/A/T/E 20.1-30 CM,450012036,CDM,450,RC,12036,HCPCS,outpatient,,,1449,1014.3,,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,1304.1,90,,1043.28,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,957.79,66.1,,766.23,percent of total billed charges,66.1% of total billed charges,1202.67,83,,962.14,percent of total billed charges,83% of total,1376.55,95,,1101.24,percent of total billed charges ,95% of total billed charges,1159.2,80,,927.36,percent of total billed charges,78% of total billed charges,1130.22,78,,904.176,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1376.55,
LAC INT NCK/HND/FT 2.5CM OR<,450012041,CDM,450,RC,12041,HCPCS,outpatient,,,847,592.9,,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,559.87,66.1,,447.9,percent of total billed charges,66.1% of total billed charges,703.01,83,,562.41,percent of total billed charges,83% of total,804.65,95,,643.72,percent of total billed charges ,95% of total billed charges,677.6,80,,542.08,percent of total billed charges,78% of total billed charges,660.66,78,,528.528,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,762.3,90,,609.84,percent of total billed charges,90% of total billed charges,677.6,80,,542.08,percent of total billed charges,80% of total billed charges,533.61,63,,426.89,percent of total billed charges,63% of total billed charges,719.95,85,,575.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,669.13,79,,535.3,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC INT NCK/HND/FT 2.6-7.5CM,450012042,CDM,450,RC,12042,HCPCS,outpatient,,,305,213.5,,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,201.61,66.1,,161.29,percent of total billed charges,66.1% of total billed charges,253.15,83,,202.52,percent of total billed charges,83% of total,289.75,95,,231.8,percent of total billed charges ,95% of total billed charges,244,80,,195.2,percent of total billed charges,78% of total billed charges,237.9,78,,190.32,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,192.15,881,
LAC INT NCK/HND/FT 7.6-12.5CM,450012044,CDM,450,RC,12044,HCPCS,outpatient,,,762,533.4,,601.98,79,,481.58,percent of total billed charges,79% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,480.06,63,,384.05,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,503.68,66.1,,402.94,percent of total billed charges,66.1% of total billed charges,632.46,83,,505.97,percent of total billed charges,83% of total,723.9,95,,579.12,percent of total billed charges ,95% of total billed charges,609.6,80,,487.68,percent of total billed charges,78% of total billed charges,594.36,78,,475.488,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,480.06,63,,384.05,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,480.06,63,,384.05,percent of total billed charges,63% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,601.98,79,,481.58,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,881,
LAC INT NCK/HND/FT 12.6-20.0CM,450012045,CDM,450,RC,12045,HCPCS,outpatient,,,860,602,,679.4,79,,543.52,percent of total billed charges,79% of total billed charges,774,90,,619.2,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,568.46,66.1,,454.77,percent of total billed charges,66.1% of total billed charges,713.8,83,,571.04,percent of total billed charges,83% of total,817,95,,653.6,percent of total billed charges ,95% of total billed charges,688,80,,550.4,percent of total billed charges,78% of total billed charges,670.8,78,,536.64,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,774,90,,619.2,percent of total billed charges,90% of total billed charges,688,80,,550.4,percent of total billed charges,80% of total billed charges,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,731,85,,584.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,679.4,79,,543.52,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,881,
LAC INT FACE 2.5 CM OR <,450012051,CDM,450,RC,12051,HCPCS,outpatient,,,507,354.9,,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,335.13,66.1,,268.1,percent of total billed charges,66.1% of total billed charges,420.81,83,,336.65,percent of total billed charges,83% of total,481.65,95,,385.32,percent of total billed charges ,95% of total billed charges,405.6,80,,324.48,percent of total billed charges,78% of total billed charges,395.46,78,,316.368,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,405.6,80,,324.48,percent of total billed charges,80% of total billed charges,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,430.95,85,,344.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC INT FACE 2.6-5.0 CM,450012052,CDM,450,RC,12052,HCPCS,outpatient,,,305,213.5,,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,274.5,90,,219.6,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,201.61,66.1,,161.29,percent of total billed charges,66.1% of total billed charges,253.15,83,,202.52,percent of total billed charges,83% of total,289.75,95,,231.8,percent of total billed charges ,95% of total billed charges,244,80,,195.2,percent of total billed charges,78% of total billed charges,237.9,78,,190.32,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,192.15,63,,153.72,percent of total billed charges,63% of total billed charges,259.25,85,,207.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,240.95,79,,192.76,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,192.15,881,
LAC INT FACE 5.1-7.5 CM,450012053,CDM,450,RC,12053,HCPCS,outpatient,,,762,533.4,,601.98,79,,481.58,percent of total billed charges,79% of total billed charges,685.8,90,,548.64,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,480.06,63,,384.05,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,503.68,66.1,,402.94,percent of total billed charges,66.1% of total billed charges,632.46,83,,505.97,percent of total billed charges,83% of total,723.9,95,,579.12,percent of total billed charges ,95% of total billed charges,609.6,80,,487.68,percent of total billed charges,78% of total billed charges,594.36,78,,475.488,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,480.06,63,,384.05,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,480.06,63,,384.05,percent of total billed charges,63% of total billed charges,647.7,85,,518.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,601.98,79,,481.58,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC INTERM FACE 7.6-12.5 CM,450012054,CDM,450,RC,12054,HCPCS,outpatient,,,860,602,,679.4,79,,543.52,percent of total billed charges,79% of total billed charges,774,90,,619.2,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,568.46,66.1,,454.77,percent of total billed charges,66.1% of total billed charges,713.8,83,,571.04,percent of total billed charges,83% of total,817,95,,653.6,percent of total billed charges ,95% of total billed charges,688,80,,550.4,percent of total billed charges,78% of total billed charges,670.8,78,,536.64,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,774,90,,619.2,percent of total billed charges,90% of total billed charges,688,80,,550.4,percent of total billed charges,80% of total billed charges,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,731,85,,584.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,679.4,79,,543.52,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC INT FACE 12.6-20.0 CM,450012055,CDM,450,RC,12055,HCPCS,outpatient,,,919,643.3,,726.01,79,,580.81,percent of total billed charges,79% of total billed charges,827.1,90,,661.68,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,578.97,63,,463.18,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,607.46,66.1,,485.97,percent of total billed charges,66.1% of total billed charges,762.77,83,,610.22,percent of total billed charges,83% of total,873.05,95,,698.44,percent of total billed charges ,95% of total billed charges,735.2,80,,588.16,percent of total billed charges,78% of total billed charges,716.82,78,,573.456,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,578.97,63,,463.18,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,578.97,63,,463.18,percent of total billed charges,63% of total billed charges,781.15,85,,624.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,726.01,79,,580.81,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC COMP TRNK 1.1-2.5CM,450013100,CDM,450,RC,13100,HCPCS,outpatient,,,860,602,,679.4,79,,543.52,percent of total billed charges,79% of total billed charges,774,90,,619.2,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,568.46,66.1,,454.77,percent of total billed charges,66.1% of total billed charges,713.8,83,,571.04,percent of total billed charges,83% of total,817,95,,653.6,percent of total billed charges ,95% of total billed charges,688,80,,550.4,percent of total billed charges,78% of total billed charges,670.8,78,,536.64,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,774,90,,619.2,percent of total billed charges,90% of total billed charges,688,80,,550.4,percent of total billed charges,80% of total billed charges,541.8,63,,433.44,percent of total billed charges,63% of total billed charges,731,85,,584.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,679.4,79,,543.52,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,881,
LAC COMP TRUNK 2.6-7.5CM,450013101,CDM,450,RC,13101,HCPCS,outpatient,,,998,698.6,,788.42,79,,630.74,percent of total billed charges,79% of total billed charges,898.2,90,,718.56,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,628.74,63,,502.99,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,659.68,66.1,,527.74,percent of total billed charges,66.1% of total billed charges,828.34,83,,662.67,percent of total billed charges,83% of total,948.1,95,,758.48,percent of total billed charges ,95% of total billed charges,798.4,80,,638.72,percent of total billed charges,78% of total billed charges,778.44,78,,622.752,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,628.74,63,,502.99,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,898.2,90,,718.56,percent of total billed charges,90% of total billed charges,798.4,80,,638.72,percent of total billed charges,80% of total billed charges,628.74,63,,502.99,percent of total billed charges,63% of total billed charges,848.3,85,,678.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,788.42,79,,630.74,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,948.1,
LAC COMP TRUNK EA ADDL 5 CM/<,450013102,CDM,450,RC,13102,HCPCS,outpatient,,,193,135.1,,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,173.7,90,,138.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.59,63,,97.27,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,127.57,66.1,,102.06,percent of total billed charges,66.1% of total billed charges,160.19,83,,128.15,percent of total billed charges,83% of total,183.35,95,,146.68,percent of total billed charges ,95% of total billed charges,154.4,80,,123.52,percent of total billed charges,78% of total billed charges,150.54,78,,120.432,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,121.59,63,,97.27,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,121.59,63,,97.27,percent of total billed charges,63% of total billed charges,164.05,85,,131.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,152.47,79,,121.98,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,121.59,881,
LAC COM SCLP/EXT 1.1-2.5 CM,450013120,CDM,450,RC,13120,HCPCS,outpatient,,,418,292.6,,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,376.2,90,,300.96,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,276.3,66.1,,221.04,percent of total billed charges,66.1% of total billed charges,346.94,83,,277.55,percent of total billed charges,83% of total,397.1,95,,317.68,percent of total billed charges ,95% of total billed charges,334.4,80,,267.52,percent of total billed charges,78% of total billed charges,326.04,78,,260.832,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,263.34,63,,210.67,percent of total billed charges,63% of total billed charges,355.3,85,,284.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,330.22,79,,264.18,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,263.34,881,
LAC COM SCLP/EXT 2.6-7.5 CM,450013121,CDM,450,RC,13121,HCPCS,outpatient,,,1452,1016.4,,1147.08,79,,917.66,percent of total billed charges,79% of total billed charges,1306.8,90,,1045.44,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,914.76,63,,731.81,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,959.77,66.1,,767.82,percent of total billed charges,66.1% of total billed charges,1205.16,83,,964.13,percent of total billed charges,83% of total,1379.4,95,,1103.52,percent of total billed charges ,95% of total billed charges,1161.6,80,,929.28,percent of total billed charges,78% of total billed charges,1132.56,78,,906.048,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,914.76,63,,731.81,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,1306.8,90,,1045.44,percent of total billed charges,90% of total billed charges,1161.6,80,,929.28,percent of total billed charges,80% of total billed charges,914.76,63,,731.81,percent of total billed charges,63% of total billed charges,1234.2,85,,987.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,1147.08,79,,917.66,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1379.4,
LAC COM SCLP/EXT EA ADD 5 CM/>,450013122,CDM,450,RC,13122,HCPCS,outpatient,,,77,53.9,,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,69.3,90,,55.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,50.9,66.1,,40.72,percent of total billed charges,66.1% of total billed charges,63.91,83,,51.13,percent of total billed charges,83% of total,73.15,95,,58.52,percent of total billed charges ,95% of total billed charges,61.6,80,,49.28,percent of total billed charges,78% of total billed charges,60.06,78,,48.048,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,48.51,63,,38.81,percent of total billed charges,63% of total billed charges,65.45,85,,52.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,60.83,79,,48.66,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.51,881,
LAC COMP FAC/HND/FT 1.1-2.5 CM,450013131,CDM,450,RC,13131,HCPCS,outpatient,,,543,380.1,,428.97,79,,343.18,percent of total billed charges,79% of total billed charges,488.7,90,,390.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,358.92,66.1,,287.14,percent of total billed charges,66.1% of total billed charges,450.69,83,,360.55,percent of total billed charges,83% of total,515.85,95,,412.68,percent of total billed charges ,95% of total billed charges,434.4,80,,347.52,percent of total billed charges,78% of total billed charges,423.54,78,,338.832,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,488.7,90,,390.96,percent of total billed charges,90% of total billed charges,434.4,80,,347.52,percent of total billed charges,80% of total billed charges,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,461.55,85,,369.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,428.97,79,,343.18,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
LAC COMP FAC/HND/FT 2.6-7.5 CM,450013132,CDM,450,RC,13132,HCPCS,outpatient,,,1449,1014.3,,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,1304.1,90,,1043.28,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,957.79,66.1,,766.23,percent of total billed charges,66.1% of total billed charges,1202.67,83,,962.14,percent of total billed charges,83% of total,1376.55,95,,1101.24,percent of total billed charges ,95% of total billed charges,1159.2,80,,927.36,percent of total billed charges,78% of total billed charges,1130.22,78,,904.176,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,912.87,63,,730.3,percent of total billed charges,63% of total billed charges,1231.65,85,,985.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,1144.71,79,,915.77,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1376.55,
LAC COMP FAC/HND/FT ADDL 5CM/<,450013133,CDM,450,RC,13133,HCPCS,outpatient,,,323,226.1,,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,290.7,90,,232.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,213.5,66.1,,170.8,percent of total billed charges,66.1% of total billed charges,268.09,83,,214.47,percent of total billed charges,83% of total,306.85,95,,245.48,percent of total billed charges ,95% of total billed charges,258.4,80,,206.72,percent of total billed charges,78% of total billed charges,251.94,78,,201.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,203.49,63,,162.79,percent of total billed charges,63% of total billed charges,274.55,85,,219.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,255.17,79,,204.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,203.49,881,
LAC CMP EY/NSE/ER/LP 1.1-2.5CM,450013151,CDM,450,RC,13151,HCPCS,outpatient,,,998,698.6,,788.42,79,,630.74,percent of total billed charges,79% of total billed charges,898.2,90,,718.56,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,628.74,63,,502.99,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,659.68,66.1,,527.74,percent of total billed charges,66.1% of total billed charges,828.34,83,,662.67,percent of total billed charges,83% of total,948.1,95,,758.48,percent of total billed charges ,95% of total billed charges,798.4,80,,638.72,percent of total billed charges,78% of total billed charges,778.44,78,,622.752,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,628.74,63,,502.99,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,898.2,90,,718.56,percent of total billed charges,90% of total billed charges,798.4,80,,638.72,percent of total billed charges,80% of total billed charges,628.74,63,,502.99,percent of total billed charges,63% of total billed charges,848.3,85,,678.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,788.42,79,,630.74,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,948.1,
LAC CMP EY/NSE/ER/LP 2.6-7.5CM,450013152,CDM,450,RC,13152,HCPCS,outpatient,,,1086,760.2,,857.94,79,,686.35,percent of total billed charges,79% of total billed charges,977.4,90,,781.92,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,684.18,63,,547.34,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,717.85,66.1,,574.28,percent of total billed charges,66.1% of total billed charges,901.38,83,,721.1,percent of total billed charges,83% of total,1031.7,95,,825.36,percent of total billed charges ,95% of total billed charges,868.8,80,,695.04,percent of total billed charges,78% of total billed charges,847.08,78,,677.664,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,684.18,63,,547.34,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,977.4,90,,781.92,percent of total billed charges,90% of total billed charges,868.8,80,,695.04,percent of total billed charges,80% of total billed charges,684.18,63,,547.34,percent of total billed charges,63% of total billed charges,923.1,85,,738.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,857.94,79,,686.35,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1031.7,
LAC CMP EY/NSE/ER/LP ADD 5CM/<,450013153,CDM,450,RC,13153,HCPCS,outpatient,,,351,245.7,,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,315.9,90,,252.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.13,63,,176.9,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,232.01,66.1,,185.61,percent of total billed charges,66.1% of total billed charges,291.33,83,,233.06,percent of total billed charges,83% of total,333.45,95,,266.76,percent of total billed charges ,95% of total billed charges,280.8,80,,224.64,percent of total billed charges,78% of total billed charges,273.78,78,,219.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,221.13,63,,176.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,221.13,63,,176.9,percent of total billed charges,63% of total billed charges,298.35,85,,238.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,277.29,79,,221.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,221.13,881,
REMOVAL SUTR/STAPL XREQ ANES,450015853,CDM,450,RC,15853,HCPCS,outpatient,,,210,147,,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,138.81,66.1,,111.05,percent of total billed charges,66.1% of total billed charges,174.3,83,,139.44,percent of total billed charges,83% of total,199.5,95,,159.6,percent of total billed charges ,95% of total billed charges,168,80,,134.4,percent of total billed charges,78% of total billed charges,163.8,78,,131.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.3,881,
REMOVAL SUTR & STAPL XREQ ANES,450015854,CDM,450,RC,15854,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,881,
BURN 1ST DEGREE,450016000,CDM,450,RC,16000,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,881,
BURN DRSS/DBRD PRT-THICK SMALL,450016020,CDM,450,RC,16020,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
BURN DRESS/DBRD PRT-THICK MED,450016025,CDM,450,RC,16025,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
BURN DRESS/DBRD PRT-THICK LG,450016030,CDM,450,RC,16030,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
DSTRCT CUT VSC LESION <10 SQCM,450017106,CDM,450,RC,17106,HCPCS,outpatient,,,578,404.6,,456.62,79,,365.3,percent of total billed charges,79% of total billed charges,520.2,90,,416.16,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,364.14,63,,291.31,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,382.06,66.1,,305.65,percent of total billed charges,66.1% of total billed charges,479.74,83,,383.79,percent of total billed charges,83% of total,549.1,95,,439.28,percent of total billed charges ,95% of total billed charges,462.4,80,,369.92,percent of total billed charges,78% of total billed charges,450.84,78,,360.672,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,364.14,63,,291.31,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,520.2,90,,416.16,percent of total billed charges,90% of total billed charges,462.4,80,,369.92,percent of total billed charges,80% of total billed charges,364.14,63,,291.31,percent of total billed charges,63% of total billed charges,491.3,85,,393.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,456.62,79,,365.3,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,881,
"DESTRUCT BENIGN LESIONS, #1-14",450017110,CDM,450,RC,17110,HCPCS,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
ER SKIN/TISSUE - UNLISTED,450017999,CDM,450,RC,17999,HCPCS,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,881,
BREAST CYST PNCTR ASPIRATION,450019000,CDM,450,RC,19000,HCPCS,outpatient,,,1624,1136.8,,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1073.46,66.1,,858.77,percent of total billed charges,66.1% of total billed charges,1347.92,83,,1078.34,percent of total billed charges,83% of total,1542.8,95,,1234.24,percent of total billed charges ,95% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,78% of total billed charges,1266.72,78,,1013.376,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1461.6,90,,1169.28,percent of total billed charges,90% of total billed charges,1299.2,80,,1039.36,percent of total billed charges,80% of total billed charges,1023.12,63,,818.5,percent of total billed charges,63% of total billed charges,1380.4,85,,1104.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1282.96,79,,1026.37,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1542.8,
ABCESS BREAST I&D DEEP,450019020,CDM,450,RC,19020,HCPCS,outpatient,,,3296,2307.2,,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2178.66,66.1,,1742.93,percent of total billed charges,66.1% of total billed charges,2735.68,83,,2188.54,percent of total billed charges,83% of total,3131.2,95,,2504.96,percent of total billed charges ,95% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,78% of total billed charges,2570.88,78,,2056.704,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,80% of total billed charges,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,2801.6,85,,2241.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3131.2,
EXP PENETRATING WND NECK,450020100,CDM,450,RC,20100,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,736.09,160,,,Fee Schedule,160% of CMS OPPS rate,598.07,130,,,Fee Schedule,130% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,756.85,66.1,,605.48,percent of total billed charges,66.1% of total billed charges,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,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,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,427.85,93,,,fee schedule,93% of CMS OPPS rate,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,427.85,1087.75,
EXP PENETRATING WND CHEST,450020101,CDM,450,RC,20101,HCPCS,outpatient,,,2880,2016,,2275.2,79,,1820.16,percent of total billed charges,79% of total billed charges,2592,90,,2073.6,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1903.68,66.1,,1522.94,percent of total billed charges,66.1% of total billed charges,2390.4,83,,1912.32,percent of total billed charges,83% of total,2736,95,,2188.8,percent of total billed charges ,95% of total billed charges,2304,80,,1843.2,percent of total billed charges,78% of total billed charges,2246.4,78,,1797.12,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2592,90,,2073.6,percent of total billed charges,90% of total billed charges,2304,80,,1843.2,percent of total billed charges,80% of total billed charges,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,2448,85,,1958.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,2275.2,79,,1820.16,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,2736,
EXP PENETRATING WND ABD/BACK,450020102,CDM,450,RC,20102,HCPCS,outpatient,,,2880,2016,,2275.2,79,,1820.16,percent of total billed charges,79% of total billed charges,2592,90,,2073.6,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1903.68,66.1,,1522.94,percent of total billed charges,66.1% of total billed charges,2390.4,83,,1912.32,percent of total billed charges,83% of total,2736,95,,2188.8,percent of total billed charges ,95% of total billed charges,2304,80,,1843.2,percent of total billed charges,78% of total billed charges,2246.4,78,,1797.12,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2592,90,,2073.6,percent of total billed charges,90% of total billed charges,2304,80,,1843.2,percent of total billed charges,80% of total billed charges,1814.4,63,,1451.52,percent of total billed charges,63% of total billed charges,2448,85,,1958.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,2275.2,79,,1820.16,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,2736,
EXP PENETRATING WND EXT,450020103,CDM,450,RC,20103,HCPCS,outpatient,,,155,108.5,,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,102.46,66.1,,81.97,percent of total billed charges,66.1% of total billed charges,128.65,83,,102.92,percent of total billed charges,83% of total,147.25,95,,117.8,percent of total billed charges ,95% of total billed charges,124,80,,99.2,percent of total billed charges,78% of total billed charges,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,2169.07,
FB REMOVAL MUSCLE/TENDON SMPL,450020520,CDM,450,RC,20520,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
FB REMOVAL MUSCLE/TENDON COMPL,450020525,CDM,450,RC,20525,HCPCS,outpatient,,,3647,2552.9,,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2410.67,66.1,,1928.54,percent of total billed charges,66.1% of total billed charges,3027.01,83,,2421.61,percent of total billed charges,83% of total,3464.65,95,,2771.72,percent of total billed charges ,95% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,78% of total billed charges,2844.66,78,,2275.728,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,80% of total billed charges,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,3099.95,85,,2479.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,3801.55,
"INJ TNDN SHTH/LIGMNT, SINGLE",450020550,CDM,450,RC,20550,HCPCS,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,881,
"INJ TNDN ORIGIN/INSERT,SINGLE",450020551,CDM,450,RC,20551,HCPCS,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,881,
TRIGGER PNT INJ 1-2- MUSCLES,450020552,CDM,450,RC,20552,HCPCS,outpatient,,,523,366.1,,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,345.7,66.1,,276.56,percent of total billed charges,66.1% of total billed charges,434.09,83,,347.27,percent of total billed charges,83% of total,496.85,95,,397.48,percent of total billed charges ,95% of total billed charges,418.4,80,,334.72,percent of total billed charges,78% of total billed charges,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,881,
ASP/INJ JNT/BURSA SML W/O U/S,450020600,CDM,450,RC,20600,HCPCS,outpatient,,,523,366.1,,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,345.7,66.1,,276.56,percent of total billed charges,66.1% of total billed charges,434.09,83,,347.27,percent of total billed charges,83% of total,496.85,95,,397.48,percent of total billed charges ,95% of total billed charges,418.4,80,,334.72,percent of total billed charges,78% of total billed charges,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,881,
ASP/INJ JNT/BURSA INT W/O U/S,450020605,CDM,450,RC,20605,HCPCS,outpatient,,,523,366.1,,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,345.7,66.1,,276.56,percent of total billed charges,66.1% of total billed charges,434.09,83,,347.27,percent of total billed charges,83% of total,496.85,95,,397.48,percent of total billed charges ,95% of total billed charges,418.4,80,,334.72,percent of total billed charges,78% of total billed charges,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,881,
ASP/INJ JNT/BURSA MAJ W/O U/S,450020610,CDM,450,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,881,
FX NASAL CLSD NO MANIPULATION,450021310,CDM,450,RC,21310,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.51,881,
FX NASAL CLSD W MANIP WO STABN,450021315,CDM,450,RC,21315,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,2040.31,160,,,Fee Schedule,160% of CMS OPPS rate,1657.75,130,,,Fee Schedule,130% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,756.85,66.1,,605.48,percent of total billed charges,66.1% of total billed charges,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,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,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1185.92,93,,,fee schedule,93% of CMS OPPS rate,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,450,2040.31,
FX NASAL SEP CLSD W/WO STABILI,450021337,CDM,450,RC,21337,HCPCS,outpatient,,,2558,1790.6,,2020.82,79,,1616.66,percent of total billed charges,79% of total billed charges,2302.2,90,,1841.76,percent of total billed charges,90% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,4307.42,160,,,Fee Schedule,160% of CMS OPPS rate,3499.78,130,,,Fee Schedule,130% of CMS OPPS rate,1611.54,63,,1289.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1690.84,66.1,,1352.67,percent of total billed charges,66.1% of total billed charges,2123.14,83,,1698.51,percent of total billed charges,83% of total,2430.1,95,,1944.08,percent of total billed charges ,95% of total billed charges,2046.4,80,,1637.12,percent of total billed charges,78% of total billed charges,1995.24,78,,1596.192,percent of total billed charges,78% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,1611.54,63,,1289.23,percent of total billed charges,63% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,2302.2,90,,1841.76,percent of total billed charges,90% of total billed charges,2046.4,80,,1637.12,percent of total billed charges,80% of total billed charges,1611.54,63,,1289.23,percent of total billed charges,63% of total billed charges,2174.3,85,,1739.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2503.67,93,,,fee schedule,93% of CMS OPPS rate,2020.82,79,,1616.66,percent of total billed charges,79% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,450,4307.42,
DISLOC TMJ CLSD INITIAL/SUBS,450021480,CDM,450,RC,21480,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,111.51,881,
"FX RIB CLSD UNCOMP, EA RIB",450021800,CDM,450,RC,,,outpatient,,,401,280.7,,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,265.06,66.1,,212.05,percent of total billed charges,66.1% of total billed charges,332.83,83,,266.26,percent of total billed charges,83% of total,380.95,95,,304.76,percent of total billed charges ,95% of total billed charges,320.8,80,,256.64,percent of total billed charges,78% of total billed charges,312.78,78,,250.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,252.63,881,
SHOULDER ABSCESS I&D DEEP,450023030,CDM,450,RC,23030,HCPCS,outpatient,,,3296,2307.2,,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2178.66,66.1,,1742.93,percent of total billed charges,66.1% of total billed charges,2735.68,83,,2188.54,percent of total billed charges,83% of total,3131.2,95,,2504.96,percent of total billed charges ,95% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,78% of total billed charges,2570.88,78,,2056.704,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,80% of total billed charges,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,2801.6,85,,2241.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,3801.55,
FX CLAVICLE CLSD NO MANIP,450023500,CDM,450,RC,23500,HCPCS,outpatient,,,401,280.7,,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,265.06,66.1,,212.05,percent of total billed charges,66.1% of total billed charges,332.83,83,,266.26,percent of total billed charges,83% of total,380.95,95,,304.76,percent of total billed charges ,95% of total billed charges,320.8,80,,256.64,percent of total billed charges,78% of total billed charges,312.78,78,,250.224,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
DISLOC ACROMIOCLAV CLSD NO MAN,450023540,CDM,450,RC,23540,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,881,
DISLOC ACROMIOCLAV CLSD W/ MAN,450023545,CDM,450,RC,23545,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX SCAPULA CLSD NO MANIPULAT,450023570,CDM,450,RC,23570,HCPCS,outpatient,,,401,280.7,,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,265.06,66.1,,212.05,percent of total billed charges,66.1% of total billed charges,332.83,83,,266.26,percent of total billed charges,83% of total,380.95,95,,304.76,percent of total billed charges ,95% of total billed charges,320.8,80,,256.64,percent of total billed charges,78% of total billed charges,312.78,78,,250.224,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX HUMERUS PRX NO MANIP,450023600,CDM,450,RC,23600,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
CLTX PROX HUMRL FX W/MAN TRACT,450023605,CDM,450,RC,23605,HCPCS,outpatient,,,3375,2362.5,,2666.25,79,,2133,percent of total billed charges,79% of total billed charges,3037.5,90,,2430,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,2126.25,63,,1701,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2230.88,66.1,,1784.7,percent of total billed charges,66.1% of total billed charges,2801.25,83,,2241,percent of total billed charges,83% of total,3206.25,95,,2565,percent of total billed charges ,95% of total billed charges,2700,80,,2160,percent of total billed charges,78% of total billed charges,2632.5,78,,2106,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2126.25,63,,1701,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,3037.5,90,,2430,percent of total billed charges,90% of total billed charges,2700,80,,2160,percent of total billed charges,80% of total billed charges,2126.25,63,,1701,percent of total billed charges,63% of total billed charges,2868.75,85,,2295,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2666.25,79,,2133,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,3206.25,
DSLC SHLDR CLSD W/MNP NO ANSTH,450023650,CDM,450,RC,23650,HCPCS,outpatient,,,335,234.5,,264.65,79,,211.72,percent of total billed charges,79% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,221.44,66.1,,177.15,percent of total billed charges,66.1% of total billed charges,278.05,83,,222.44,percent of total billed charges,83% of total,318.25,95,,254.6,percent of total billed charges ,95% of total billed charges,268,80,,214.4,percent of total billed charges,78% of total billed charges,261.3,78,,209.04,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,264.65,79,,211.72,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
SHLDER DISLOC TX W MANIPU/ANES,450023655,CDM,450,RC,23655,HCPCS,outpatient,,,3705,2593.5,,2926.95,79,,2341.56,percent of total billed charges,79% of total billed charges,3334.5,90,,2667.6,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,2334.15,63,,1867.32,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2449.01,66.1,,1959.21,percent of total billed charges,66.1% of total billed charges,3075.15,83,,2460.12,percent of total billed charges,83% of total,3519.75,95,,2815.8,percent of total billed charges ,95% of total billed charges,2964,80,,2371.2,percent of total billed charges,78% of total billed charges,2889.9,78,,2311.92,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2334.15,63,,1867.32,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,3334.5,90,,2667.6,percent of total billed charges,90% of total billed charges,2964,80,,2371.2,percent of total billed charges,80% of total billed charges,2334.15,63,,1867.32,percent of total billed charges,63% of total billed charges,3149.25,85,,2519.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2926.95,79,,2341.56,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,3519.75,
DSLC SHLDR CLSD W/FX W/MANIP,450023665,CDM,450,RC,23665,HCPCS,outpatient,,,943,660.1,,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,623.32,66.1,,498.66,percent of total billed charges,66.1% of total billed charges,782.69,83,,626.15,percent of total billed charges,83% of total,895.85,95,,716.68,percent of total billed charges ,95% of total billed charges,754.4,80,,603.52,percent of total billed charges,78% of total billed charges,735.54,78,,588.432,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,754.4,80,,603.52,percent of total billed charges,80% of total billed charges,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,801.55,85,,641.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
UPPER ARM/ELBOW BURSA I&D,450023931,CDM,450,RC,23931,HCPCS,outpatient,,,1774,1241.8,,1401.46,79,,1121.17,percent of total billed charges,79% of total billed charges,1596.6,90,,1277.28,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1117.62,63,,894.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1172.61,66.1,,938.09,percent of total billed charges,66.1% of total billed charges,1472.42,83,,1177.94,percent of total billed charges,83% of total,1685.3,95,,1348.24,percent of total billed charges ,95% of total billed charges,1419.2,80,,1135.36,percent of total billed charges,78% of total billed charges,1383.72,78,,1106.976,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1117.62,63,,894.1,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,1117.62,63,,894.1,percent of total billed charges,63% of total billed charges,1507.9,85,,1206.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1401.46,79,,1121.17,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
FB REMOVAL UPPER ARM/ELBOW SQ,450024200,CDM,450,RC,24200,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
FX HUMERUS SHFT CLSD NO MANIP,450024500,CDM,450,RC,24500,HCPCS,outpatient,,,560,392,,442.4,79,,353.92,percent of total billed charges,79% of total billed charges,504,90,,403.2,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,352.8,63,,282.24,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,370.16,66.1,,296.13,percent of total billed charges,66.1% of total billed charges,464.8,83,,371.84,percent of total billed charges,83% of total,532,95,,425.6,percent of total billed charges ,95% of total billed charges,448,80,,358.4,percent of total billed charges,78% of total billed charges,436.8,78,,349.44,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,352.8,63,,282.24,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,504,90,,403.2,percent of total billed charges,90% of total billed charges,448,80,,358.4,percent of total billed charges,80% of total billed charges,352.8,63,,282.24,percent of total billed charges,63% of total billed charges,476,85,,380.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,442.4,79,,353.92,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX HUMERUS SHFT CLSD W/MANIP,450024505,CDM,450,RC,24505,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,2150.21,
FX HUMERUS CONDYLE CLSD NO/MAN,450024530,CDM,450,RC,24530,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX HUMERUS CLSD TX W/ MANIP,450024565,CDM,450,RC,24565,HCPCS,outpatient,,,243,170.1,,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,218.7,90,,174.96,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,160.62,66.1,,128.5,percent of total billed charges,66.1% of total billed charges,201.69,83,,161.35,percent of total billed charges,83% of total,230.85,95,,184.68,percent of total billed charges ,95% of total billed charges,194.4,80,,155.52,percent of total billed charges,78% of total billed charges,189.54,78,,151.632,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,153.09,63,,122.47,percent of total billed charges,63% of total billed charges,206.55,85,,165.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,191.97,79,,153.58,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,153.09,2150.21,
FX HMRL CNDYL M/L CLTX W/O MAN,450024576,CDM,450,RC,24576,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX HMRS CNDYL MD/LAT/CLSDW/MA,450024577,CDM,450,RC,24577,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,2150.21,
DISLOC ELBOW CLSD NO ANSTH,450024600,CDM,450,RC,24600,HCPCS,outpatient,,,935,654.5,,738.65,79,,590.92,percent of total billed charges,79% of total billed charges,841.5,90,,673.2,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,589.05,63,,471.24,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,618.04,66.1,,494.43,percent of total billed charges,66.1% of total billed charges,776.05,83,,620.84,percent of total billed charges,83% of total,888.25,95,,710.6,percent of total billed charges ,95% of total billed charges,748,80,,598.4,percent of total billed charges,78% of total billed charges,729.3,78,,583.44,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,589.05,63,,471.24,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,841.5,90,,673.2,percent of total billed charges,90% of total billed charges,748,80,,598.4,percent of total billed charges,80% of total billed charges,589.05,63,,471.24,percent of total billed charges,63% of total billed charges,794.75,85,,635.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,738.65,79,,590.92,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,888.25,
DISLOC ELBOW CLSD W/ ANESTH,450024605,CDM,450,RC,24605,HCPCS,outpatient,,,1092,764.4,,862.68,79,,690.14,percent of total billed charges,79% of total billed charges,982.8,90,,786.24,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,721.81,66.1,,577.45,percent of total billed charges,66.1% of total billed charges,906.36,83,,725.09,percent of total billed charges,83% of total,1037.4,95,,829.92,percent of total billed charges ,95% of total billed charges,873.6,80,,698.88,percent of total billed charges,78% of total billed charges,851.76,78,,681.408,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,928.2,85,,742.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,862.68,79,,690.14,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
FX DISLOC MONTEGGIA W/MANIP,450024620,CDM,450,RC,24620,HCPCS,outpatient,,,2630,1841,,2077.7,79,,1662.16,percent of total billed charges,79% of total billed charges,2367,90,,1893.6,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1656.9,63,,1325.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1738.43,66.1,,1390.74,percent of total billed charges,66.1% of total billed charges,2182.9,83,,1746.32,percent of total billed charges,83% of total,2498.5,95,,1998.8,percent of total billed charges ,95% of total billed charges,2104,80,,1683.2,percent of total billed charges,78% of total billed charges,2051.4,78,,1641.12,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1656.9,63,,1325.52,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2367,90,,1893.6,percent of total billed charges,90% of total billed charges,2104,80,,1683.2,percent of total billed charges,80% of total billed charges,1656.9,63,,1325.52,percent of total billed charges,63% of total billed charges,2235.5,85,,1788.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2077.7,79,,1662.16,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2498.5,
"DSLC RDL HEAD CLSD W/MAN,CHILD",450024640,CDM,450,RC,24640,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,881,
FX RADIAL HEAD CLSD NO MANIP,450024650,CDM,450,RC,24650,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX RADIAL HEAD CLSD W/MANIP,450024655,CDM,450,RC,24655,HCPCS,outpatient,,,634,443.8,,500.86,79,,400.69,percent of total billed charges,79% of total billed charges,570.6,90,,456.48,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,399.42,63,,319.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,419.07,66.1,,335.26,percent of total billed charges,66.1% of total billed charges,526.22,83,,420.98,percent of total billed charges,83% of total,602.3,95,,481.84,percent of total billed charges ,95% of total billed charges,507.2,80,,405.76,percent of total billed charges,78% of total billed charges,494.52,78,,395.616,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,399.42,63,,319.54,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,570.6,90,,456.48,percent of total billed charges,90% of total billed charges,507.2,80,,405.76,percent of total billed charges,80% of total billed charges,399.42,63,,319.54,percent of total billed charges,63% of total billed charges,538.9,85,,431.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,500.86,79,,400.69,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,399.42,2150.21,
FX ULNA PRX CLSD NO MANIP,450024670,CDM,450,RC,24670,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
TREAT ULNA FRACTURE W/ MANIPUL,450024675,CDM,450,RC,24675,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,2150.21,
ER REPAIR FOREARM TENDON/MUSCL,450025270,CDM,450,RC,25270,HCPCS,outpatient,,,3480,2436,,2749.2,79,,2199.36,percent of total billed charges,79% of total billed charges,3132,90,,2505.6,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,2192.4,63,,1753.92,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2300.28,66.1,,1840.22,percent of total billed charges,66.1% of total billed charges,2888.4,83,,2310.72,percent of total billed charges,83% of total,3306,95,,2644.8,percent of total billed charges ,95% of total billed charges,2784,80,,2227.2,percent of total billed charges,78% of total billed charges,2714.4,78,,2171.52,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2192.4,63,,1753.92,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,3132,90,,2505.6,percent of total billed charges,90% of total billed charges,2784,80,,2227.2,percent of total billed charges,80% of total billed charges,2192.4,63,,1753.92,percent of total billed charges,63% of total billed charges,2958,85,,2366.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,2749.2,79,,2199.36,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
FX RADIAL SHFT CLSD NO MANIP,450025500,CDM,450,RC,25500,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
FX RADIAL SHFT CLSD W/MANIP,450025505,CDM,450,RC,25505,HCPCS,outpatient,,,943,660.1,,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,623.32,66.1,,498.66,percent of total billed charges,66.1% of total billed charges,782.69,83,,626.15,percent of total billed charges,83% of total,895.85,95,,716.68,percent of total billed charges ,95% of total billed charges,754.4,80,,603.52,percent of total billed charges,78% of total billed charges,735.54,78,,588.432,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,848.7,90,,678.96,percent of total billed charges,90% of total billed charges,754.4,80,,603.52,percent of total billed charges,80% of total billed charges,594.09,63,,475.27,percent of total billed charges,63% of total billed charges,801.55,85,,641.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,744.97,79,,595.98,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
FX ULNA SHFT CLSD NO/MANIP,450025530,CDM,450,RC,25530,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
FX ULNA SHFT CLSD W/MANIP,450025535,CDM,450,RC,25535,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX RAD/ULNA SHFT CLSD NO MANIP,450025560,CDM,450,RC,25560,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
FX RAD/ULNA SHFT CLSD W/MANIP,450025565,CDM,450,RC,25565,HCPCS,outpatient,,,2710,1897,,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,2439,90,,1951.2,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1791.31,66.1,,1433.05,percent of total billed charges,66.1% of total billed charges,2249.3,83,,1799.44,percent of total billed charges,83% of total,2574.5,95,,2059.6,percent of total billed charges ,95% of total billed charges,2168,80,,1734.4,percent of total billed charges,78% of total billed charges,2113.8,78,,1691.04,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2574.5,
FX RAD DIST CLSD NO MANIP,450025600,CDM,450,RC,25600,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX RAD DIST CLSD W/MANIP,450025605,CDM,450,RC,25605,HCPCS,outpatient,,,2710,1897,,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,2439,90,,1951.2,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1791.31,66.1,,1433.05,percent of total billed charges,66.1% of total billed charges,2249.3,83,,1799.44,percent of total billed charges,83% of total,2574.5,95,,2059.6,percent of total billed charges ,95% of total billed charges,2168,80,,1734.4,percent of total billed charges,78% of total billed charges,2113.8,78,,1691.04,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2574.5,
TX FX DISTAL RADIAL,450025606,CDM,450,RC,25606,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
FX CARPAL CLSD N/MANIP EA BONE,450025630,CDM,450,RC,25630,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX ULNAR STYLOID CLSD,450025650,CDM,450,RC,25650,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
ABCESS FINGER SMPL,450026010,CDM,450,RC,26010,HCPCS,outpatient,,,898,628.6,,709.42,79,,567.54,percent of total billed charges,79% of total billed charges,808.2,90,,646.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,593.58,66.1,,474.86,percent of total billed charges,66.1% of total billed charges,745.34,83,,596.27,percent of total billed charges,83% of total,853.1,95,,682.48,percent of total billed charges ,95% of total billed charges,718.4,80,,574.72,percent of total billed charges,78% of total billed charges,700.44,78,,560.352,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,808.2,90,,646.56,percent of total billed charges,90% of total billed charges,718.4,80,,574.72,percent of total billed charges,80% of total billed charges,565.74,63,,452.59,percent of total billed charges,63% of total billed charges,763.3,85,,610.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,709.42,79,,567.54,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
ABSCESS FINGER COMPL,450026011,CDM,450,RC,26011,HCPCS,outpatient,,,3233,2263.1,,2554.07,79,,2043.26,percent of total billed charges,79% of total billed charges,2909.7,90,,2327.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2036.79,63,,1629.43,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2137.01,66.1,,1709.61,percent of total billed charges,66.1% of total billed charges,2683.39,83,,2146.71,percent of total billed charges,83% of total,3071.35,95,,2457.08,percent of total billed charges ,95% of total billed charges,2586.4,80,,2069.12,percent of total billed charges,78% of total billed charges,2521.74,78,,2017.392,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2036.79,63,,1629.43,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2909.7,90,,2327.76,percent of total billed charges,90% of total billed charges,2586.4,80,,2069.12,percent of total billed charges,80% of total billed charges,2036.79,63,,1629.43,percent of total billed charges,63% of total billed charges,2748.05,85,,2198.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2554.07,79,,2043.26,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3071.35,
ER DRAIN HAND TENDON SHEATH,450026020,CDM,450,RC,26020,HCPCS,outpatient,,,1880,1316,,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1242.68,66.1,,994.14,percent of total billed charges,66.1% of total billed charges,1560.4,83,,1248.32,percent of total billed charges,83% of total,1786,95,,1428.8,percent of total billed charges ,95% of total billed charges,1504,80,,1203.2,percent of total billed charges,78% of total billed charges,1466.4,78,,1173.12,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,1504,80,,1203.2,percent of total billed charges,80% of total billed charges,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1598,85,,1278.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
ER REMOV TENDON SHEATH LESION,450026160,CDM,450,RC,26160,HCPCS,outpatient,,,1880,1316,,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1242.68,66.1,,994.14,percent of total billed charges,66.1% of total billed charges,1560.4,83,,1248.32,percent of total billed charges,83% of total,1786,95,,1428.8,percent of total billed charges ,95% of total billed charges,1504,80,,1203.2,percent of total billed charges,78% of total billed charges,1466.4,78,,1173.12,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,1504,80,,1203.2,percent of total billed charges,80% of total billed charges,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1598,85,,1278.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
ER REMOVAL OF FINGER TENDON,450026180,CDM,450,RC,26180,HCPCS,outpatient,,,1475,1032.5,,1165.25,79,,932.2,percent of total billed charges,79% of total billed charges,1327.5,90,,1062,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,929.25,63,,743.4,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,974.98,66.1,,779.98,percent of total billed charges,66.1% of total billed charges,1224.25,83,,979.4,percent of total billed charges,83% of total,1401.25,95,,1121,percent of total billed charges ,95% of total billed charges,1180,80,,944,percent of total billed charges,78% of total billed charges,1150.5,78,,920.4,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,929.25,63,,743.4,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1327.5,90,,1062,percent of total billed charges,90% of total billed charges,1180,80,,944,percent of total billed charges,80% of total billed charges,929.25,63,,743.4,percent of total billed charges,63% of total billed charges,1253.75,85,,1003,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1165.25,79,,932.2,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
ER REPAIR FINGER/HAND TENDON,450026356,CDM,450,RC,26356,HCPCS,outpatient,,,3274,2291.8,,2586.46,79,,2069.17,percent of total billed charges,79% of total billed charges,2946.6,90,,2357.28,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,2062.62,63,,1650.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2164.11,66.1,,1731.29,percent of total billed charges,66.1% of total billed charges,2717.42,83,,2173.94,percent of total billed charges,83% of total,3110.3,95,,2488.24,percent of total billed charges ,95% of total billed charges,2619.2,80,,2095.36,percent of total billed charges,78% of total billed charges,2553.72,78,,2042.976,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2062.62,63,,1650.1,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,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,2062.62,63,,1650.1,percent of total billed charges,63% of total billed charges,2782.9,85,,2226.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,2586.46,79,,2069.17,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
REPAIR HAND TENDON W/O GRAFT,450026410,CDM,450,RC,26410,HCPCS,outpatient,,,1284,898.8,,1014.36,79,,811.49,percent of total billed charges,79% of total billed charges,1155.6,90,,924.48,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,808.92,63,,647.14,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,848.72,66.1,,678.98,percent of total billed charges,66.1% of total billed charges,1065.72,83,,852.58,percent of total billed charges,83% of total,1219.8,95,,975.84,percent of total billed charges ,95% of total billed charges,1027.2,80,,821.76,percent of total billed charges,78% of total billed charges,1001.52,78,,801.216,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,808.92,63,,647.14,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1155.6,90,,924.48,percent of total billed charges,90% of total billed charges,1027.2,80,,821.76,percent of total billed charges,80% of total billed charges,808.92,63,,647.14,percent of total billed charges,63% of total billed charges,1091.4,85,,873.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1014.36,79,,811.49,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
REPAIR FINGER TENDON W/O GRAFT,450026418,CDM,450,RC,26418,HCPCS,outpatient,,,1880,1316,,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1242.68,66.1,,994.14,percent of total billed charges,66.1% of total billed charges,1560.4,83,,1248.32,percent of total billed charges,83% of total,1786,95,,1428.8,percent of total billed charges ,95% of total billed charges,1504,80,,1203.2,percent of total billed charges,78% of total billed charges,1466.4,78,,1173.12,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,1504,80,,1203.2,percent of total billed charges,80% of total billed charges,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1598,85,,1278.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
ER CAPSULECTOMY FINGER JOINT,450026520,CDM,450,RC,26520,HCPCS,outpatient,,,1790,1253,,1414.1,79,,1131.28,percent of total billed charges,79% of total billed charges,1611,90,,1288.8,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1127.7,63,,902.16,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1183.19,66.1,,946.55,percent of total billed charges,66.1% of total billed charges,1485.7,83,,1188.56,percent of total billed charges,83% of total,1700.5,95,,1360.4,percent of total billed charges ,95% of total billed charges,1432,80,,1145.6,percent of total billed charges,78% of total billed charges,1396.2,78,,1116.96,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1127.7,63,,902.16,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1611,90,,1288.8,percent of total billed charges,90% of total billed charges,1432,80,,1145.6,percent of total billed charges,80% of total billed charges,1127.7,63,,902.16,percent of total billed charges,63% of total billed charges,1521.5,85,,1217.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1414.1,79,,1131.28,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
ER REPAIR HAND JOINT,450026540,CDM,450,RC,26540,HCPCS,outpatient,,,1880,1316,,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1242.68,66.1,,994.14,percent of total billed charges,66.1% of total billed charges,1560.4,83,,1248.32,percent of total billed charges,83% of total,1786,95,,1428.8,percent of total billed charges ,95% of total billed charges,1504,80,,1203.2,percent of total billed charges,78% of total billed charges,1466.4,78,,1173.12,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1692,90,,1353.6,percent of total billed charges,90% of total billed charges,1504,80,,1203.2,percent of total billed charges,80% of total billed charges,1184.4,63,,947.52,percent of total billed charges,63% of total billed charges,1598,85,,1278.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1485.2,79,,1188.16,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
FX METACRP CLSD SNGL N/MAN EA,450026600,CDM,450,RC,26600,HCPCS,outpatient,,,297,207.9,,234.63,79,,187.7,percent of total billed charges,79% of total billed charges,267.3,90,,213.84,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,187.11,63,,149.69,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,196.32,66.1,,157.06,percent of total billed charges,66.1% of total billed charges,246.51,83,,197.21,percent of total billed charges,83% of total,282.15,95,,225.72,percent of total billed charges ,95% of total billed charges,237.6,80,,190.08,percent of total billed charges,78% of total billed charges,231.66,78,,185.328,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,187.11,63,,149.69,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,187.11,63,,149.69,percent of total billed charges,63% of total billed charges,252.45,85,,201.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,234.63,79,,187.7,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX METACRP CLSD SNGL W/MAN EA,450026605,CDM,450,RC,26605,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
ER OPEN TX METACARPAL FX,450026615,CDM,450,RC,26615,HCPCS,outpatient,,,5679,3975.3,,4486.41,79,,3589.13,percent of total billed charges,79% of total billed charges,5111.1,90,,4088.88,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,3577.77,63,,2862.22,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,3753.82,66.1,,3003.06,percent of total billed charges,66.1% of total billed charges,4713.57,83,,3770.86,percent of total billed charges,83% of total,5395.05,95,,4316.04,percent of total billed charges ,95% of total billed charges,4543.2,80,,3634.56,percent of total billed charges,78% of total billed charges,4429.62,78,,3543.696,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,3577.77,63,,2862.22,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,5111.1,90,,4088.88,percent of total billed charges,90% of total billed charges,4543.2,80,,3634.56,percent of total billed charges,80% of total billed charges,3577.77,63,,2862.22,percent of total billed charges,63% of total billed charges,4827.15,85,,3861.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,4486.41,79,,3589.13,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,5395.05,
FX DSLC CMC CLSD THUMB W/MANIP,450026645,CDM,450,RC,26645,HCPCS,outpatient,,,382,267.4,,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,343.8,90,,275.04,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,252.5,66.1,,202,percent of total billed charges,66.1% of total billed charges,317.06,83,,253.65,percent of total billed charges,83% of total,362.9,95,,290.32,percent of total billed charges ,95% of total billed charges,305.6,80,,244.48,percent of total billed charges,78% of total billed charges,297.96,78,,238.368,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,240.66,63,,192.53,percent of total billed charges,63% of total billed charges,324.7,85,,259.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,301.78,79,,241.42,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,240.66,2150.21,
FX DSLC CMC CLSD NT TMB/N ANT,450026670,CDM,450,RC,26670,HCPCS,outpatient,,,535,374.5,,422.65,79,,338.12,percent of total billed charges,79% of total billed charges,481.5,90,,385.2,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,337.05,63,,269.64,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,353.64,66.1,,282.91,percent of total billed charges,66.1% of total billed charges,444.05,83,,355.24,percent of total billed charges,83% of total,508.25,95,,406.6,percent of total billed charges ,95% of total billed charges,428,80,,342.4,percent of total billed charges,78% of total billed charges,417.3,78,,333.84,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,337.05,63,,269.64,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,337.05,63,,269.64,percent of total billed charges,63% of total billed charges,454.75,85,,363.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,422.65,79,,338.12,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
"CLTX CARPO DISL,NOT THB,W/ANES",450026675,CDM,450,RC,26675,HCPCS,outpatient,,,114,79.8,,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,102.6,90,,82.08,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,75.35,66.1,,60.28,percent of total billed charges,66.1% of total billed charges,94.62,83,,75.7,percent of total billed charges,83% of total,108.3,95,,86.64,percent of total billed charges ,95% of total billed charges,91.2,80,,72.96,percent of total billed charges,78% of total billed charges,88.92,78,,71.136,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,71.82,63,,57.46,percent of total billed charges,63% of total billed charges,96.9,85,,77.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,90.06,79,,72.05,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,71.82,2150.21,
DSLC MCP CLSD SGL W/MAN/NO/ANS,450026700,CDM,450,RC,26700,HCPCS,outpatient,,,803,562.1,,634.37,79,,507.5,percent of total billed charges,79% of total billed charges,722.7,90,,578.16,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,530.78,66.1,,424.62,percent of total billed charges,66.1% of total billed charges,666.49,83,,533.19,percent of total billed charges,83% of total,762.85,95,,610.28,percent of total billed charges ,95% of total billed charges,642.4,80,,513.92,percent of total billed charges,78% of total billed charges,626.34,78,,501.072,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,722.7,90,,578.16,percent of total billed charges,90% of total billed charges,642.4,80,,513.92,percent of total billed charges,80% of total billed charges,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,682.55,85,,546.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,634.37,79,,507.5,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
DISLOC KNUCKLE CLTX W/ MANIPU,450026705,CDM,450,RC,26706,HCPCS,outpatient,,,1262,883.4,,996.98,79,,797.58,percent of total billed charges,79% of total billed charges,1135.8,90,,908.64,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,795.06,63,,636.05,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,834.18,66.1,,667.34,percent of total billed charges,66.1% of total billed charges,1047.46,83,,837.97,percent of total billed charges,83% of total,1198.9,95,,959.12,percent of total billed charges ,95% of total billed charges,1009.6,80,,807.68,percent of total billed charges,78% of total billed charges,984.36,78,,787.488,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,795.06,63,,636.05,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,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,795.06,63,,636.05,percent of total billed charges,63% of total billed charges,1072.7,85,,858.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,996.98,79,,797.58,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
FX FINGER CLTX PRX/MD W/O MANI,450026720,CDM,450,RC,26720,HCPCS,outpatient,,,401,280.7,,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,265.06,66.1,,212.05,percent of total billed charges,66.1% of total billed charges,332.83,83,,266.26,percent of total billed charges,83% of total,380.95,95,,304.76,percent of total billed charges ,95% of total billed charges,320.8,80,,256.64,percent of total billed charges,78% of total billed charges,312.78,78,,250.224,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX FNGR SHFT CLSD W/MANIP EA,450026725,CDM,450,RC,26725,HCPCS,outpatient,,,803,562.1,,634.37,79,,507.5,percent of total billed charges,79% of total billed charges,722.7,90,,578.16,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,530.78,66.1,,424.62,percent of total billed charges,66.1% of total billed charges,666.49,83,,533.19,percent of total billed charges,83% of total,762.85,95,,610.28,percent of total billed charges ,95% of total billed charges,642.4,80,,513.92,percent of total billed charges,78% of total billed charges,626.34,78,,501.072,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,722.7,90,,578.16,percent of total billed charges,90% of total billed charges,642.4,80,,513.92,percent of total billed charges,80% of total billed charges,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,682.55,85,,546.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,634.37,79,,507.5,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
ER SIGNIFIC TX FINGER FX EACH,450026735,CDM,450,RC,26735,HCPCS,outpatient,,,1959,1371.3,,1547.61,79,,1238.09,percent of total billed charges,79% of total billed charges,1763.1,90,,1410.48,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1294.9,66.1,,1035.92,percent of total billed charges,66.1% of total billed charges,1625.97,83,,1300.78,percent of total billed charges,83% of total,1861.05,95,,1488.84,percent of total billed charges ,95% of total billed charges,1567.2,80,,1253.76,percent of total billed charges,78% of total billed charges,1528.02,78,,1222.416,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1763.1,90,,1410.48,percent of total billed charges,90% of total billed charges,1567.2,80,,1253.76,percent of total billed charges,80% of total billed charges,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,1665.15,85,,1332.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1547.61,79,,1238.09,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
FX ART MCP/IP JNT CLS W/MNP EA,450026742,CDM,450,RC,26742,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,2150.21,
ER OPEN TX ARTICULAR FX EACH,450026746,CDM,450,RC,26746,HCPCS,outpatient,,,1959,1371.3,,1547.61,79,,1238.09,percent of total billed charges,79% of total billed charges,1763.1,90,,1410.48,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1294.9,66.1,,1035.92,percent of total billed charges,66.1% of total billed charges,1625.97,83,,1300.78,percent of total billed charges,83% of total,1861.05,95,,1488.84,percent of total billed charges ,95% of total billed charges,1567.2,80,,1253.76,percent of total billed charges,78% of total billed charges,1528.02,78,,1222.416,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1763.1,90,,1410.48,percent of total billed charges,90% of total billed charges,1567.2,80,,1253.76,percent of total billed charges,80% of total billed charges,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,1665.15,85,,1332.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1547.61,79,,1238.09,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
"FX FNGR DIST CLSD N/MNP, EA",450026750,CDM,450,RC,26750,HCPCS,outpatient,,,401,280.7,,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,360.9,90,,288.72,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,265.06,66.1,,212.05,percent of total billed charges,66.1% of total billed charges,332.83,83,,266.26,percent of total billed charges,83% of total,380.95,95,,304.76,percent of total billed charges ,95% of total billed charges,320.8,80,,256.64,percent of total billed charges,78% of total billed charges,312.78,78,,250.224,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,252.63,63,,202.1,percent of total billed charges,63% of total billed charges,340.85,85,,272.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,316.79,79,,253.43,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
"FX FNGR DIST CLSD W/MNP, EA",450026755,CDM,450,RC,26755,HCPCS,outpatient,,,440,308,,347.6,79,,278.08,percent of total billed charges,79% of total billed charges,396,90,,316.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,277.2,63,,221.76,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,290.84,66.1,,232.67,percent of total billed charges,66.1% of total billed charges,365.2,83,,292.16,percent of total billed charges,83% of total,418,95,,334.4,percent of total billed charges ,95% of total billed charges,352,80,,281.6,percent of total billed charges,78% of total billed charges,343.2,78,,274.56,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,277.2,63,,221.76,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,277.2,63,,221.76,percent of total billed charges,63% of total billed charges,374,85,,299.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,347.6,79,,278.08,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
"ER TREAT FINGER FRACTURE,EACH",450026765,CDM,450,RC,26765,HCPCS,outpatient,,,2455,1718.5,,1939.45,79,,1551.56,percent of total billed charges,79% of total billed charges,2209.5,90,,1767.6,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1546.65,63,,1237.32,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1622.76,66.1,,1298.21,percent of total billed charges,66.1% of total billed charges,2037.65,83,,1630.12,percent of total billed charges,83% of total,2332.25,95,,1865.8,percent of total billed charges ,95% of total billed charges,1964,80,,1571.2,percent of total billed charges,78% of total billed charges,1914.9,78,,1531.92,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1546.65,63,,1237.32,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2209.5,90,,1767.6,percent of total billed charges,90% of total billed charges,1964,80,,1571.2,percent of total billed charges,80% of total billed charges,1546.65,63,,1237.32,percent of total billed charges,63% of total billed charges,2086.75,85,,1669.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1939.45,79,,1551.56,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
DSCL IP JNT CLSD SI W/O ANEST,450026770,CDM,450,RC,26770,HCPCS,outpatient,,,295,206.5,,233.05,79,,186.44,percent of total billed charges,79% of total billed charges,265.5,90,,212.4,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,195,66.1,,156,percent of total billed charges,66.1% of total billed charges,244.85,83,,195.88,percent of total billed charges,83% of total,280.25,95,,224.2,percent of total billed charges ,95% of total billed charges,236,80,,188.8,percent of total billed charges,78% of total billed charges,230.1,78,,184.08,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,185.85,63,,148.68,percent of total billed charges,63% of total billed charges,250.75,85,,200.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,233.05,79,,186.44,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
"DSLC IP JNT CLTX,W/ MAN & ANES",450026775,CDM,450,RC,26775,HCPCS,outpatient,,,1092,764.4,,862.68,79,,690.14,percent of total billed charges,79% of total billed charges,982.8,90,,786.24,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,721.81,66.1,,577.45,percent of total billed charges,66.1% of total billed charges,906.36,83,,725.09,percent of total billed charges,83% of total,1037.4,95,,829.92,percent of total billed charges ,95% of total billed charges,873.6,80,,698.88,percent of total billed charges,78% of total billed charges,851.76,78,,681.408,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,928.2,85,,742.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,862.68,79,,690.14,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,208.83,1037.4,
AMPUTATE FNGR W/DIRECT CLOSURE,450026951,CDM,450,RC,26951,HCPCS,outpatient,,,2627,1838.9,,2075.33,79,,1660.26,percent of total billed charges,79% of total billed charges,2364.3,90,,1891.44,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1655.01,63,,1324.01,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1736.45,66.1,,1389.16,percent of total billed charges,66.1% of total billed charges,2180.41,83,,1744.33,percent of total billed charges,83% of total,2495.65,95,,1996.52,percent of total billed charges ,95% of total billed charges,2101.6,80,,1681.28,percent of total billed charges,78% of total billed charges,2049.06,78,,1639.248,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1655.01,63,,1324.01,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2364.3,90,,1891.44,percent of total billed charges,90% of total billed charges,2101.6,80,,1681.28,percent of total billed charges,80% of total billed charges,1655.01,63,,1324.01,percent of total billed charges,63% of total billed charges,2232.95,85,,1786.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,2075.33,79,,1660.26,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
AMPUTATE FINGER W/ADVNC FLAPS,450026952,CDM,450,RC,26952,HCPCS,outpatient,,,2627,1838.9,,2075.33,79,,1660.26,percent of total billed charges,79% of total billed charges,2364.3,90,,1891.44,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1655.01,63,,1324.01,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1736.45,66.1,,1389.16,percent of total billed charges,66.1% of total billed charges,2180.41,83,,1744.33,percent of total billed charges,83% of total,2495.65,95,,1996.52,percent of total billed charges ,95% of total billed charges,2101.6,80,,1681.28,percent of total billed charges,78% of total billed charges,2049.06,78,,1639.248,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1655.01,63,,1324.01,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2364.3,90,,1891.44,percent of total billed charges,90% of total billed charges,2101.6,80,,1681.28,percent of total billed charges,80% of total billed charges,1655.01,63,,1324.01,percent of total billed charges,63% of total billed charges,2232.95,85,,1786.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,2075.33,79,,1660.26,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
CLSD TX PELVIC RING WO MANIP,450027197,CDM,450,RC,27197,HCPCS,outpatient,,,499,349.3,,394.21,79,,315.37,percent of total billed charges,79% of total billed charges,449.1,90,,359.28,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,314.37,63,,251.5,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,329.84,66.1,,263.87,percent of total billed charges,66.1% of total billed charges,414.17,83,,331.34,percent of total billed charges,83% of total,474.05,95,,379.24,percent of total billed charges ,95% of total billed charges,399.2,80,,319.36,percent of total billed charges,78% of total billed charges,389.22,78,,311.376,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,314.37,63,,251.5,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,314.37,63,,251.5,percent of total billed charges,63% of total billed charges,424.15,85,,339.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,394.21,79,,315.37,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
CLSD TX PELVIC RING W MANIP,450027198,CDM,450,RC,27198,HCPCS,outpatient,,,499,349.3,,394.21,79,,315.37,percent of total billed charges,79% of total billed charges,449.1,90,,359.28,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,314.37,63,,251.5,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,329.84,66.1,,263.87,percent of total billed charges,66.1% of total billed charges,414.17,83,,331.34,percent of total billed charges,83% of total,474.05,95,,379.24,percent of total billed charges ,95% of total billed charges,399.2,80,,319.36,percent of total billed charges,78% of total billed charges,389.22,78,,311.376,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,314.37,63,,251.5,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,314.37,63,,251.5,percent of total billed charges,63% of total billed charges,424.15,85,,339.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,394.21,79,,315.37,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
"FX HIP SOCKET CLTX, W/ MANIP",450027222,CDM,450,RC,27222,HCPCS,outpatient,,,1684,1178.8,,1330.36,79,,1064.29,percent of total billed charges,79% of total billed charges,1515.6,90,,1212.48,percent of total billed charges,90% of total billed charges,1684,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1684,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1684,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1060.92,63,,848.74,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1113.12,66.1,,890.5,percent of total billed charges,66.1% of total billed charges,1397.72,83,,1118.18,percent of total billed charges,83% of total,1599.8,95,,1279.84,percent of total billed charges ,95% of total billed charges,1347.2,80,,1077.76,percent of total billed charges,78% of total billed charges,1313.52,78,,1050.816,percent of total billed charges,78% of total billed charges,1684,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1060.92,63,,848.74,percent of total billed charges,63% of total billed charges,1684,100,,,fee schedule ,100% of CMS fee schedule,1515.6,90,,1212.48,percent of total billed charges,90% of total billed charges,1347.2,80,,1077.76,percent of total billed charges,80% of total billed charges,1060.92,63,,848.74,percent of total billed charges,63% of total billed charges,1431.4,85,,1145.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1684,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1330.36,79,,1064.29,percent of total billed charges,79% of total billed charges,1684,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1684,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,450,1684,
DSLC HIP CLSD TRAUMA NO ANSTH,450027250,CDM,450,RC,27250,HCPCS,outpatient,,,550,385,,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,495,90,,396,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,363.55,66.1,,290.84,percent of total billed charges,66.1% of total billed charges,456.5,83,,365.2,percent of total billed charges,83% of total,522.5,95,,418,percent of total billed charges ,95% of total billed charges,440,80,,352,percent of total billed charges,78% of total billed charges,429,78,,343.2,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,495,90,,396,percent of total billed charges,90% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,467.5,85,,374,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
DSLC HIP POSTOP CLSD NO ANSTH,450027265,CDM,450,RC,27265,HCPCS,outpatient,,,1167,816.9,,921.93,79,,737.54,percent of total billed charges,79% of total billed charges,1050.3,90,,840.24,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,735.21,63,,588.17,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,771.39,66.1,,617.11,percent of total billed charges,66.1% of total billed charges,968.61,83,,774.89,percent of total billed charges,83% of total,1108.65,95,,886.92,percent of total billed charges ,95% of total billed charges,933.6,80,,746.88,percent of total billed charges,78% of total billed charges,910.26,78,,728.208,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,735.21,63,,588.17,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,1050.3,90,,840.24,percent of total billed charges,90% of total billed charges,933.6,80,,746.88,percent of total billed charges,80% of total billed charges,735.21,63,,588.17,percent of total billed charges,63% of total billed charges,991.95,85,,793.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,921.93,79,,737.54,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,1108.65,
"DSLC HIP CLTX, W/ ANESTH",450027266,CDM,450,RC,27266,HCPCS,outpatient,,,2343,1640.1,,1850.97,79,,1480.78,percent of total billed charges,79% of total billed charges,2108.7,90,,1686.96,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1476.09,63,,1180.87,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1548.72,66.1,,1238.98,percent of total billed charges,66.1% of total billed charges,1944.69,83,,1555.75,percent of total billed charges,83% of total,2225.85,95,,1780.68,percent of total billed charges ,95% of total billed charges,1874.4,80,,1499.52,percent of total billed charges,78% of total billed charges,1827.54,78,,1462.032,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1476.09,63,,1180.87,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2108.7,90,,1686.96,percent of total billed charges,90% of total billed charges,1874.4,80,,1499.52,percent of total billed charges,80% of total billed charges,1476.09,63,,1180.87,percent of total billed charges,63% of total billed charges,1991.55,85,,1593.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1850.97,79,,1480.78,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2225.85,
ABCESS THIGH/KNEE I&D DEEP,450027301,CDM,450,RC,27301,HCPCS,outpatient,,,3296,2307.2,,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2178.66,66.1,,1742.93,percent of total billed charges,66.1% of total billed charges,2735.68,83,,2188.54,percent of total billed charges,83% of total,3131.2,95,,2504.96,percent of total billed charges ,95% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,78% of total billed charges,2570.88,78,,2056.704,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2966.4,90,,2373.12,percent of total billed charges,90% of total billed charges,2636.8,80,,2109.44,percent of total billed charges,80% of total billed charges,2076.48,63,,1661.18,percent of total billed charges,63% of total billed charges,2801.6,85,,2241.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,2603.84,79,,2083.07,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,3801.55,
FB REMOVAL THIGH/KNEE DEEP,450027372,CDM,450,RC,27372,HCPCS,outpatient,,,3647,2552.9,,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2410.67,66.1,,1928.54,percent of total billed charges,66.1% of total billed charges,3027.01,83,,2421.61,percent of total billed charges,83% of total,3464.65,95,,2771.72,percent of total billed charges ,95% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,78% of total billed charges,2844.66,78,,2275.728,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3282.3,90,,2625.84,percent of total billed charges,90% of total billed charges,2917.6,80,,2334.08,percent of total billed charges,80% of total billed charges,2297.61,63,,1838.09,percent of total billed charges,63% of total billed charges,3099.95,85,,2479.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,2881.13,79,,2304.9,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,3801.55,
RECONSTRUCTION LIGAMENT,450027409,CDM,450,RC,27409,HCPCS,outpatient,,,8845,6191.5,,6987.55,79,,5590.04,percent of total billed charges,79% of total billed charges,7960.5,90,,6368.4,percent of total billed charges,90% of total billed charges,5982.01,100,,,Fee Schedule,100% of CMS OPPS rate,9571.2,160,,,Fee Schedule,160% of CMS OPPS rate,7776.6,130,,,Fee Schedule,130% of CMS OPPS rate,5572.35,63,,4457.88,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,5846.55,66.1,,4677.24,percent of total billed charges,66.1% of total billed charges,7341.35,83,,5873.08,percent of total billed charges,83% of total,8402.75,95,,6722.2,percent of total billed charges ,95% of total billed charges,7076,80,,5660.8,percent of total billed charges,78% of total billed charges,6899.1,78,,5519.28,percent of total billed charges,78% of total billed charges,5982.01,100,,,Fee Schedule,100% of CMS OPPS rate,5572.35,63,,4457.88,percent of total billed charges,63% of total billed charges,5982.01,100,,,Fee Schedule,100% of CMS OPPS rate,7960.5,90,,6368.4,percent of total billed charges,90% of total billed charges,7076,80,,5660.8,percent of total billed charges,80% of total billed charges,5572.35,63,,4457.88,percent of total billed charges,63% of total billed charges,7518.25,85,,6014.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5563.26,93,,,fee schedule,93% of CMS OPPS rate,6987.55,79,,5590.04,percent of total billed charges,79% of total billed charges,5982.01,100,,,Fee Schedule,100% of CMS OPPS rate,5982.01,100,,,Fee Schedule,100% of CMS OPPS rate,450,9571.2,
FX FEMUR CONDYLE CLSD NO MANIP,450027501,CDM,450,RC,27501,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX FEMUR DISTAL CLSD NO MANIP,450027508,CDM,450,RC,27508,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX FEMUR DISTAL CLSD W/MANIP,450027510,CDM,450,RC,27510,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,289.8,2150.21,
SEPARATION FEMUR CLSD NO MANIP,450027516,CDM,450,RC,27516,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
FX PATELLA CLSD NO MANIP,450027520,CDM,450,RC,27520,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX TIBIA PRX CLSD NO MANIP,450027530,CDM,450,RC,27530,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
CLOSE TX OF TIBIAL FX,450027532,CDM,450,RC,27532,HCPCS,outpatient,,,1058,740.6,,835.82,79,,668.66,percent of total billed charges,79% of total billed charges,952.2,90,,761.76,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,666.54,63,,533.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,699.34,66.1,,559.47,percent of total billed charges,66.1% of total billed charges,878.14,83,,702.51,percent of total billed charges,83% of total,1005.1,95,,804.08,percent of total billed charges ,95% of total billed charges,846.4,80,,677.12,percent of total billed charges,78% of total billed charges,825.24,78,,660.192,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,666.54,63,,533.23,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,952.2,90,,761.76,percent of total billed charges,90% of total billed charges,846.4,80,,677.12,percent of total billed charges,80% of total billed charges,666.54,63,,533.23,percent of total billed charges,63% of total billed charges,899.3,85,,719.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,835.82,79,,668.66,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
DISLOC KNEE CLSD NO ANSTH,450027550,CDM,450,RC,27550,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,881,
CLSD TREAT OF KNEE REQ ANESTH,450027552,CDM,450,RC,27552,HCPCS,outpatient,,,2419,1693.3,,1911.01,79,,1528.81,percent of total billed charges,79% of total billed charges,2177.1,90,,1741.68,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1523.97,63,,1219.18,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1598.96,66.1,,1279.17,percent of total billed charges,66.1% of total billed charges,2007.77,83,,1606.22,percent of total billed charges,83% of total,2298.05,95,,1838.44,percent of total billed charges ,95% of total billed charges,1935.2,80,,1548.16,percent of total billed charges,78% of total billed charges,1886.82,78,,1509.456,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1523.97,63,,1219.18,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2177.1,90,,1741.68,percent of total billed charges,90% of total billed charges,1935.2,80,,1548.16,percent of total billed charges,80% of total billed charges,1523.97,63,,1219.18,percent of total billed charges,63% of total billed charges,2056.15,85,,1644.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1911.01,79,,1528.81,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2298.05,
DISLOC PATELLA CLSD NO ANSTH,450027560,CDM,450,RC,27560,HCPCS,outpatient,,,595,416.5,,470.05,79,,376.04,percent of total billed charges,79% of total billed charges,535.5,90,,428.4,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,374.85,63,,299.88,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,393.3,66.1,,314.64,percent of total billed charges,66.1% of total billed charges,493.85,83,,395.08,percent of total billed charges,83% of total,565.25,95,,452.2,percent of total billed charges ,95% of total billed charges,476,80,,380.8,percent of total billed charges,78% of total billed charges,464.1,78,,371.28,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,374.85,63,,299.88,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,535.5,90,,428.4,percent of total billed charges,90% of total billed charges,476,80,,380.8,percent of total billed charges,80% of total billed charges,374.85,63,,299.88,percent of total billed charges,63% of total billed charges,505.75,85,,404.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,470.05,79,,376.04,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
"DSLC KNEECAP CLTX, W/ ANESTH",450027562,CDM,450,RC,27562,HCPCS,outpatient,,,1094,765.8,,864.26,79,,691.41,percent of total billed charges,79% of total billed charges,984.6,90,,787.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,689.22,63,,551.38,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,723.13,66.1,,578.5,percent of total billed charges,66.1% of total billed charges,908.02,83,,726.42,percent of total billed charges,83% of total,1039.3,95,,831.44,percent of total billed charges ,95% of total billed charges,875.2,80,,700.16,percent of total billed charges,78% of total billed charges,853.32,78,,682.656,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,689.22,63,,551.38,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,984.6,90,,787.68,percent of total billed charges,90% of total billed charges,875.2,80,,700.16,percent of total billed charges,80% of total billed charges,689.22,63,,551.38,percent of total billed charges,63% of total billed charges,929.9,85,,743.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,864.26,79,,691.41,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,1039.3,
REPAIR EXTENSOR TENDON LEG,450027664,CDM,450,RC,35226,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
ER REPAIR OF TIBIA EPIPHYSIS,450027730,CDM,450,RC,27730,HCPCS,outpatient,,,3654,2557.8,,2886.66,79,,2309.33,percent of total billed charges,79% of total billed charges,3288.6,90,,2630.88,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,2302.02,63,,1841.62,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2415.29,66.1,,1932.23,percent of total billed charges,66.1% of total billed charges,3032.82,83,,2426.26,percent of total billed charges,83% of total,3471.3,95,,2777.04,percent of total billed charges ,95% of total billed charges,2923.2,80,,2338.56,percent of total billed charges,78% of total billed charges,2850.12,78,,2280.096,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2302.02,63,,1841.62,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,3288.6,90,,2630.88,percent of total billed charges,90% of total billed charges,2923.2,80,,2338.56,percent of total billed charges,80% of total billed charges,2302.02,63,,1841.62,percent of total billed charges,63% of total billed charges,3105.9,85,,2484.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,2886.66,79,,2309.33,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
FX TIBIA SHFT CLSD NO MANIP,450027750,CDM,450,RC,27750,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
"FX TIBIA CLTX, W/ MANIPULATION",450027752,CDM,450,RC,27752,HCPCS,outpatient,,,1893,1325.1,,1495.47,79,,1196.38,percent of total billed charges,79% of total billed charges,1703.7,90,,1362.96,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1192.59,63,,954.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1251.27,66.1,,1001.02,percent of total billed charges,66.1% of total billed charges,1571.19,83,,1256.95,percent of total billed charges,83% of total,1798.35,95,,1438.68,percent of total billed charges ,95% of total billed charges,1514.4,80,,1211.52,percent of total billed charges,78% of total billed charges,1476.54,78,,1181.232,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1192.59,63,,954.07,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1703.7,90,,1362.96,percent of total billed charges,90% of total billed charges,1514.4,80,,1211.52,percent of total billed charges,80% of total billed charges,1192.59,63,,954.07,percent of total billed charges,63% of total billed charges,1609.05,85,,1287.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1495.47,79,,1196.38,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
FX MALLEOLUS MED CLSD NO MANIP,450027760,CDM,450,RC,27760,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX FIBULA PRS/SHFT CLSD N/MANI,450027780,CDM,450,RC,27780,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX FIBULA DIST CLSD NO MANIP,450027786,CDM,450,RC,27786,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX FIBULA DIST CLSD W/MANIP,450027788,CDM,450,RC,27788,HCPCS,outpatient,,,755,528.5,,596.45,79,,477.16,percent of total billed charges,79% of total billed charges,679.5,90,,543.6,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,499.06,66.1,,399.25,percent of total billed charges,66.1% of total billed charges,626.65,83,,501.32,percent of total billed charges,83% of total,717.25,95,,573.8,percent of total billed charges ,95% of total billed charges,604,80,,483.2,percent of total billed charges,78% of total billed charges,588.9,78,,471.12,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,679.5,90,,543.6,percent of total billed charges,90% of total billed charges,604,80,,483.2,percent of total billed charges,80% of total billed charges,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,641.75,85,,513.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,596.45,79,,477.16,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX ANKLE BIMAL CLSD W/MANIP,450027810,CDM,450,RC,27810,HCPCS,outpatient,,,1234,863.8,,974.86,79,,779.89,percent of total billed charges,79% of total billed charges,1110.6,90,,888.48,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,777.42,63,,621.94,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,815.67,66.1,,652.54,percent of total billed charges,66.1% of total billed charges,1024.22,83,,819.38,percent of total billed charges,83% of total,1172.3,95,,937.84,percent of total billed charges ,95% of total billed charges,987.2,80,,789.76,percent of total billed charges,78% of total billed charges,962.52,78,,770.016,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,777.42,63,,621.94,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1110.6,90,,888.48,percent of total billed charges,90% of total billed charges,987.2,80,,789.76,percent of total billed charges,80% of total billed charges,777.42,63,,621.94,percent of total billed charges,63% of total billed charges,1048.9,85,,839.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,974.86,79,,779.89,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
FX ANKLE TRIMAL CLSD W/MANIP,450027818,CDM,450,RC,27818,HCPCS,outpatient,,,3705,2593.5,,2926.95,79,,2341.56,percent of total billed charges,79% of total billed charges,3334.5,90,,2667.6,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,2334.15,63,,1867.32,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2449.01,66.1,,1959.21,percent of total billed charges,66.1% of total billed charges,3075.15,83,,2460.12,percent of total billed charges,83% of total,3519.75,95,,2815.8,percent of total billed charges ,95% of total billed charges,2964,80,,2371.2,percent of total billed charges,78% of total billed charges,2889.9,78,,2311.92,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2334.15,63,,1867.32,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,3334.5,90,,2667.6,percent of total billed charges,90% of total billed charges,2964,80,,2371.2,percent of total billed charges,80% of total billed charges,2334.15,63,,1867.32,percent of total billed charges,63% of total billed charges,3149.25,85,,2519.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2926.95,79,,2341.56,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,3519.75,
FX TIBIA DIST CLSD NO MANIP,450027824,CDM,450,RC,27824,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
ER CLSD TX FX DISTAL TIBIA,450027825,CDM,450,RC,27825,HCPCS,outpatient,,,1396,977.2,,1102.84,79,,882.27,percent of total billed charges,79% of total billed charges,1256.4,90,,1005.12,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,879.48,63,,703.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,922.76,66.1,,738.21,percent of total billed charges,66.1% of total billed charges,1158.68,83,,926.94,percent of total billed charges,83% of total,1326.2,95,,1060.96,percent of total billed charges ,95% of total billed charges,1116.8,80,,893.44,percent of total billed charges,78% of total billed charges,1088.88,78,,871.104,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,879.48,63,,703.58,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1256.4,90,,1005.12,percent of total billed charges,90% of total billed charges,1116.8,80,,893.44,percent of total billed charges,80% of total billed charges,879.48,63,,703.58,percent of total billed charges,63% of total billed charges,1186.6,85,,949.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1102.84,79,,882.27,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
DISLOC ANKLE CLSD NO ANSTH,450027840,CDM,450,RC,27840,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,881,
ER CLSD TX ANKLE DISLOC W/ANES,450027842,CDM,450,RC,27842,HCPCS,outpatient,,,1569,1098.3,,1239.51,79,,991.61,percent of total billed charges,79% of total billed charges,1412.1,90,,1129.68,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,988.47,63,,790.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1037.11,66.1,,829.69,percent of total billed charges,66.1% of total billed charges,1302.27,83,,1041.82,percent of total billed charges,83% of total,1490.55,95,,1192.44,percent of total billed charges ,95% of total billed charges,1255.2,80,,1004.16,percent of total billed charges,78% of total billed charges,1223.82,78,,979.056,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,988.47,63,,790.78,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1412.1,90,,1129.68,percent of total billed charges,90% of total billed charges,1255.2,80,,1004.16,percent of total billed charges,80% of total billed charges,988.47,63,,790.78,percent of total billed charges,63% of total billed charges,1333.65,85,,1066.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,1239.51,79,,991.61,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2150.21,
ER REMOVAL OF FOOT SQ,450028190,CDM,450,RC,28190,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
FB REMOVAL FOOT DEEP,450028192,CDM,450,RC,28192,HCPCS,outpatient,,,2408,1685.6,,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1591.69,66.1,,1273.35,percent of total billed charges,66.1% of total billed charges,1998.64,83,,1598.91,percent of total billed charges,83% of total,2287.6,95,,1830.08,percent of total billed charges ,95% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,78% of total billed charges,1878.24,78,,1502.592,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,80% of total billed charges,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,2046.8,85,,1637.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2287.6,
"REPAIR FOOT TENDON, EA",450028208,CDM,450,RC,28208,HCPCS,outpatient,,,2510,1757,,1982.9,79,,1586.32,percent of total billed charges,79% of total billed charges,2259,90,,1807.2,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1581.3,63,,1265.04,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1659.11,66.1,,1327.29,percent of total billed charges,66.1% of total billed charges,2083.3,83,,1666.64,percent of total billed charges,83% of total,2384.5,95,,1907.6,percent of total billed charges ,95% of total billed charges,2008,80,,1606.4,percent of total billed charges,78% of total billed charges,1957.8,78,,1566.24,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1581.3,63,,1265.04,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2259,90,,1807.2,percent of total billed charges,90% of total billed charges,2008,80,,1606.4,percent of total billed charges,80% of total billed charges,1581.3,63,,1265.04,percent of total billed charges,63% of total billed charges,2133.5,85,,1706.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1982.9,79,,1586.32,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
FX CALCANEUS CLSD NO MANIP,450028400,CDM,450,RC,28400,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX TALUS CLSD NO MANIP,450028430,CDM,450,RC,28430,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
CLOSED TX TALUS FRACTURE W/MAN,450028435,CDM,450,RC,28435,HCPCS,outpatient,,,3228,2259.6,,2550.12,79,,2040.1,percent of total billed charges,79% of total billed charges,2905.2,90,,2324.16,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,2033.64,63,,1626.91,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2133.71,66.1,,1706.97,percent of total billed charges,66.1% of total billed charges,2679.24,83,,2143.39,percent of total billed charges,83% of total,3066.6,95,,2453.28,percent of total billed charges ,95% of total billed charges,2582.4,80,,2065.92,percent of total billed charges,78% of total billed charges,2517.84,78,,2014.272,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2033.64,63,,1626.91,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2905.2,90,,2324.16,percent of total billed charges,90% of total billed charges,2582.4,80,,2065.92,percent of total billed charges,80% of total billed charges,2033.64,63,,1626.91,percent of total billed charges,63% of total billed charges,2743.8,85,,2195.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2550.12,79,,2040.1,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,3066.6,
FX TARSUS NO MANIP EA,450028450,CDM,450,RC,28450,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
FX METATARSAL CLSD NO MANIP EA,450028470,CDM,450,RC,28470,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX GREAT TOE CLSD NO MANIP,450028490,CDM,450,RC,28490,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
FX GREAT TOE CLSD W/MANIP,450028495,CDM,450,RC,28495,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX TOE CLSD NO MANIP EA,450028510,CDM,450,RC,28510,HCPCS,outpatient,,,360,252,,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,237.96,66.1,,190.37,percent of total billed charges,66.1% of total billed charges,298.8,83,,239.04,percent of total billed charges,83% of total,342,95,,273.6,percent of total billed charges ,95% of total billed charges,288,80,,230.4,percent of total billed charges,78% of total billed charges,280.8,78,,224.64,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
FX TOE CLSD W/MANIP EA,450028515,CDM,450,RC,28515,HCPCS,outpatient,,,803,562.1,,634.37,79,,507.5,percent of total billed charges,79% of total billed charges,722.7,90,,578.16,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,530.78,66.1,,424.62,percent of total billed charges,66.1% of total billed charges,666.49,83,,533.19,percent of total billed charges,83% of total,762.85,95,,610.28,percent of total billed charges ,95% of total billed charges,642.4,80,,513.92,percent of total billed charges,78% of total billed charges,626.34,78,,501.072,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,722.7,90,,578.16,percent of total billed charges,90% of total billed charges,642.4,80,,513.92,percent of total billed charges,80% of total billed charges,505.89,63,,404.71,percent of total billed charges,63% of total billed charges,682.55,85,,546.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,634.37,79,,507.5,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
TREAT SESAMOID BONE FX,450028530,CDM,450,RC,28530,HCPCS,outpatient,,,269,188.3,,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,242.1,90,,193.68,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,177.81,66.1,,142.25,percent of total billed charges,66.1% of total billed charges,223.27,83,,178.62,percent of total billed charges,83% of total,255.55,95,,204.44,percent of total billed charges ,95% of total billed charges,215.2,80,,172.16,percent of total billed charges,78% of total billed charges,209.82,78,,167.856,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,169.47,63,,135.58,percent of total billed charges,63% of total billed charges,228.65,85,,182.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,212.51,79,,170.01,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,169.47,881,
"DSLC TARSAL BONE CLTX, W/ ANES",450028545,CDM,450,RC,28545,HCPCS,outpatient,,,1959,1371.3,,1547.61,79,,1238.09,percent of total billed charges,79% of total billed charges,1763.1,90,,1410.48,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1294.9,66.1,,1035.92,percent of total billed charges,66.1% of total billed charges,1625.97,83,,1300.78,percent of total billed charges,83% of total,1861.05,95,,1488.84,percent of total billed charges ,95% of total billed charges,1567.2,80,,1253.76,percent of total billed charges,78% of total billed charges,1528.02,78,,1222.416,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1763.1,90,,1410.48,percent of total billed charges,90% of total billed charges,1567.2,80,,1253.76,percent of total billed charges,80% of total billed charges,1234.17,63,,987.34,percent of total billed charges,63% of total billed charges,1665.15,85,,1332.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1547.61,79,,1238.09,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
DISLOC MTP CLSD NO ANSTH,450028630,CDM,450,RC,28630,HCPCS,outpatient,,,365,255.5,,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,328.5,90,,262.8,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,241.27,66.1,,193.02,percent of total billed charges,66.1% of total billed charges,302.95,83,,242.36,percent of total billed charges,83% of total,346.75,95,,277.4,percent of total billed charges ,95% of total billed charges,292,80,,233.6,percent of total billed charges,78% of total billed charges,284.7,78,,227.76,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,229.95,63,,183.96,percent of total billed charges,63% of total billed charges,310.25,85,,248.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,288.35,79,,230.68,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,183.38,881,
DISLOC IP CLSD NO ANSTH,450028660,CDM,450,RC,28660,HCPCS,outpatient,,,233,163.1,,184.07,79,,147.26,percent of total billed charges,79% of total billed charges,209.7,90,,167.76,percent of total billed charges,90% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,315.49,160,,,Fee Schedule,160% of CMS OPPS rate,256.33,130,,,Fee Schedule,130% of CMS OPPS rate,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,154.01,66.1,,123.21,percent of total billed charges,66.1% of total billed charges,193.39,83,,154.71,percent of total billed charges,83% of total,221.35,95,,177.08,percent of total billed charges ,95% of total billed charges,186.4,80,,149.12,percent of total billed charges,78% of total billed charges,181.74,78,,145.392,percent of total billed charges,78% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,146.79,63,,117.43,percent of total billed charges,63% of total billed charges,198.05,85,,158.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,183.38,93,,,fee schedule,93% of CMS OPPS rate,184.07,79,,147.26,percent of total billed charges,79% of total billed charges,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,197.18,100,,,Fee Schedule,100% of CMS OPPS rate,146.79,881,
"DSLC IP JNT CLTX, W/ ANESTH",450028665,CDM,450,RC,28665,HCPCS,outpatient,,,291,203.7,,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,192.35,66.1,,153.88,percent of total billed charges,66.1% of total billed charges,241.53,83,,193.22,percent of total billed charges,83% of total,276.45,95,,221.16,percent of total billed charges ,95% of total billed charges,232.8,80,,186.24,percent of total billed charges,78% of total billed charges,226.98,78,,181.584,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,881,
ER AMPUTATION TOE INTERPHL JNT,450028825,CDM,450,RC,28825,HCPCS,outpatient,,,2390,1673,,1888.1,79,,1510.48,percent of total billed charges,79% of total billed charges,2151,90,,1720.8,percent of total billed charges,90% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,4330.46,160,,,Fee Schedule,160% of CMS OPPS rate,3518.5,130,,,Fee Schedule,130% of CMS OPPS rate,1505.7,63,,1204.56,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1579.79,66.1,,1263.83,percent of total billed charges,66.1% of total billed charges,1983.7,83,,1586.96,percent of total billed charges,83% of total,2270.5,95,,1816.4,percent of total billed charges ,95% of total billed charges,1912,80,,1529.6,percent of total billed charges,78% of total billed charges,1864.2,78,,1491.36,percent of total billed charges,78% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,1505.7,63,,1204.56,percent of total billed charges,63% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2151,90,,1720.8,percent of total billed charges,90% of total billed charges,1912,80,,1529.6,percent of total billed charges,80% of total billed charges,1505.7,63,,1204.56,percent of total billed charges,63% of total billed charges,2031.5,85,,1625.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2517.08,93,,,fee schedule,93% of CMS OPPS rate,1888.1,79,,1510.48,percent of total billed charges,79% of total billed charges,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,2706.54,100,,,Fee Schedule,100% of CMS OPPS rate,450,4330.46,
APPLY CAST FIGURE OF EIGHT,450029049,CDM,450,RC,29049,HCPCS,outpatient,,,217,151.9,,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,195.3,90,,156.24,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,143.44,66.1,,114.75,percent of total billed charges,66.1% of total billed charges,180.11,83,,144.09,percent of total billed charges,83% of total,206.15,95,,164.92,percent of total billed charges ,95% of total billed charges,173.6,80,,138.88,percent of total billed charges,78% of total billed charges,169.26,78,,135.408,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,136.71,63,,109.37,percent of total billed charges,63% of total billed charges,184.45,85,,147.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,171.43,79,,137.14,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,136.71,881,
APPLY CAST SHOULDER SPICA,450029055,CDM,450,RC,29055,HCPCS,outpatient,,,291,203.7,,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,192.35,66.1,,153.88,percent of total billed charges,66.1% of total billed charges,241.53,83,,193.22,percent of total billed charges,83% of total,276.45,95,,221.16,percent of total billed charges ,95% of total billed charges,232.8,80,,186.24,percent of total billed charges,78% of total billed charges,226.98,78,,181.584,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,881,
APPLY CAST LONG ARM,450029065,CDM,450,RC,29065,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,208.83,881,
APPLY CAST SHORT ARM,450029075,CDM,450,RC,29075,HCPCS,outpatient,,,460,322,,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,414,90,,331.2,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,304.06,66.1,,243.25,percent of total billed charges,66.1% of total billed charges,381.8,83,,305.44,percent of total billed charges,83% of total,437,95,,349.6,percent of total billed charges ,95% of total billed charges,368,80,,294.4,percent of total billed charges,78% of total billed charges,358.8,78,,287.04,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,289.8,63,,231.84,percent of total billed charges,63% of total billed charges,391,85,,312.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,363.4,79,,290.72,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,208.83,881,
APPLY CAST HAND/LOW FOREARM,450029085,CDM,450,RC,29085,HCPCS,outpatient,,,267,186.9,,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,176.49,66.1,,141.19,percent of total billed charges,66.1% of total billed charges,221.61,83,,177.29,percent of total billed charges,83% of total,253.65,95,,202.92,percent of total billed charges ,95% of total billed charges,213.6,80,,170.88,percent of total billed charges,78% of total billed charges,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
APPLY SPLINT LONG ARM,450029105,CDM,450,RC,29105,HCPCS,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
"APPLY SPLINT SHORT ARM, STATIC",450029125,CDM,450,RC,29125,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
"APPLY SPLINT SHORT ARM,DYNAMIC",450029126,CDM,450,RC,29126,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
"APPLY SPLINT FINGER, STATIC",450029130,CDM,450,RC,29130,HCPCS,outpatient,,,230,161,,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,152.03,66.1,,121.62,percent of total billed charges,66.1% of total billed charges,190.9,83,,152.72,percent of total billed charges,83% of total,218.5,95,,174.8,percent of total billed charges ,95% of total billed charges,184,80,,147.2,percent of total billed charges,78% of total billed charges,179.4,78,,143.52,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
"APPLY SPLINT FINGER, DYNAMIC",450029131,CDM,450,RC,29131,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
APPLY STRAP SHOULDER,450029240,CDM,450,RC,29240,HCPCS,outpatient,,,227,158.9,,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,204.3,90,,163.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,150.05,66.1,,120.04,percent of total billed charges,66.1% of total billed charges,188.41,83,,150.73,percent of total billed charges,83% of total,215.65,95,,172.52,percent of total billed charges ,95% of total billed charges,181.6,80,,145.28,percent of total billed charges,78% of total billed charges,177.06,78,,141.648,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.01,63,,114.41,percent of total billed charges,63% of total billed charges,192.95,85,,154.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,179.33,79,,143.46,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
APPLY STRAP ELBOW/WRIST,450029260,CDM,450,RC,29260,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
APPLY STRAP HAND/FINGER,450029280,CDM,450,RC,29280,HCPCS,outpatient,,,183,128.1,,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,164.7,90,,131.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,120.96,66.1,,96.77,percent of total billed charges,66.1% of total billed charges,151.89,83,,121.51,percent of total billed charges,83% of total,173.85,95,,139.08,percent of total billed charges ,95% of total billed charges,146.4,80,,117.12,percent of total billed charges,78% of total billed charges,142.74,78,,114.192,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,115.29,63,,92.23,percent of total billed charges,63% of total billed charges,155.55,85,,124.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,144.57,79,,115.66,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
APPLY CAST LONG LEG,450029345,CDM,450,RC,29345,HCPCS,outpatient,,,291,203.7,,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,192.35,66.1,,153.88,percent of total billed charges,66.1% of total billed charges,241.53,83,,193.22,percent of total billed charges,83% of total,276.45,95,,221.16,percent of total billed charges ,95% of total billed charges,232.8,80,,186.24,percent of total billed charges,78% of total billed charges,226.98,78,,181.584,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,881,
APPLY CAST SHORT LEG,450029405,CDM,450,RC,29405,HCPCS,outpatient,,,291,203.7,,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,261.9,90,,209.52,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,192.35,66.1,,153.88,percent of total billed charges,66.1% of total billed charges,241.53,83,,193.22,percent of total billed charges,83% of total,276.45,95,,221.16,percent of total billed charges ,95% of total billed charges,232.8,80,,186.24,percent of total billed charges,78% of total billed charges,226.98,78,,181.584,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,183.33,63,,146.66,percent of total billed charges,63% of total billed charges,247.35,85,,197.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,229.89,79,,183.91,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,183.33,881,
APPLY CAST CLUBFOOT,450029450,CDM,450,RC,29450,HCPCS,outpatient,,,242,169.4,,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,159.96,66.1,,127.97,percent of total billed charges,66.1% of total billed charges,200.86,83,,160.69,percent of total billed charges,83% of total,229.9,95,,183.92,percent of total billed charges ,95% of total billed charges,193.6,80,,154.88,percent of total billed charges,78% of total billed charges,188.76,78,,151.008,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
APPLY SPLINT LONG LEG,450029505,CDM,450,RC,29505,HCPCS,outpatient,,,467,326.9,,368.93,79,,295.14,percent of total billed charges,79% of total billed charges,420.3,90,,336.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,294.21,63,,235.37,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,308.69,66.1,,246.95,percent of total billed charges,66.1% of total billed charges,387.61,83,,310.09,percent of total billed charges,83% of total,443.65,95,,354.92,percent of total billed charges ,95% of total billed charges,373.6,80,,298.88,percent of total billed charges,78% of total billed charges,364.26,78,,291.408,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,294.21,63,,235.37,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,294.21,63,,235.37,percent of total billed charges,63% of total billed charges,396.95,85,,317.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,368.93,79,,295.14,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
APPLY SPLINT SHORT LEG,450029515,CDM,450,RC,29515,HCPCS,outpatient,,,428,299.6,,338.12,79,,270.5,percent of total billed charges,79% of total billed charges,385.2,90,,308.16,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,282.91,66.1,,226.33,percent of total billed charges,66.1% of total billed charges,355.24,83,,284.19,percent of total billed charges,83% of total,406.6,95,,325.28,percent of total billed charges ,95% of total billed charges,342.4,80,,273.92,percent of total billed charges,78% of total billed charges,333.84,78,,267.072,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,363.8,85,,291.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,338.12,79,,270.5,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
APPLY STRAP KNEE,450029530,CDM,450,RC,29530,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,144.1,66.1,,115.28,percent of total billed charges,66.1% of total billed charges,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
APPLY STRAP ANKLE/FOOT,450029540,CDM,450,RC,29540,HCPCS,outpatient,,,267,186.9,,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,176.49,66.1,,141.19,percent of total billed charges,66.1% of total billed charges,221.61,83,,177.29,percent of total billed charges,83% of total,253.65,95,,202.92,percent of total billed charges ,95% of total billed charges,213.6,80,,170.88,percent of total billed charges,78% of total billed charges,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
APPLY STRAP TOES,450029550,CDM,450,RC,29550,HCPCS,outpatient,,,177,123.9,,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,159.3,90,,127.44,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,117,66.1,,93.6,percent of total billed charges,66.1% of total billed charges,146.91,83,,117.53,percent of total billed charges,83% of total,168.15,95,,134.52,percent of total billed charges ,95% of total billed charges,141.6,80,,113.28,percent of total billed charges,78% of total billed charges,138.06,78,,110.448,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,111.51,63,,89.21,percent of total billed charges,63% of total billed charges,150.45,85,,120.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,139.83,79,,111.86,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
APPLY STRAP UNNA BOOT,450029580,CDM,450,RC,29580,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
REMOVE CAST BOOT/BODY/GAUNTLET,450029700,CDM,450,RC,29700,HCPCS,outpatient,,,210,147,,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,138.81,66.1,,111.05,percent of total billed charges,66.1% of total billed charges,174.3,83,,139.44,percent of total billed charges,83% of total,199.5,95,,159.6,percent of total billed charges ,95% of total billed charges,168,80,,134.4,percent of total billed charges,78% of total billed charges,163.8,78,,131.04,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,881,
REMOVE CAST FULL ARM/LEG,450029705,CDM,450,RC,29705,HCPCS,outpatient,,,210,147,,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,138.81,66.1,,111.05,percent of total billed charges,66.1% of total billed charges,174.3,83,,139.44,percent of total billed charges,83% of total,199.5,95,,159.6,percent of total billed charges ,95% of total billed charges,168,80,,134.4,percent of total billed charges,78% of total billed charges,163.8,78,,131.04,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,881,
ER CASTING/STRAPPING PROCEDURE,450029799,CDM,450,RC,29799,HCPCS,outpatient,,,267,186.9,,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,240.3,90,,192.24,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,176.49,66.1,,141.19,percent of total billed charges,66.1% of total billed charges,221.61,83,,177.29,percent of total billed charges,83% of total,253.65,95,,202.92,percent of total billed charges ,95% of total billed charges,213.6,80,,170.88,percent of total billed charges,78% of total billed charges,208.26,78,,166.608,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,168.21,63,,134.57,percent of total billed charges,63% of total billed charges,226.95,85,,181.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,210.93,79,,168.74,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,881,
DRAIN ABCESS NASAL INTERNAL,450030000,CDM,450,RC,30000,HCPCS,outpatient,,,405,283.5,,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,267.71,66.1,,214.17,percent of total billed charges,66.1% of total billed charges,336.15,83,,268.92,percent of total billed charges,83% of total,384.75,95,,307.8,percent of total billed charges ,95% of total billed charges,324,80,,259.2,percent of total billed charges,78% of total billed charges,315.9,78,,252.72,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,364.5,90,,291.6,percent of total billed charges,90% of total billed charges,324,80,,259.2,percent of total billed charges,80% of total billed charges,255.15,63,,204.12,percent of total billed charges,63% of total billed charges,344.25,85,,275.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,319.95,79,,255.96,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,881,
FB REMOVAL INTRANASAL,450030300,CDM,450,RC,30300,HCPCS,outpatient,,,123,86.1,,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,110.7,90,,88.56,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,81.3,66.1,,65.04,percent of total billed charges,66.1% of total billed charges,102.09,83,,81.67,percent of total billed charges,83% of total,116.85,95,,93.48,percent of total billed charges ,95% of total billed charges,98.4,80,,78.72,percent of total billed charges,78% of total billed charges,95.94,78,,76.752,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,77.49,63,,61.99,percent of total billed charges,63% of total billed charges,104.55,85,,83.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,97.17,79,,77.74,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,77.49,881,
CNTRL NOSE BLEED ANTER SIMPLE,450030901,CDM,450,RC,30901,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
CNTRL NOSE BLEED ANTER COMPLEX,450030903,CDM,450,RC,30903,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.89,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,881,
CNTRL NOSE BLEED POSTER INIT,450030905,CDM,450,RC,30905,HCPCS,outpatient,,,319,223.3,,252.01,79,,201.61,percent of total billed charges,79% of total billed charges,287.1,90,,229.68,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.89,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,200.97,63,,160.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,210.86,66.1,,168.69,percent of total billed charges,66.1% of total billed charges,264.77,83,,211.82,percent of total billed charges,83% of total,303.05,95,,242.44,percent of total billed charges ,95% of total billed charges,255.2,80,,204.16,percent of total billed charges,78% of total billed charges,248.82,78,,199.056,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,200.97,63,,160.78,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,200.97,63,,160.78,percent of total billed charges,63% of total billed charges,271.15,85,,216.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,252.01,79,,201.61,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
NASAL ENDOSCOPY DX,450031231,CDM,450,RC,31231,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,265,160,,,Fee Schedule,160% of CMS OPPS rate,215.31,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.02,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,154.02,881,
NASAL ENDOSCOPY W/CNTRL BLEED,450031238,CDM,450,RC,31238,HCPCS,outpatient,,,2555,1788.5,,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,2270.71,160,,,Fee Schedule,160% of CMS OPPS rate,1844.96,130,,,Fee Schedule,130% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1688.86,66.1,,1351.09,percent of total billed charges,66.1% of total billed charges,2120.65,83,,1696.52,percent of total billed charges,83% of total,2427.25,95,,1941.8,percent of total billed charges ,95% of total billed charges,2044,80,,1635.2,percent of total billed charges,78% of total billed charges,1992.9,78,,1594.32,percent of total billed charges,78% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,2044,80,,1635.2,percent of total billed charges,80% of total billed charges,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,2171.75,85,,1737.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1319.85,93,,,fee schedule,93% of CMS OPPS rate,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,450,2427.25,
ENDOTRACHEAL INTUBATION,450031500,CDM,450,RC,31500,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,881,
TRACH TUBE CHG BEFORE FISTULA,450031502,CDM,450,RC,31502,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,881,
LARYNGOSCOPY IND W/FB REMOVAL,450031511,CDM,450,RC,31511,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,265,160,,,Fee Schedule,160% of CMS OPPS rate,215.31,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.02,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,165.63,100,,,Fee Schedule,100% of CMS OPPS rate,154.02,881,
LARYNGOSCOPY DRCT FOR ASPIRATI,450031515,CDM,450,RC,31515,HCPCS,outpatient,,,2555,1788.5,,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,341.43,100,,,Fee Schedule,100% of CMS OPPS rate,546.29,160,,,Fee Schedule,160% of CMS OPPS rate,443.85,130,,,Fee Schedule,130% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1688.86,66.1,,1351.09,percent of total billed charges,66.1% of total billed charges,2120.65,83,,1696.52,percent of total billed charges,83% of total,2427.25,95,,1941.8,percent of total billed charges ,95% of total billed charges,2044,80,,1635.2,percent of total billed charges,78% of total billed charges,1992.9,78,,1594.32,percent of total billed charges,78% of total billed charges,341.43,100,,,Fee Schedule,100% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,341.43,100,,,Fee Schedule,100% of CMS OPPS rate,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,2044,80,,1635.2,percent of total billed charges,80% of total billed charges,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,2171.75,85,,1737.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,317.52,93,,,fee schedule,93% of CMS OPPS rate,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,341.43,100,,,Fee Schedule,100% of CMS OPPS rate,341.43,100,,,Fee Schedule,100% of CMS OPPS rate,317.52,2427.25,
LARYNGOSCOPY DRT DX NO NEWB0RN,450031525,CDM,450,RC,31525,HCPCS,outpatient,,,2555,1788.5,,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,2270.71,160,,,Fee Schedule,160% of CMS OPPS rate,1844.96,130,,,Fee Schedule,130% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1688.86,66.1,,1351.09,percent of total billed charges,66.1% of total billed charges,2120.65,83,,1696.52,percent of total billed charges,83% of total,2427.25,95,,1941.8,percent of total billed charges ,95% of total billed charges,2044,80,,1635.2,percent of total billed charges,78% of total billed charges,1992.9,78,,1594.32,percent of total billed charges,78% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,2044,80,,1635.2,percent of total billed charges,80% of total billed charges,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,2171.75,85,,1737.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1319.85,93,,,fee schedule,93% of CMS OPPS rate,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,450,2427.25,
LARYNGOSCOPY IND W/FB REMOVAL,450031530,CDM,450,RC,31530,HCPCS,outpatient,,,2555,1788.5,,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,2270.71,160,,,Fee Schedule,160% of CMS OPPS rate,1844.96,130,,,Fee Schedule,130% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1688.86,66.1,,1351.09,percent of total billed charges,66.1% of total billed charges,2120.65,83,,1696.52,percent of total billed charges,83% of total,2427.25,95,,1941.8,percent of total billed charges ,95% of total billed charges,2044,80,,1635.2,percent of total billed charges,78% of total billed charges,1992.9,78,,1594.32,percent of total billed charges,78% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,2299.5,90,,1839.6,percent of total billed charges,90% of total billed charges,2044,80,,1635.2,percent of total billed charges,80% of total billed charges,1609.65,63,,1287.72,percent of total billed charges,63% of total billed charges,2171.75,85,,1737.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1319.85,93,,,fee schedule,93% of CMS OPPS rate,2018.45,79,,1614.76,percent of total billed charges,79% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,450,2427.25,
TRACHEOSTOMY TRANSTRACHEAL,450031603,CDM,450,RC,31603,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,2040.31,160,,,Fee Schedule,160% of CMS OPPS rate,1657.75,130,,,Fee Schedule,130% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,756.85,66.1,,605.48,percent of total billed charges,66.1% of total billed charges,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,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,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1185.92,93,,,fee schedule,93% of CMS OPPS rate,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,450,2040.31,
TRACHEOSTOMY CRICOTHYROID,450031605,CDM,450,RC,31605,HCPCS,outpatient,,,458,320.6,,361.82,79,,289.46,percent of total billed charges,79% of total billed charges,412.2,90,,329.76,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,302.74,66.1,,242.19,percent of total billed charges,66.1% of total billed charges,380.14,83,,304.11,percent of total billed charges,83% of total,435.1,95,,348.08,percent of total billed charges ,95% of total billed charges,366.4,80,,293.12,percent of total billed charges,78% of total billed charges,357.24,78,,285.792,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,288.54,63,,230.83,percent of total billed charges,63% of total billed charges,389.3,85,,311.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,361.82,79,,289.46,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,881,
BRONCHOSCOPY DX,450031622,CDM,450,RC,31622,HCPCS,outpatient,,,1999,1399.3,,1579.21,79,,1263.37,percent of total billed charges,79% of total billed charges,1799.1,90,,1439.28,percent of total billed charges,90% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,2270.71,160,,,Fee Schedule,160% of CMS OPPS rate,1844.96,130,,,Fee Schedule,130% of CMS OPPS rate,1259.37,63,,1007.5,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1321.34,66.1,,1057.07,percent of total billed charges,66.1% of total billed charges,1659.17,83,,1327.34,percent of total billed charges,83% of total,1899.05,95,,1519.24,percent of total billed charges ,95% of total billed charges,1599.2,80,,1279.36,percent of total billed charges,78% of total billed charges,1559.22,78,,1247.376,percent of total billed charges,78% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1259.37,63,,1007.5,percent of total billed charges,63% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1799.1,90,,1439.28,percent of total billed charges,90% of total billed charges,1599.2,80,,1279.36,percent of total billed charges,80% of total billed charges,1259.37,63,,1007.5,percent of total billed charges,63% of total billed charges,1699.15,85,,1359.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1319.85,93,,,fee schedule,93% of CMS OPPS rate,1579.21,79,,1263.37,percent of total billed charges,79% of total billed charges,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,1419.2,100,,,Fee Schedule,100% of CMS OPPS rate,450,2270.71,
ER DRAIN CHES THORANCE W/O GUI,450032000,CDM,450,RC,32554,HCPCS,outpatient,,,1261,882.7,,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,833.52,66.1,,666.82,percent of total billed charges,66.1% of total billed charges,1046.63,83,,837.3,percent of total billed charges,83% of total,1197.95,95,,958.36,percent of total billed charges ,95% of total billed charges,1008.8,80,,807.04,percent of total billed charges,78% of total billed charges,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,1071.85,85,,857.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1197.95,
TRT COLLAP LUNG THORAN W/O GUI,450032002,CDM,450,RC,32554,HCPCS,outpatient,,,1261,882.7,,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,833.52,66.1,,666.82,percent of total billed charges,66.1% of total billed charges,1046.63,83,,837.3,percent of total billed charges,83% of total,1197.95,95,,958.36,percent of total billed charges ,95% of total billed charges,1008.8,80,,807.04,percent of total billed charges,78% of total billed charges,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,1071.85,85,,857.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1197.95,
ER THORACENT PUNC/PLEUR WO GU,450032421,CDM,450,RC,32554,HCPCS,outpatient,,,1261,882.7,,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,833.52,66.1,,666.82,percent of total billed charges,66.1% of total billed charges,1046.63,83,,837.3,percent of total billed charges,83% of total,1197.95,95,,958.36,percent of total billed charges ,95% of total billed charges,1008.8,80,,807.04,percent of total billed charges,78% of total billed charges,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,1071.85,85,,857.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1197.95,
THORA/TUBE INS/INCL WTR WO GUI,450032422,CDM,450,RC,32554,HCPCS,outpatient,,,1261,882.7,,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,833.52,66.1,,666.82,percent of total billed charges,66.1% of total billed charges,1046.63,83,,837.3,percent of total billed charges,83% of total,1197.95,95,,958.36,percent of total billed charges ,95% of total billed charges,1008.8,80,,807.04,percent of total billed charges,78% of total billed charges,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,1071.85,85,,857.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1197.95,
TUBE THORACOSTOMY OPEN,450032551,CDM,450,RC,32551,HCPCS,outpatient,,,3262,2283.4,,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2156.18,66.1,,1724.94,percent of total billed charges,66.1% of total billed charges,2707.46,83,,2165.97,percent of total billed charges,83% of total,3098.9,95,,2479.12,percent of total billed charges ,95% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,78% of total billed charges,2544.36,78,,2035.488,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,80% of total billed charges,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,2772.7,85,,2218.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3098.9,
THORACENTESIS NO GUIDANCE,450032554,CDM,450,RC,32554,HCPCS,outpatient,,,1261,882.7,,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,833.52,66.1,,666.82,percent of total billed charges,66.1% of total billed charges,1046.63,83,,837.3,percent of total billed charges,83% of total,1197.95,95,,958.36,percent of total billed charges ,95% of total billed charges,1008.8,80,,807.04,percent of total billed charges,78% of total billed charges,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,1071.85,85,,857.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1197.95,
PERICARDIOCENTESIS W/IMAGING,450033016,CDM,450,RC,33016,HCPCS,outpatient,,,3670,2569,,2899.3,79,,2319.44,percent of total billed charges,79% of total billed charges,3303,90,,2642.4,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2312.1,63,,1849.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2425.87,66.1,,1940.7,percent of total billed charges,66.1% of total billed charges,3046.1,83,,2436.88,percent of total billed charges,83% of total,3486.5,95,,2789.2,percent of total billed charges ,95% of total billed charges,2936,80,,2348.8,percent of total billed charges,78% of total billed charges,2862.6,78,,2290.08,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2312.1,63,,1849.68,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,3303,90,,2642.4,percent of total billed charges,90% of total billed charges,2936,80,,2348.8,percent of total billed charges,80% of total billed charges,2312.1,63,,1849.68,percent of total billed charges,63% of total billed charges,3119.5,85,,2495.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2899.3,79,,2319.44,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3486.5,
INST TEMP CARDIAC CATH,450033210,CDM,450,RC,33210,HCPCS,outpatient,,,9665,6765.5,,7635.35,79,,6108.28,percent of total billed charges,79% of total billed charges,8698.5,90,,6958.8,percent of total billed charges,90% of total billed charges,7103.83,100,,,Fee Schedule,100% of CMS OPPS rate,11366.12,160,,,Fee Schedule,160% of CMS OPPS rate,9234.96,130,,,Fee Schedule,130% of CMS OPPS rate,6088.95,63,,4871.16,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,6388.57,66.1,,5110.86,percent of total billed charges,66.1% of total billed charges,8021.95,83,,6417.56,percent of total billed charges,83% of total,9181.75,95,,7345.4,percent of total billed charges ,95% of total billed charges,7732,80,,6185.6,percent of total billed charges,78% of total billed charges,7538.7,78,,6030.96,percent of total billed charges,78% of total billed charges,7103.83,100,,,Fee Schedule,100% of CMS OPPS rate,6088.95,63,,4871.16,percent of total billed charges,63% of total billed charges,7103.83,100,,,Fee Schedule,100% of CMS OPPS rate,8698.5,90,,6958.8,percent of total billed charges,90% of total billed charges,7732,80,,6185.6,percent of total billed charges,80% of total billed charges,6088.95,63,,4871.16,percent of total billed charges,63% of total billed charges,8215.25,85,,6572.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,6606.55,93,,,fee schedule,93% of CMS OPPS rate,7635.35,79,,6108.28,percent of total billed charges,79% of total billed charges,7103.83,100,,,Fee Schedule,100% of CMS OPPS rate,7103.83,100,,,Fee Schedule,100% of CMS OPPS rate,450,11366.12,
REPAIR BLOOD VESSEL ARM,450035206,CDM,450,RC,35206,HCPCS,outpatient,,,5978,4184.6,,4722.62,79,,3778.1,percent of total billed charges,79% of total billed charges,5380.2,90,,4304.16,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,3766.14,63,,3012.91,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,3951.46,66.1,,3161.17,percent of total billed charges,66.1% of total billed charges,4961.74,83,,3969.39,percent of total billed charges,83% of total,5679.1,95,,4543.28,percent of total billed charges ,95% of total billed charges,4782.4,80,,3825.92,percent of total billed charges,78% of total billed charges,4662.84,78,,3730.272,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,3766.14,63,,3012.91,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,5380.2,90,,4304.16,percent of total billed charges,90% of total billed charges,4782.4,80,,3825.92,percent of total billed charges,80% of total billed charges,3766.14,63,,3012.91,percent of total billed charges,63% of total billed charges,5081.3,85,,4065.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,4722.62,79,,3778.1,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,5679.1,
REPAIR BLOOD VESSEL HAND/FNGR,450035207,CDM,450,RC,35207,HCPCS,outpatient,,,3024,2116.8,,2388.96,79,,1911.17,percent of total billed charges,79% of total billed charges,2721.6,90,,2177.28,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,1905.12,63,,1524.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1998.86,66.1,,1599.09,percent of total billed charges,66.1% of total billed charges,2509.92,83,,2007.94,percent of total billed charges,83% of total,2872.8,95,,2298.24,percent of total billed charges ,95% of total billed charges,2419.2,80,,1935.36,percent of total billed charges,78% of total billed charges,2358.72,78,,1886.976,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1905.12,63,,1524.1,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2721.6,90,,2177.28,percent of total billed charges,90% of total billed charges,2419.2,80,,1935.36,percent of total billed charges,80% of total billed charges,1905.12,63,,1524.1,percent of total billed charges,63% of total billed charges,2570.4,85,,2056.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,2388.96,79,,1911.17,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
REPAIR BLOOD VESSEL LEG,450035226,CDM,450,RC,35226,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
VENIPUNCTURE CUTDOWN<1 YR,450036420,CDM,450,RC,36420,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
VENIPUNCTURE CUTDOWN 1 YR OR >,450036425,CDM,450,RC,36425,HCPCS,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,52.29,881,
ER COLLECTION OF BLOOD SPECIME,450036540,CDM,450,RC,36591,HCPCS,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
CICC NON-TUNNEL<5 YRS,450036555,CDM,450,RC,36555,HCPCS,outpatient,,,1784,1248.8,,1409.36,79,,1127.49,percent of total billed charges,79% of total billed charges,1605.6,90,,1284.48,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,1123.92,63,,899.14,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1179.22,66.1,,943.38,percent of total billed charges,66.1% of total billed charges,1480.72,83,,1184.58,percent of total billed charges,83% of total,1694.8,95,,1355.84,percent of total billed charges ,95% of total billed charges,1427.2,80,,1141.76,percent of total billed charges,78% of total billed charges,1391.52,78,,1113.216,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1123.92,63,,899.14,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1605.6,90,,1284.48,percent of total billed charges,90% of total billed charges,1427.2,80,,1141.76,percent of total billed charges,80% of total billed charges,1123.92,63,,899.14,percent of total billed charges,63% of total billed charges,1516.4,85,,1213.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,1409.36,79,,1127.49,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
INSERT NON-TUNL CV CATH 5 YRS>,450036556,CDM,450,RC,36556,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
CICC TUNNEL 5YR&>WO PORT/PUMP,450036558,CDM,450,RC,36558,HCPCS,outpatient,,,4041,2828.7,,3192.39,79,,2553.91,percent of total billed charges,79% of total billed charges,3636.9,90,,2909.52,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,2545.83,63,,2036.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2671.1,66.1,,2136.88,percent of total billed charges,66.1% of total billed charges,3354.03,83,,2683.22,percent of total billed charges,83% of total,3838.95,95,,3071.16,percent of total billed charges ,95% of total billed charges,3232.8,80,,2586.24,percent of total billed charges,78% of total billed charges,3151.98,78,,2521.584,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2545.83,63,,2036.66,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,3636.9,90,,2909.52,percent of total billed charges,90% of total billed charges,3232.8,80,,2586.24,percent of total billed charges,80% of total billed charges,2545.83,63,,2036.66,percent of total billed charges,63% of total billed charges,3434.85,85,,2747.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,3192.39,79,,2553.91,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
PICC 5YRS OR > W/O PORT/PUMP,450036569,CDM,450,RC,36569,HCPCS,outpatient,,,3348,2343.6,,2644.92,79,,2115.94,percent of total billed charges,79% of total billed charges,3013.2,90,,2410.56,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2213.03,66.1,,1770.42,percent of total billed charges,66.1% of total billed charges,2778.84,83,,2223.07,percent of total billed charges,83% of total,3180.6,95,,2544.48,percent of total billed charges ,95% of total billed charges,2678.4,80,,2142.72,percent of total billed charges,78% of total billed charges,2611.44,78,,2089.152,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,3013.2,90,,2410.56,percent of total billed charges,90% of total billed charges,2678.4,80,,2142.72,percent of total billed charges,80% of total billed charges,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,2845.8,85,,2276.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2644.92,79,,2115.94,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3180.6,
PIC VAD W/PORT 5 YRS & >,450036571,CDM,450,RC,36571,HCPCS,outpatient,,,5542,3879.4,,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,3663.26,66.1,,2930.61,percent of total billed charges,66.1% of total billed charges,4599.86,83,,3679.89,percent of total billed charges,83% of total,5264.9,95,,4211.92,percent of total billed charges ,95% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,78% of total billed charges,4322.76,78,,3458.208,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,80% of total billed charges,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,4710.7,85,,3768.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,5264.9,
INSERTION PICC RS&I <5 YR,450036572,CDM,450,RC,36572,HCPCS,outpatient,,,1550,1085,,1224.5,79,,979.6,percent of total billed charges,79% of total billed charges,1395,90,,1116,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,976.5,63,,781.2,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1024.55,66.1,,819.64,percent of total billed charges,66.1% of total billed charges,1286.5,83,,1029.2,percent of total billed charges,83% of total,1472.5,95,,1178,percent of total billed charges ,95% of total billed charges,1240,80,,992,percent of total billed charges,78% of total billed charges,1209,78,,967.2,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,976.5,63,,781.2,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,1395,90,,1116,percent of total billed charges,90% of total billed charges,1240,80,,992,percent of total billed charges,80% of total billed charges,976.5,63,,781.2,percent of total billed charges,63% of total billed charges,1317.5,85,,1054,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,1224.5,79,,979.6,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1472.5,
INSJ PICC RS&I 5 YR+,450036573,CDM,450,RC,36573,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,2769.25,
RMV TUNNEL CATH W/O PORT/PUMP,450036589,CDM,450,RC,36589,HCPCS,outpatient,,,980,686,,774.2,79,,619.36,percent of total billed charges,79% of total billed charges,882,90,,705.6,percent of total billed charges,90% of total billed charges,525.28,100,,,Fee Schedule,100% of CMS OPPS rate,840.45,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,617.4,63,,493.92,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,647.78,66.1,,518.22,percent of total billed charges,66.1% of total billed charges,813.4,83,,650.72,percent of total billed charges,83% of total,931,95,,744.8,percent of total billed charges ,95% of total billed charges,784,80,,627.2,percent of total billed charges,78% of total billed charges,764.4,78,,611.52,percent of total billed charges,78% of total billed charges,525.28,100,,,Fee Schedule,100% of CMS OPPS rate,617.4,63,,493.92,percent of total billed charges,63% of total billed charges,525.28,100,,,Fee Schedule,100% of CMS OPPS rate,882,90,,705.6,percent of total billed charges,90% of total billed charges,784,80,,627.2,percent of total billed charges,80% of total billed charges,617.4,63,,493.92,percent of total billed charges,63% of total billed charges,833,85,,666.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,774.2,79,,619.36,percent of total billed charges,79% of total billed charges,525.28,100,,,Fee Schedule,100% of CMS OPPS rate,525.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,931,
ER BLOOD COLLECT IMPLNT VAD,450036591,CDM,450,RC,36591,HCPCS,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
BLOOD COLLECT CENT/PERIPH CATH,450036592,CDM,450,RC,36592,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,144.1,66.1,,115.28,percent of total billed charges,66.1% of total billed charges,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
ARTERIAL PUNCTURE FOR DX,450036600,CDM,450,RC,36600,HCPCS,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
NEEDLE PLCMT INTRAOSSEOUS INF,450036680,CDM,450,RC,36680,HCPCS,outpatient,,,870,609,,687.3,79,,549.84,percent of total billed charges,79% of total billed charges,783,90,,626.4,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,548.1,63,,438.48,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,575.07,66.1,,460.06,percent of total billed charges,66.1% of total billed charges,722.1,83,,577.68,percent of total billed charges,83% of total,826.5,95,,661.2,percent of total billed charges ,95% of total billed charges,696,80,,556.8,percent of total billed charges,78% of total billed charges,678.6,78,,542.88,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,548.1,63,,438.48,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,548.1,63,,438.48,percent of total billed charges,63% of total billed charges,739.5,85,,591.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,687.3,79,,549.84,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,309.84,881,
THROMBOLYSIS CEREBRAL BY IV IN,450037195,CDM,450,RC,37195,HCPCS,outpatient,,,387,270.9,,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,348.3,90,,278.64,percent of total billed charges,90% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,453.08,160,,,Fee Schedule,160% of CMS OPPS rate,368.13,130,,,Fee Schedule,130% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,255.81,66.1,,204.65,percent of total billed charges,66.1% of total billed charges,321.21,83,,256.97,percent of total billed charges,83% of total,367.65,95,,294.12,percent of total billed charges ,95% of total billed charges,309.6,80,,247.68,percent of total billed charges,78% of total billed charges,301.86,78,,241.488,percent of total billed charges,78% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,243.81,63,,195.05,percent of total billed charges,63% of total billed charges,328.95,85,,263.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,263.35,93,,,fee schedule,93% of CMS OPPS rate,305.73,79,,244.58,percent of total billed charges,79% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,243.81,881,
ER TRANSCATHETER THERAPY INFUS,450037201,CDM,450,RC,,,outpatient,,,320,224,,252.8,79,,202.24,percent of total billed charges,79% of total billed charges,288,90,,230.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,211.52,66.1,,169.22,percent of total billed charges,66.1% of total billed charges,265.6,83,,212.48,percent of total billed charges,83% of total,304,95,,243.2,percent of total billed charges ,95% of total billed charges,256,80,,204.8,percent of total billed charges,78% of total billed charges,249.6,78,,199.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,288,90,,230.4,percent of total billed charges,90% of total billed charges,256,80,,204.8,percent of total billed charges,80% of total billed charges,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,272,85,,217.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,252.8,79,,202.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,201.6,881,
LIGATE OR BX TEMPORAL ARTERY,450037609,CDM,450,RC,37609,HCPCS,outpatient,,,2408,1685.6,,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1591.69,66.1,,1273.35,percent of total billed charges,66.1% of total billed charges,1998.64,83,,1598.91,percent of total billed charges,83% of total,2287.6,95,,1830.08,percent of total billed charges ,95% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,78% of total billed charges,1878.24,78,,1502.592,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2167.2,90,,1733.76,percent of total billed charges,90% of total billed charges,1926.4,80,,1541.12,percent of total billed charges,80% of total billed charges,1517.04,63,,1213.63,percent of total billed charges,63% of total billed charges,2046.8,85,,1637.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,1902.32,79,,1521.86,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2287.6,
ER LIGATION OF EXTREMITY ARTER,450037618,CDM,450,RC,37618,HCPCS,outpatient,,,1521,1064.7,,1201.59,79,,961.27,percent of total billed charges,79% of total billed charges,1368.9,90,,1095.12,percent of total billed charges,90% of total billed charges,1521,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1521,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1521,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1005.38,66.1,,804.3,percent of total billed charges,66.1% of total billed charges,1262.43,83,,1009.94,percent of total billed charges,83% of total,1444.95,95,,1155.96,percent of total billed charges ,95% of total billed charges,1216.8,80,,973.44,percent of total billed charges,78% of total billed charges,1186.38,78,,949.104,percent of total billed charges,78% of total billed charges,1521,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,1521,100,,,fee schedule ,100% of CMS fee schedule,1368.9,90,,1095.12,percent of total billed charges,90% of total billed charges,1216.8,80,,973.44,percent of total billed charges,80% of total billed charges,958.23,63,,766.58,percent of total billed charges,63% of total billed charges,1292.85,85,,1034.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1521,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1201.59,79,,961.27,percent of total billed charges,79% of total billed charges,1521,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,1521,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,450,1521,
LIGATE FEMORAL VEIN,450037650,CDM,450,RC,37650,HCPCS,outpatient,,,4492,3144.4,,3548.68,79,,2838.94,percent of total billed charges,79% of total billed charges,4042.8,90,,3234.24,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,2829.96,63,,2263.97,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2969.21,66.1,,2375.37,percent of total billed charges,66.1% of total billed charges,3728.36,83,,2982.69,percent of total billed charges,83% of total,4267.4,95,,3413.92,percent of total billed charges ,95% of total billed charges,3593.6,80,,2874.88,percent of total billed charges,78% of total billed charges,3503.76,78,,2803.008,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2829.96,63,,2263.97,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4042.8,90,,3234.24,percent of total billed charges,90% of total billed charges,3593.6,80,,2874.88,percent of total billed charges,80% of total billed charges,2829.96,63,,2263.97,percent of total billed charges,63% of total billed charges,3818.2,85,,3054.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,3548.68,79,,2838.94,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4267.4,
ER VASCULAR SURGERY PROCEDURE,450037799,CDM,450,RC,37799,HCPCS,outpatient,,,120,84,,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,108,90,,86.4,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,79.32,66.1,,63.46,percent of total billed charges,66.1% of total billed charges,99.6,83,,79.68,percent of total billed charges,83% of total,114,95,,91.2,percent of total billed charges ,95% of total billed charges,96,80,,76.8,percent of total billed charges,78% of total billed charges,93.6,78,,74.88,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,75.6,63,,60.48,percent of total billed charges,63% of total billed charges,102,85,,81.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,94.8,79,,75.84,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,75.6,881,
LAC LIP FULL THICK TO 1/2 VERT,450040652,CDM,450,RC,40652,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,736.09,160,,,Fee Schedule,160% of CMS OPPS rate,598.07,130,,,Fee Schedule,130% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,756.85,66.1,,605.48,percent of total billed charges,66.1% of total billed charges,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,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,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,427.85,93,,,fee schedule,93% of CMS OPPS rate,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,427.85,1087.75,
LAC LIP FULL THCK>1/2 VT CMPX,450040654,CDM,450,RC,40654,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,2040.31,160,,,Fee Schedule,160% of CMS OPPS rate,1657.75,130,,,Fee Schedule,130% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,756.85,66.1,,605.48,percent of total billed charges,66.1% of total billed charges,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,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,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1185.92,93,,,fee schedule,93% of CMS OPPS rate,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,1275.19,100,,,Fee Schedule,100% of CMS OPPS rate,450,2040.31,
ABSCESS MOUTH SIMPLE,450040800,CDM,450,RC,40800,HCPCS,outpatient,,,335,234.5,,264.65,79,,211.72,percent of total billed charges,79% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,221.44,66.1,,177.15,percent of total billed charges,66.1% of total billed charges,278.05,83,,222.44,percent of total billed charges,83% of total,318.25,95,,254.6,percent of total billed charges ,95% of total billed charges,268,80,,214.4,percent of total billed charges,78% of total billed charges,261.3,78,,209.04,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,264.65,79,,211.72,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,211.05,941.28,
FB REMOVAL MOUTH EMBED SMPL,450040804,CDM,450,RC,40804,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,1212.75,
FB REMOVAL MOUTH EMBED COMPL,450040805,CDM,450,RC,40805,HCPCS,outpatient,,,3905,2733.5,,3084.95,79,,2467.96,percent of total billed charges,79% of total billed charges,3514.5,90,,2811.6,percent of total billed charges,90% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,736.09,160,,,Fee Schedule,160% of CMS OPPS rate,598.07,130,,,Fee Schedule,130% of CMS OPPS rate,2460.15,63,,1968.12,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2581.21,66.1,,2064.97,percent of total billed charges,66.1% of total billed charges,3241.15,83,,2592.92,percent of total billed charges,83% of total,3709.75,95,,2967.8,percent of total billed charges ,95% of total billed charges,3124,80,,2499.2,percent of total billed charges,78% of total billed charges,3045.9,78,,2436.72,percent of total billed charges,78% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,2460.15,63,,1968.12,percent of total billed charges,63% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,3514.5,90,,2811.6,percent of total billed charges,90% of total billed charges,3124,80,,2499.2,percent of total billed charges,80% of total billed charges,2460.15,63,,1968.12,percent of total billed charges,63% of total billed charges,3319.25,85,,2655.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,427.85,93,,,fee schedule,93% of CMS OPPS rate,3084.95,79,,2467.96,percent of total billed charges,79% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,427.85,3709.75,
LAC MOUTH 2.5 CM OR <,450040830,CDM,450,RC,40830,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,881,
LAC MOUTH > 2.5 COMPL,450040831,CDM,450,RC,40831,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,736.09,160,,,Fee Schedule,160% of CMS OPPS rate,598.07,130,,,Fee Schedule,130% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,756.85,66.1,,605.48,percent of total billed charges,66.1% of total billed charges,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,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,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,427.85,93,,,fee schedule,93% of CMS OPPS rate,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,427.85,1087.75,
ABCESS I&D LINGUAL,450041000,CDM,450,RC,41000,HCPCS,outpatient,,,1145,801.5,,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,1030.5,90,,824.4,percent of total billed charges,90% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,736.09,160,,,Fee Schedule,160% of CMS OPPS rate,598.07,130,,,Fee Schedule,130% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,756.85,66.1,,605.48,percent of total billed charges,66.1% of total billed charges,950.35,83,,760.28,percent of total billed charges,83% of total,1087.75,95,,870.2,percent of total billed charges ,95% of total billed charges,916,80,,732.8,percent of total billed charges,78% of total billed charges,893.1,78,,714.48,percent of total billed charges,78% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,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,721.35,63,,577.08,percent of total billed charges,63% of total billed charges,973.25,85,,778.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,427.85,93,,,fee schedule,93% of CMS OPPS rate,904.55,79,,723.64,percent of total billed charges,79% of total billed charges,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,460.06,100,,,Fee Schedule,100% of CMS OPPS rate,427.85,1087.75,
ABSCESS I&D SUBMANDIBULAR,450041008,CDM,450,RC,41008,HCPCS,outpatient,,,2558,1790.6,,2020.82,79,,1616.66,percent of total billed charges,79% of total billed charges,2302.2,90,,1841.76,percent of total billed charges,90% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,4307.42,160,,,Fee Schedule,160% of CMS OPPS rate,3499.78,130,,,Fee Schedule,130% of CMS OPPS rate,1611.54,63,,1289.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1690.84,66.1,,1352.67,percent of total billed charges,66.1% of total billed charges,2123.14,83,,1698.51,percent of total billed charges,83% of total,2430.1,95,,1944.08,percent of total billed charges ,95% of total billed charges,2046.4,80,,1637.12,percent of total billed charges,78% of total billed charges,1995.24,78,,1596.192,percent of total billed charges,78% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,1611.54,63,,1289.23,percent of total billed charges,63% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,2302.2,90,,1841.76,percent of total billed charges,90% of total billed charges,2046.4,80,,1637.12,percent of total billed charges,80% of total billed charges,1611.54,63,,1289.23,percent of total billed charges,63% of total billed charges,2174.3,85,,1739.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2503.67,93,,,fee schedule,93% of CMS OPPS rate,2020.82,79,,1616.66,percent of total billed charges,79% of total billed charges,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,2692.14,100,,,Fee Schedule,100% of CMS OPPS rate,450,4307.42,
LAC MOUTH FLR/TONGUE 2.5CM OR<,450041250,CDM,450,RC,41250,HCPCS,outpatient,,,263,184.1,,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,173.84,66.1,,139.07,percent of total billed charges,66.1% of total billed charges,218.29,83,,174.63,percent of total billed charges,83% of total,249.85,95,,199.88,percent of total billed charges ,95% of total billed charges,210.4,80,,168.32,percent of total billed charges,78% of total billed charges,205.14,78,,164.112,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,165.69,881,
ABCESS DENTOALVELOAR DRAIN,450041800,CDM,450,RC,41800,HCPCS,outpatient,,,433,303.1,,342.07,79,,273.66,percent of total billed charges,79% of total billed charges,389.7,90,,311.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,272.79,63,,218.23,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,286.21,66.1,,228.97,percent of total billed charges,66.1% of total billed charges,359.39,83,,287.51,percent of total billed charges,83% of total,411.35,95,,329.08,percent of total billed charges ,95% of total billed charges,346.4,80,,277.12,percent of total billed charges,78% of total billed charges,337.74,78,,270.192,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,272.79,63,,218.23,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,272.79,63,,218.23,percent of total billed charges,63% of total billed charges,368.05,85,,294.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,342.07,79,,273.66,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
ABSCESS I&D PERITONSILLAR,450042700,CDM,450,RC,42700,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,881,
FB REMOVAL PHARYNX,450042809,CDM,450,RC,42809,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,881,
RPLC GASTRO TUBE NO REVJ TRC,450043762,CDM,450,RC,43762,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,881,
REPLC GTUBE REVJ GSTRST TRC,450043763,CDM,450,RC,43763,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,881,
RIGID PROCTOSIGMOIDOSCOPY,450045300,CDM,450,RC,,,outpatient,,,1637,1145.9,,1293.23,79,,1034.58,percent of total billed charges,79% of total billed charges,1473.3,90,,1178.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1082.06,66.1,,865.65,percent of total billed charges,66.1% of total billed charges,1358.71,83,,1086.97,percent of total billed charges,83% of total,1555.15,95,,1244.12,percent of total billed charges ,95% of total billed charges,1309.6,80,,1047.68,percent of total billed charges,78% of total billed charges,1276.86,78,,1021.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1473.3,90,,1178.64,percent of total billed charges,90% of total billed charges,1309.6,80,,1047.68,percent of total billed charges,80% of total billed charges,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,1391.45,85,,1113.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1293.23,79,,1034.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1555.15,
ABSCESS RECTUM I&D,450046040,CDM,450,RC,46040,HCPCS,outpatient,,,5615,3930.5,,4435.85,79,,3548.68,percent of total billed charges,79% of total billed charges,5053.5,90,,4042.8,percent of total billed charges,90% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1578.77,160,,,Fee Schedule,160% of CMS OPPS rate,1282.75,130,,,Fee Schedule,130% of CMS OPPS rate,3537.45,63,,2829.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,3711.52,66.1,,2969.22,percent of total billed charges,66.1% of total billed charges,4660.45,83,,3728.36,percent of total billed charges,83% of total,5334.25,95,,4267.4,percent of total billed charges ,95% of total billed charges,4492,80,,3593.6,percent of total billed charges,78% of total billed charges,4379.7,78,,3503.76,percent of total billed charges,78% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,3537.45,63,,2829.96,percent of total billed charges,63% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,5053.5,90,,4042.8,percent of total billed charges,90% of total billed charges,4492,80,,3593.6,percent of total billed charges,80% of total billed charges,3537.45,63,,2829.96,percent of total billed charges,63% of total billed charges,4772.75,85,,3818.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,917.66,93,,,fee schedule,93% of CMS OPPS rate,4435.85,79,,3548.68,percent of total billed charges,79% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,450,5334.25,
EXC ANAL TAGS MULTIPLE,450046230,CDM,450,RC,46230,HCPCS,outpatient,,,2982,2087.4,,2355.78,79,,1884.62,percent of total billed charges,79% of total billed charges,2683.8,90,,2147.04,percent of total billed charges,90% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,3756.46,160,,,Fee Schedule,160% of CMS OPPS rate,3052.12,130,,,Fee Schedule,130% of CMS OPPS rate,1878.66,63,,1502.93,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1971.1,66.1,,1576.88,percent of total billed charges,66.1% of total billed charges,2475.06,83,,1980.05,percent of total billed charges,83% of total,2832.9,95,,2266.32,percent of total billed charges ,95% of total billed charges,2385.6,80,,1908.48,percent of total billed charges,78% of total billed charges,2325.96,78,,1860.768,percent of total billed charges,78% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,1878.66,63,,1502.93,percent of total billed charges,63% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,2683.8,90,,2147.04,percent of total billed charges,90% of total billed charges,2385.6,80,,1908.48,percent of total billed charges,80% of total billed charges,1878.66,63,,1502.93,percent of total billed charges,63% of total billed charges,2534.7,85,,2027.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2183.44,93,,,fee schedule,93% of CMS OPPS rate,2355.78,79,,1884.62,percent of total billed charges,79% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,450,3756.46,
UNLISTED PROCEDURE ANUS,450046999,CDM,450,RC,46999,HCPCS,outpatient,,,1664,1164.8,,1314.56,79,,1051.65,percent of total billed charges,79% of total billed charges,1497.6,90,,1198.08,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,1048.32,63,,838.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1099.9,66.1,,879.92,percent of total billed charges,66.1% of total billed charges,1381.12,83,,1104.9,percent of total billed charges,83% of total,1580.8,95,,1264.64,percent of total billed charges ,95% of total billed charges,1331.2,80,,1064.96,percent of total billed charges,78% of total billed charges,1297.92,78,,1038.336,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1048.32,63,,838.66,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1497.6,90,,1198.08,percent of total billed charges,90% of total billed charges,1331.2,80,,1064.96,percent of total billed charges,80% of total billed charges,1048.32,63,,838.66,percent of total billed charges,63% of total billed charges,1414.4,85,,1131.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,1314.56,79,,1051.65,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,1580.8,
BLADDER ASPIRA SUPRAPUBIC CATH,450051102,CDM,450,RC,51102,HCPCS,outpatient,,,2980,2086,,2354.2,79,,1883.36,percent of total billed charges,79% of total billed charges,2682,90,,2145.6,percent of total billed charges,90% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,2724.99,160,,,Fee Schedule,160% of CMS OPPS rate,2214.05,130,,,Fee Schedule,130% of CMS OPPS rate,1877.4,63,,1501.92,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1969.78,66.1,,1575.82,percent of total billed charges,66.1% of total billed charges,2473.4,83,,1978.72,percent of total billed charges,83% of total,2831,95,,2264.8,percent of total billed charges ,95% of total billed charges,2384,80,,1907.2,percent of total billed charges,78% of total billed charges,2324.4,78,,1859.52,percent of total billed charges,78% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,1877.4,63,,1501.92,percent of total billed charges,63% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,2682,90,,2145.6,percent of total billed charges,90% of total billed charges,2384,80,,1907.2,percent of total billed charges,80% of total billed charges,1877.4,63,,1501.92,percent of total billed charges,63% of total billed charges,2533,85,,2026.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1583.9,93,,,fee schedule,93% of CMS OPPS rate,2354.2,79,,1883.36,percent of total billed charges,79% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,450,2831,
BLADDER IRRIGAT SMPL LVG/INSTL,450051700,CDM,450,RC,51700,HCPCS,outpatient,,,698,488.6,,551.42,79,,441.14,percent of total billed charges,79% of total billed charges,628.2,90,,502.56,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,461.38,66.1,,369.1,percent of total billed charges,66.1% of total billed charges,579.34,83,,463.47,percent of total billed charges,83% of total,663.1,95,,530.48,percent of total billed charges ,95% of total billed charges,558.4,80,,446.72,percent of total billed charges,78% of total billed charges,544.44,78,,435.552,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,628.2,90,,502.56,percent of total billed charges,90% of total billed charges,558.4,80,,446.72,percent of total billed charges,80% of total billed charges,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,551.42,79,,441.14,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,881,
BLADDER CATH NON-INDWELLING,450051701,CDM,450,RC,51701,HCPCS,outpatient,,,277,193.9,,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,183.1,66.1,,146.48,percent of total billed charges,66.1% of total billed charges,229.91,83,,183.93,percent of total billed charges,83% of total,263.15,95,,210.52,percent of total billed charges ,95% of total billed charges,221.6,80,,177.28,percent of total billed charges,78% of total billed charges,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
ER BLADDER CATH TEMP INDW SMPL,450051702,CDM,450,RC,51702,HCPCS,outpatient,,,283,198.1,,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,187.06,66.1,,149.65,percent of total billed charges,66.1% of total billed charges,234.89,83,,187.91,percent of total billed charges,83% of total,268.85,95,,215.08,percent of total billed charges ,95% of total billed charges,226.4,80,,181.12,percent of total billed charges,78% of total billed charges,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
BLADDER CATH TEMP INDWELL COMP,450051703,CDM,450,RC,51703,HCPCS,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.97,160,,,Fee Schedule,160% of CMS OPPS rate,169.78,130,,,Fee Schedule,130% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.46,93,,,fee schedule,93% of CMS OPPS rate,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.46,881,
"CHG CYSTOSTOMY TUBE,SIMPLE",450051705,CDM,450,RC,51705,HCPCS,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,881,
US POST-VOID BLADDER CAPACITY,450051798,CDM,450,RC,51798,HCPCS,outpatient,,,136,95.2,,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,122.4,90,,97.92,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,89.9,66.1,,71.92,percent of total billed charges,66.1% of total billed charges,112.88,83,,90.3,percent of total billed charges,83% of total,129.2,95,,103.36,percent of total billed charges ,95% of total billed charges,108.8,80,,87.04,percent of total billed charges,78% of total billed charges,106.08,78,,84.864,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,85.68,63,,68.54,percent of total billed charges,63% of total billed charges,115.6,85,,92.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,107.44,79,,85.95,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
DILATE URETH SND/DLTR MALE INI,450053600,CDM,450,RC,53600,HCPCS,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,881,
DILATE URETH FILIFRM/FLLW MALE,450053620,CDM,450,RC,53620,HCPCS,outpatient,,,1113,779.1,,879.27,79,,703.42,percent of total billed charges,79% of total billed charges,1001.7,90,,801.36,percent of total billed charges,90% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,913.9,160,,,Fee Schedule,160% of CMS OPPS rate,742.54,130,,,Fee Schedule,130% of CMS OPPS rate,701.19,63,,560.95,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,735.69,66.1,,588.55,percent of total billed charges,66.1% of total billed charges,923.79,83,,739.03,percent of total billed charges,83% of total,1057.35,95,,845.88,percent of total billed charges ,95% of total billed charges,890.4,80,,712.32,percent of total billed charges,78% of total billed charges,868.14,78,,694.512,percent of total billed charges,78% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,701.19,63,,560.95,percent of total billed charges,63% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,1001.7,90,,801.36,percent of total billed charges,90% of total billed charges,890.4,80,,712.32,percent of total billed charges,80% of total billed charges,701.19,63,,560.95,percent of total billed charges,63% of total billed charges,946.05,85,,756.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,531.2,93,,,fee schedule,93% of CMS OPPS rate,879.27,79,,703.42,percent of total billed charges,79% of total billed charges,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,571.19,100,,,Fee Schedule,100% of CMS OPPS rate,450,1057.35,
IRRIGATE FOR PRIAPISM,450054220,CDM,450,RC,54220,HCPCS,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,881,
INJECT PENIS FOR ERECTILE DYSF,450054235,CDM,450,RC,54235,HCPCS,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,881,
INC DRN EPIDIDYMIS TESTIS SCRO,450054700,CDM,450,RC,54700,HCPCS,outpatient,,,3986,2790.2,,3148.94,79,,2519.15,percent of total billed charges,79% of total billed charges,3587.4,90,,2869.92,percent of total billed charges,90% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,2724.99,160,,,Fee Schedule,160% of CMS OPPS rate,2214.05,130,,,Fee Schedule,130% of CMS OPPS rate,2511.18,63,,2008.94,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2634.75,66.1,,2107.8,percent of total billed charges,66.1% of total billed charges,3308.38,83,,2646.7,percent of total billed charges,83% of total,3786.7,95,,3029.36,percent of total billed charges ,95% of total billed charges,3188.8,80,,2551.04,percent of total billed charges,78% of total billed charges,3109.08,78,,2487.264,percent of total billed charges,78% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,2511.18,63,,2008.94,percent of total billed charges,63% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,3587.4,90,,2869.92,percent of total billed charges,90% of total billed charges,3188.8,80,,2551.04,percent of total billed charges,80% of total billed charges,2511.18,63,,2008.94,percent of total billed charges,63% of total billed charges,3388.1,85,,2710.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1583.9,93,,,fee schedule,93% of CMS OPPS rate,3148.94,79,,2519.15,percent of total billed charges,79% of total billed charges,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,1703.12,100,,,Fee Schedule,100% of CMS OPPS rate,450,3786.7,
ABSCESS SCROTAL WALL DRAIN,450055100,CDM,450,RC,55100,HCPCS,outpatient,,,1265,885.5,,999.35,79,,799.48,percent of total billed charges,79% of total billed charges,1138.5,90,,910.8,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,796.95,63,,637.56,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,836.17,66.1,,668.94,percent of total billed charges,66.1% of total billed charges,1049.95,83,,839.96,percent of total billed charges,83% of total,1201.75,95,,961.4,percent of total billed charges ,95% of total billed charges,1012,80,,809.6,percent of total billed charges,78% of total billed charges,986.7,78,,789.36,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,796.95,63,,637.56,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,796.95,63,,637.56,percent of total billed charges,63% of total billed charges,1075.25,85,,860.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,999.35,79,,799.48,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2169.07,
ABSCESS VULVA/PERINEAL,450056405,CDM,450,RC,56405,HCPCS,outpatient,,,339,237.3,,267.81,79,,214.25,percent of total billed charges,79% of total billed charges,305.1,90,,244.08,percent of total billed charges,90% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,429.19,160,,,Fee Schedule,160% of CMS OPPS rate,348.71,130,,,Fee Schedule,130% of CMS OPPS rate,213.57,63,,170.86,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,224.08,66.1,,179.26,percent of total billed charges,66.1% of total billed charges,281.37,83,,225.1,percent of total billed charges,83% of total,322.05,95,,257.64,percent of total billed charges ,95% of total billed charges,271.2,80,,216.96,percent of total billed charges,78% of total billed charges,264.42,78,,211.536,percent of total billed charges,78% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,213.57,63,,170.86,percent of total billed charges,63% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,213.57,63,,170.86,percent of total billed charges,63% of total billed charges,288.15,85,,230.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,249.46,93,,,fee schedule,93% of CMS OPPS rate,267.81,79,,214.25,percent of total billed charges,79% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,213.57,881,
ABSCESS BARTHOLIN'S GLAND,450056420,CDM,450,RC,56420,HCPCS,outpatient,,,332,232.4,,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,219.45,66.1,,175.56,percent of total billed charges,66.1% of total billed charges,275.56,83,,220.45,percent of total billed charges,83% of total,315.4,95,,252.32,percent of total billed charges ,95% of total billed charges,265.6,80,,212.48,percent of total billed charges,78% of total billed charges,258.96,78,,207.168,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,881,
BX VULVA OR PERINEUM 1 LESION,450056605,CDM,450,RC,56605,HCPCS,outpatient,,,775,542.5,,612.25,79,,489.8,percent of total billed charges,79% of total billed charges,697.5,90,,558,percent of total billed charges,90% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,1075.52,160,,,Fee Schedule,160% of CMS OPPS rate,873.86,130,,,Fee Schedule,130% of CMS OPPS rate,488.25,63,,390.6,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,512.28,66.1,,409.82,percent of total billed charges,66.1% of total billed charges,643.25,83,,514.6,percent of total billed charges,83% of total,736.25,95,,589,percent of total billed charges ,95% of total billed charges,620,80,,496,percent of total billed charges,78% of total billed charges,604.5,78,,483.6,percent of total billed charges,78% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,488.25,63,,390.6,percent of total billed charges,63% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,697.5,90,,558,percent of total billed charges,90% of total billed charges,620,80,,496,percent of total billed charges,80% of total billed charges,488.25,63,,390.6,percent of total billed charges,63% of total billed charges,658.75,85,,527,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,625.15,93,,,fee schedule,93% of CMS OPPS rate,612.25,79,,489.8,percent of total billed charges,79% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,450,1075.52,
VAG BLEED NON-OB PCKNG OR AGNT,450057180,CDM,450,RC,57180,HCPCS,outpatient,,,276,193.2,,218.04,79,,174.43,percent of total billed charges,79% of total billed charges,248.4,90,,198.72,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,173.88,63,,139.1,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,182.44,66.1,,145.95,percent of total billed charges,66.1% of total billed charges,229.08,83,,183.26,percent of total billed charges,83% of total,262.2,95,,209.76,percent of total billed charges ,95% of total billed charges,220.8,80,,176.64,percent of total billed charges,78% of total billed charges,215.28,78,,172.224,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,173.88,63,,139.1,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,173.88,63,,139.1,percent of total billed charges,63% of total billed charges,234.6,85,,187.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,218.04,79,,174.43,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,881,
FB REMOV IMPACT VAGINAL W ANES,450057415,CDM,450,RC,57415,HCPCS,outpatient,,,6785,4749.5,,5360.15,79,,4288.12,percent of total billed charges,79% of total billed charges,6106.5,90,,4885.2,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,4274.55,63,,3419.64,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,4484.89,66.1,,3587.91,percent of total billed charges,66.1% of total billed charges,5631.55,83,,4505.24,percent of total billed charges,83% of total,6445.75,95,,5156.6,percent of total billed charges ,95% of total billed charges,5428,80,,4342.4,percent of total billed charges,78% of total billed charges,5292.3,78,,4233.84,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4274.55,63,,3419.64,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,6106.5,90,,4885.2,percent of total billed charges,90% of total billed charges,5428,80,,4342.4,percent of total billed charges,80% of total billed charges,4274.55,63,,3419.64,percent of total billed charges,63% of total billed charges,5767.25,85,,4613.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,5360.15,79,,4288.12,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,6445.75,
BIOPSY OF CERVIX,450057500,CDM,450,RC,57500,HCPCS,outpatient,,,775,542.5,,612.25,79,,489.8,percent of total billed charges,79% of total billed charges,697.5,90,,558,percent of total billed charges,90% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,1075.52,160,,,Fee Schedule,160% of CMS OPPS rate,873.86,130,,,Fee Schedule,130% of CMS OPPS rate,488.25,63,,390.6,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,512.28,66.1,,409.82,percent of total billed charges,66.1% of total billed charges,643.25,83,,514.6,percent of total billed charges,83% of total,736.25,95,,589,percent of total billed charges ,95% of total billed charges,620,80,,496,percent of total billed charges,78% of total billed charges,604.5,78,,483.6,percent of total billed charges,78% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,488.25,63,,390.6,percent of total billed charges,63% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,697.5,90,,558,percent of total billed charges,90% of total billed charges,620,80,,496,percent of total billed charges,80% of total billed charges,488.25,63,,390.6,percent of total billed charges,63% of total billed charges,658.75,85,,527,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,625.15,93,,,fee schedule,93% of CMS OPPS rate,612.25,79,,489.8,percent of total billed charges,79% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,450,1075.52,
BIOPSY ENDOMETRIUM,450058100,CDM,450,RC,58100,HCPCS,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,881,
REMOVE IUD,450058301,CDM,450,RC,58301,HCPCS,outpatient,,,398,278.6,,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,358.2,90,,286.56,percent of total billed charges,90% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,429.19,160,,,Fee Schedule,160% of CMS OPPS rate,348.72,130,,,Fee Schedule,130% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,263.08,66.1,,210.46,percent of total billed charges,66.1% of total billed charges,330.34,83,,264.27,percent of total billed charges,83% of total,378.1,95,,302.48,percent of total billed charges ,95% of total billed charges,318.4,80,,254.72,percent of total billed charges,78% of total billed charges,310.44,78,,248.352,percent of total billed charges,78% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.74,63,,200.59,percent of total billed charges,63% of total billed charges,338.3,85,,270.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,249.46,93,,,fee schedule,93% of CMS OPPS rate,314.42,79,,251.54,percent of total billed charges,79% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,249.46,881,
ER UNLISTED PROC FEM GEN SYS,450058999,CDM,450,RC,58999,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,9.92,66.1,,7.94,percent of total billed charges,66.1% of total billed charges,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,9.45,63,,7.56,percent of total billed charges,63% of total billed charges,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,9.45,881,
ER DX LUMBAR SPINAL PUNCTURE,450062270,CDM,450,RC,62270,HCPCS,outpatient,,,1978,1384.6,,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1307.46,66.1,,1045.97,percent of total billed charges,66.1% of total billed charges,1641.74,83,,1313.39,percent of total billed charges,83% of total,1879.1,95,,1503.28,percent of total billed charges ,95% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,78% of total billed charges,1542.84,78,,1234.272,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,80% of total billed charges,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1681.3,85,,1345.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1879.1,
INJECT EPDRL/SBARACH LMBR/SCRL,450062311,CDM,450,RC,,,outpatient,,,1950,1365,,1540.5,79,,1232.4,percent of total billed charges,79% of total billed charges,1755,90,,1404,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1288.95,66.1,,1031.16,percent of total billed charges,66.1% of total billed charges,1618.5,83,,1294.8,percent of total billed charges,83% of total,1852.5,95,,1482,percent of total billed charges ,95% of total billed charges,1560,80,,1248,percent of total billed charges,78% of total billed charges,1521,78,,1216.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1755,90,,1404,percent of total billed charges,90% of total billed charges,1560,80,,1248,percent of total billed charges,80% of total billed charges,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,1657.5,85,,1326,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1540.5,79,,1232.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1852.5,
FB RMVE CONJUNCTIVA SUPERFIAL,450065205,CDM,450,RC,65205,HCPCS,outpatient,,,219,153.3,,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,197.1,90,,157.68,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,144.76,66.1,,115.81,percent of total billed charges,66.1% of total billed charges,181.77,83,,145.42,percent of total billed charges,83% of total,208.05,95,,166.44,percent of total billed charges ,95% of total billed charges,175.2,80,,140.16,percent of total billed charges,78% of total billed charges,170.82,78,,136.656,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.97,63,,110.38,percent of total billed charges,63% of total billed charges,186.15,85,,148.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,173.01,79,,138.41,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
FB REMOVAL CONJUNCTIVA EMBED,450065210,CDM,450,RC,65210,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,171.86,66.1,,137.49,percent of total billed charges,66.1% of total billed charges,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,163.8,881,
FB REMOVAL CORNEA NO SLIT LAMP,450065220,CDM,450,RC,65220,HCPCS,outpatient,,,320,224,,252.8,79,,202.24,percent of total billed charges,79% of total billed charges,288,90,,230.4,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,211.52,66.1,,169.22,percent of total billed charges,66.1% of total billed charges,265.6,83,,212.48,percent of total billed charges,83% of total,304,95,,243.2,percent of total billed charges ,95% of total billed charges,256,80,,204.8,percent of total billed charges,78% of total billed charges,249.6,78,,199.68,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,288,90,,230.4,percent of total billed charges,90% of total billed charges,256,80,,204.8,percent of total billed charges,80% of total billed charges,201.6,63,,161.28,percent of total billed charges,63% of total billed charges,272,85,,217.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,252.8,79,,202.24,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,201.6,881,
FB REMOVAL CORNEA W/SLIT LAMP,450065222,CDM,450,RC,65222,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,68.67,881,
UNLISTED PROC OF THE ORBIT,450067599,CDM,450,RC,,,outpatient,,,1004,702.8,,793.16,79,,634.53,percent of total billed charges,79% of total billed charges,903.6,90,,722.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,632.52,63,,506.02,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,663.64,66.1,,530.91,percent of total billed charges,66.1% of total billed charges,833.32,83,,666.66,percent of total billed charges,83% of total,953.8,95,,763.04,percent of total billed charges ,95% of total billed charges,803.2,80,,642.56,percent of total billed charges,78% of total billed charges,783.12,78,,626.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,632.52,63,,506.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,632.52,63,,506.02,percent of total billed charges,63% of total billed charges,853.4,85,,682.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,793.16,79,,634.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,953.8,
ABSCESS EYELID,450067700,CDM,450,RC,67700,HCPCS,outpatient,,,537,375.9,,424.23,79,,339.38,percent of total billed charges,79% of total billed charges,483.3,90,,386.64,percent of total billed charges,90% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,389.73,160,,,Fee Schedule,160% of CMS OPPS rate,316.64,130,,,Fee Schedule,130% of CMS OPPS rate,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,354.96,66.1,,283.97,percent of total billed charges,66.1% of total billed charges,445.71,83,,356.57,percent of total billed charges,83% of total,510.15,95,,408.12,percent of total billed charges ,95% of total billed charges,429.6,80,,343.68,percent of total billed charges,78% of total billed charges,418.86,78,,335.088,percent of total billed charges,78% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,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,338.31,63,,270.65,percent of total billed charges,63% of total billed charges,456.45,85,,365.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,226.53,93,,,fee schedule,93% of CMS OPPS rate,424.23,79,,339.38,percent of total billed charges,79% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,226.53,881,
SUTURE EYELID FULL THICKNESS,450067935,CDM,450,RC,67935,HCPCS,outpatient,,,3045,2131.5,,2405.55,79,,1924.44,percent of total billed charges,79% of total billed charges,2740.5,90,,2192.4,percent of total billed charges,90% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,3126.32,160,,,Fee Schedule,160% of CMS OPPS rate,2540.14,130,,,Fee Schedule,130% of CMS OPPS rate,1918.35,63,,1534.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,2012.75,66.1,,1610.2,percent of total billed charges,66.1% of total billed charges,2527.35,83,,2021.88,percent of total billed charges,83% of total,2892.75,95,,2314.2,percent of total billed charges ,95% of total billed charges,2436,80,,1948.8,percent of total billed charges,78% of total billed charges,2375.1,78,,1900.08,percent of total billed charges,78% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,1918.35,63,,1534.68,percent of total billed charges,63% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,2740.5,90,,2192.4,percent of total billed charges,90% of total billed charges,2436,80,,1948.8,percent of total billed charges,80% of total billed charges,1918.35,63,,1534.68,percent of total billed charges,63% of total billed charges,2588.25,85,,2070.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1817.17,93,,,fee schedule,93% of CMS OPPS rate,2405.55,79,,1924.44,percent of total billed charges,79% of total billed charges,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,1953.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,3126.32,
FB EYELID EMBED,450067938,CDM,450,RC,67938,HCPCS,outpatient,,,383,268.1,,302.57,79,,242.06,percent of total billed charges,79% of total billed charges,344.7,90,,275.76,percent of total billed charges,90% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,389.73,160,,,Fee Schedule,160% of CMS OPPS rate,316.64,130,,,Fee Schedule,130% of CMS OPPS rate,241.29,63,,193.03,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,253.16,66.1,,202.53,percent of total billed charges,66.1% of total billed charges,317.89,83,,254.31,percent of total billed charges,83% of total,363.85,95,,291.08,percent of total billed charges ,95% of total billed charges,306.4,80,,245.12,percent of total billed charges,78% of total billed charges,298.74,78,,238.992,percent of total billed charges,78% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,241.29,63,,193.03,percent of total billed charges,63% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,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,241.29,63,,193.03,percent of total billed charges,63% of total billed charges,325.55,85,,260.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,226.53,93,,,fee schedule,93% of CMS OPPS rate,302.57,79,,242.06,percent of total billed charges,79% of total billed charges,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,243.58,100,,,Fee Schedule,100% of CMS OPPS rate,226.53,881,
ABSCESS EXT EAR SMPL,450069000,CDM,450,RC,69000,HCPCS,outpatient,,,1157,809.9,,914.03,79,,731.22,percent of total billed charges,79% of total billed charges,1041.3,90,,833.04,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,728.91,63,,583.13,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,764.78,66.1,,611.82,percent of total billed charges,66.1% of total billed charges,960.31,83,,768.25,percent of total billed charges,83% of total,1099.15,95,,879.32,percent of total billed charges ,95% of total billed charges,925.6,80,,740.48,percent of total billed charges,78% of total billed charges,902.46,78,,721.968,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,728.91,63,,583.13,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,728.91,63,,583.13,percent of total billed charges,63% of total billed charges,983.45,85,,786.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,914.03,79,,731.22,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1099.15,
ABSCESS EXT AUDITORY CANAL,450069020,CDM,450,RC,69020,HCPCS,outpatient,,,335,234.5,,264.65,79,,211.72,percent of total billed charges,79% of total billed charges,301.5,90,,241.2,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,221.44,66.1,,177.15,percent of total billed charges,66.1% of total billed charges,278.05,83,,222.44,percent of total billed charges,83% of total,318.25,95,,254.6,percent of total billed charges ,95% of total billed charges,268,80,,214.4,percent of total billed charges,78% of total billed charges,261.3,78,,209.04,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,211.05,63,,168.84,percent of total billed charges,63% of total billed charges,284.75,85,,227.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,264.65,79,,211.72,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,211.05,941.28,
FB RMVL EXT AUD CANAL W/O ANES,450069200,CDM,450,RC,69200,HCPCS,outpatient,,,376,263.2,,297.04,79,,237.63,percent of total billed charges,79% of total billed charges,338.4,90,,270.72,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,236.88,63,,189.5,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,248.54,66.1,,198.83,percent of total billed charges,66.1% of total billed charges,312.08,83,,249.66,percent of total billed charges,83% of total,357.2,95,,285.76,percent of total billed charges ,95% of total billed charges,300.8,80,,240.64,percent of total billed charges,78% of total billed charges,293.28,78,,234.624,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,236.88,63,,189.5,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,236.88,63,,189.5,percent of total billed charges,63% of total billed charges,319.6,85,,255.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,297.04,79,,237.63,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,881,
REMOVE IMPACTED CERUMEN IRRIGA,450069209,CDM,450,RC,69209,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
REMOVE IMPACTED CERUMEN 1/BOTH,450069210,CDM,450,RC,69210,HCPCS,outpatient,,,164.05,114.84,,129.6,79,,103.68,percent of total billed charges,79% of total billed charges,147.65,90,,118.12,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.35,63,,82.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,108.44,66.1,,86.75,percent of total billed charges,66.1% of total billed charges,136.16,83,,108.93,percent of total billed charges,83% of total,155.85,95,,124.68,percent of total billed charges ,95% of total billed charges,131.24,80,,104.99,percent of total billed charges,78% of total billed charges,127.96,78,,102.368,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.35,63,,82.68,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,147.65,90,,118.12,percent of total billed charges,90% of total billed charges,131.24,80,,104.99,percent of total billed charges,80% of total billed charges,103.35,63,,82.68,percent of total billed charges,63% of total billed charges,139.44,85,,111.552,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.6,79,,103.68,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
ER IRIGATE FECAL IMPACTION,450091123,CDM,450,RC,,,outpatient,,,56,39.2,,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,50.4,90,,40.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,37.02,66.1,,29.62,percent of total billed charges,66.1% of total billed charges,46.48,83,,37.18,percent of total billed charges,83% of total,53.2,95,,42.56,percent of total billed charges ,95% of total billed charges,44.8,80,,35.84,percent of total billed charges,78% of total billed charges,43.68,78,,34.944,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.28,63,,28.22,percent of total billed charges,63% of total billed charges,47.6,85,,38.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,44.24,79,,35.39,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.28,881,
IV HYDRATION INITIAL 31-60 MIN,450096360,CDM,450,RC,96360,HCPCS,outpatient,,,477,333.9,,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,429.3,90,,343.44,percent of total billed charges,90% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,286.75,160,,,Fee Schedule,160% of CMS OPPS rate,232.98,130,,,Fee Schedule,130% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,315.3,66.1,,252.24,percent of total billed charges,66.1% of total billed charges,395.91,83,,316.73,percent of total billed charges,83% of total,453.15,95,,362.52,percent of total billed charges ,95% of total billed charges,381.6,80,,305.28,percent of total billed charges,78% of total billed charges,372.06,78,,297.648,percent of total billed charges,78% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,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,300.51,63,,240.41,percent of total billed charges,63% of total billed charges,405.45,85,,324.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,166.67,93,,,fee schedule,93% of CMS OPPS rate,376.83,79,,301.46,percent of total billed charges,79% of total billed charges,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,179.22,100,,,Fee Schedule,100% of CMS OPPS rate,166.67,881,
INJECT DRUG SQ/IM,450096372,CDM,450,RC,96372,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,881,
IRRIGATE IMPLANTED VAD,450096523,CDM,450,RC,96523,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,881,
ER APPLICATION OF MODALITY/1+,450097022,CDM,450,RC,97022,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,25.07,160,,,fee schedule,160% of CMS fee schedule,20.37,130,,,fee schedule,130% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,15.67,100,,,fee schedule ,100% of CMS 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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.57,93,,,fee schedule,93% of CMS fee schedule,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,15.67,100,,,fee schedule,100% of CMS fee schedule,15.67,100,,,fee schedule,100% of CMS fee schedule,14.57,881,
"DEBRIDE OPEN WND, INITIAL 20CM",450097597,CDM,450,RC,97597,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,881,
ER LEVEL 1 MAYX REQ PHYS/QHP,450099281,CDM,450,RC,99281,HCPCS,outpatient,,,173,121.1,,136.67,79,,109.34,percent of total billed charges,79% of total billed charges,155.7,90,,124.56,percent of total billed charges,90% of total billed charges,74.23,100,,,Fee Schedule,100% of CMS OPPS rate,118.77,160,,,Fee Schedule,160% of CMS OPPS rate,96.5,130,,,Fee Schedule,130% of CMS OPPS rate,108.99,63,,87.19,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,114.35,66.1,,91.48,percent of total billed charges,66.1% of total billed charges,143.59,83,,114.87,percent of total billed charges,83% of total,164.35,95,,131.48,percent of total billed charges ,95% of total billed charges,138.4,80,,110.72,percent of total billed charges,78% of total billed charges,134.94,78,,107.952,percent of total billed charges,78% of total billed charges,74.23,100,,,Fee Schedule,100% of CMS OPPS rate,108.99,63,,87.19,percent of total billed charges,63% of total billed charges,74.23,100,,,Fee Schedule,100% of CMS OPPS rate,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,108.99,63,,87.19,percent of total billed charges,63% of total billed charges,147.05,85,,117.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,69.03,93,,,fee schedule,93% of CMS OPPS rate,136.67,79,,109.34,percent of total billed charges,79% of total billed charges,74.23,100,,,Fee Schedule,100% of CMS OPPS rate,74.23,100,,,Fee Schedule,100% of CMS OPPS rate,69.03,881,
ER LEVEL 2 SF MDM,450099282,CDM,450,RC,99282,HCPCS,outpatient,,,446,312.2,,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,401.4,90,,321.12,percent of total billed charges,90% of total billed charges,136.75,100,,,Fee Schedule,100% of CMS OPPS rate,218.8,160,,,Fee Schedule,160% of CMS OPPS rate,177.77,130,,,Fee Schedule,130% of CMS OPPS rate,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,294.81,66.1,,235.85,percent of total billed charges,66.1% of total billed charges,370.18,83,,296.14,percent of total billed charges,83% of total,423.7,95,,338.96,percent of total billed charges ,95% of total billed charges,356.8,80,,285.44,percent of total billed charges,78% of total billed charges,347.88,78,,278.304,percent of total billed charges,78% of total billed charges,136.75,100,,,Fee Schedule,100% of CMS OPPS rate,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,136.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,280.98,63,,224.78,percent of total billed charges,63% of total billed charges,379.1,85,,303.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,127.18,93,,,fee schedule,93% of CMS OPPS rate,352.34,79,,281.87,percent of total billed charges,79% of total billed charges,136.75,100,,,Fee Schedule,100% of CMS OPPS rate,136.75,100,,,Fee Schedule,100% of CMS OPPS rate,127.18,881,
ER LEVEL 3 LOW MDM,450099283,CDM,450,RC,99283,HCPCS,outpatient,,,670,469,,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,603,90,,482.4,percent of total billed charges,90% of total billed charges,238.57,100,,,Fee Schedule,100% of CMS OPPS rate,381.72,160,,,Fee Schedule,160% of CMS OPPS rate,310.14,130,,,Fee Schedule,130% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,442.87,66.1,,354.3,percent of total billed charges,66.1% of total billed charges,556.1,83,,444.88,percent of total billed charges,83% of total,636.5,95,,509.2,percent of total billed charges ,95% of total billed charges,536,80,,428.8,percent of total billed charges,78% of total billed charges,522.6,78,,418.08,percent of total billed charges,78% of total billed charges,238.57,100,,,Fee Schedule,100% of CMS OPPS rate,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,238.57,100,,,Fee Schedule,100% of CMS OPPS rate,603,90,,482.4,percent of total billed charges,90% of total billed charges,536,80,,428.8,percent of total billed charges,80% of total billed charges,422.1,63,,337.68,percent of total billed charges,63% of total billed charges,569.5,85,,455.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,221.87,93,,,fee schedule,93% of CMS OPPS rate,529.3,79,,423.44,percent of total billed charges,79% of total billed charges,238.57,100,,,Fee Schedule,100% of CMS OPPS rate,238.57,100,,,Fee Schedule,100% of CMS OPPS rate,221.87,881,
ER LEVEL 4 MOD MDM,450099284,CDM,450,RC,99284,HCPCS,outpatient,,,1120,784,,884.8,79,,707.84,percent of total billed charges,79% of total billed charges,1008,90,,806.4,percent of total billed charges,90% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,592.54,160,,,Fee Schedule,160% of CMS OPPS rate,481.45,130,,,Fee Schedule,130% of CMS OPPS rate,705.6,63,,564.48,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,740.32,66.1,,592.26,percent of total billed charges,66.1% of total billed charges,929.6,83,,743.68,percent of total billed charges,83% of total,1064,95,,851.2,percent of total billed charges ,95% of total billed charges,896,80,,716.8,percent of total billed charges,78% of total billed charges,873.6,78,,698.88,percent of total billed charges,78% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,705.6,63,,564.48,percent of total billed charges,63% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,705.6,63,,564.48,percent of total billed charges,63% of total billed charges,952,85,,761.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,344.42,93,,,fee schedule,93% of CMS OPPS rate,884.8,79,,707.84,percent of total billed charges,79% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,344.42,1064,
ER LEVEL 5,450099285,CDM,450,RC,99285,HCPCS,outpatient,,,1623,1136.1,,1282.17,79,,1025.74,percent of total billed charges,79% of total billed charges,1460.7,90,,1168.56,percent of total billed charges,90% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,859.33,160,,,Fee Schedule,160% of CMS OPPS rate,698.2,130,,,Fee Schedule,130% of CMS OPPS rate,1022.49,63,,817.99,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1072.8,66.1,,858.24,percent of total billed charges,66.1% of total billed charges,1347.09,83,,1077.67,percent of total billed charges,83% of total,1541.85,95,,1233.48,percent of total billed charges ,95% of total billed charges,1298.4,80,,1038.72,percent of total billed charges,78% of total billed charges,1265.94,78,,1012.752,percent of total billed charges,78% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,1022.49,63,,817.99,percent of total billed charges,63% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,1460.7,90,,1168.56,percent of total billed charges,90% of total billed charges,1298.4,80,,1038.72,percent of total billed charges,80% of total billed charges,1022.49,63,,817.99,percent of total billed charges,63% of total billed charges,1379.55,85,,1103.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,499.48,93,,,fee schedule,93% of CMS OPPS rate,1282.17,79,,1025.74,percent of total billed charges,79% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,450,1541.85,
CRITICAL CARE 1ST 30-74 MIN,450099291,CDM,450,RC,99291,HCPCS,outpatient,,,1974,1381.8,,1559.46,79,,1247.57,percent of total billed charges,79% of total billed charges,1776.6,90,,1421.28,percent of total billed charges,90% of total billed charges,741.99,100,,,Fee Schedule,100% of CMS OPPS rate,1187.18,160,,,Fee Schedule,160% of CMS OPPS rate,964.58,130,,,Fee Schedule,130% of CMS OPPS rate,1243.62,63,,994.9,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,1304.81,66.1,,1043.85,percent of total billed charges,66.1% of total billed charges,1638.42,83,,1310.74,percent of total billed charges,83% of total,1875.3,95,,1500.24,percent of total billed charges ,95% of total billed charges,1579.2,80,,1263.36,percent of total billed charges,78% of total billed charges,1539.72,78,,1231.776,percent of total billed charges,78% of total billed charges,741.99,100,,,Fee Schedule,100% of CMS OPPS rate,1243.62,63,,994.9,percent of total billed charges,63% of total billed charges,741.99,100,,,Fee Schedule,100% of CMS OPPS rate,1776.6,90,,1421.28,percent of total billed charges,90% of total billed charges,1579.2,80,,1263.36,percent of total billed charges,80% of total billed charges,1243.62,63,,994.9,percent of total billed charges,63% of total billed charges,1677.9,85,,1342.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,690.04,93,,,fee schedule,93% of CMS OPPS rate,1559.46,79,,1247.57,percent of total billed charges,79% of total billed charges,741.99,100,,,Fee Schedule,100% of CMS OPPS rate,741.99,100,,,Fee Schedule,100% of CMS OPPS rate,450,1875.3,
CRITICAL CARE EA ADD 30 MIN,450099292,CDM,450,RC,99292,HCPCS,outpatient,,,760,532,,600.4,79,,480.32,percent of total billed charges,79% of total billed charges,684,90,,547.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,478.8,63,,383.04,percent of total billed charges,63% of total billed charges,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,502.36,66.1,,401.89,percent of total billed charges,66.1% of total billed charges,630.8,83,,504.64,percent of total billed charges,83% of total,722,95,,577.6,percent of total billed charges ,95% of total billed charges,608,80,,486.4,percent of total billed charges,78% of total billed charges,592.8,78,,474.24,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,478.8,63,,383.04,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,684,90,,547.2,percent of total billed charges,90% of total billed charges,608,80,,486.4,percent of total billed charges,80% of total billed charges,478.8,63,,383.04,percent of total billed charges,63% of total billed charges,646,85,,516.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,600.4,79,,480.32,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,881,
ER SUTURE REMOVAL NON-BILL CHG,450099999,CDM,450,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,881,77.22,,704.8,percent of total billed charges,77.22% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,881,
CAR SEAT TEST AIRWAY UP TO 12M,171094780,CDM,460,RC,94780,HCPCS,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,53.65,160,,,Fee Schedule,160% of CMS OPPS rate,43.59,130,,,Fee Schedule,130% of CMS OPPS rate,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.18,93,,,fee schedule,93% of CMS OPPS rate,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.18,450,
ADDL 30 MINS CAR SEAT TEST,171094781,CDM,460,RC,,,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,450,
AMBUING VENTILATOR ASSISTANCE,410000640,CDM,460,RC,94799,HCPCS,outpatient,,,379,265.3,,299.41,79,,239.53,percent of total billed charges,79% of total billed charges,341.1,90,,272.88,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.98,160,,,Fee Schedule,160% of CMS OPPS rate,169.79,130,,,Fee Schedule,130% of CMS OPPS rate,238.77,63,,191.02,percent of total billed charges,63% of total billed charges,292.66,77.22,,234.13,percent of total billed charges,77.22% of total billed charges,250.52,66.1,,200.42,percent of total billed charges,66.1% of total billed charges,314.57,83,,251.66,percent of total billed charges,83% of total,360.05,95,,288.04,percent of total billed charges ,95% of total billed charges,303.2,80,,242.56,percent of total billed charges,78% of total billed charges,295.62,78,,236.496,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,238.77,63,,191.02,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,238.77,63,,191.02,percent of total billed charges,63% of total billed charges,322.15,85,,257.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.47,93,,,fee schedule,93% of CMS OPPS rate,299.41,79,,239.53,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.47,450,
BRONCOSPASM EVALUATION,410000648,CDM,460,RC,94060,HCPCS,outpatient,,,658,460.6,,519.82,79,,415.86,percent of total billed charges,79% of total billed charges,592.2,90,,473.76,percent of total billed charges,90% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.18,130,,,Fee Schedule,130% of CMS OPPS rate,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,508.11,77.22,,406.49,percent of total billed charges,77.22% of total billed charges,434.94,66.1,,347.95,percent of total billed charges,66.1% of total billed charges,546.14,83,,436.91,percent of total billed charges,83% of total,625.1,95,,500.08,percent of total billed charges ,95% of total billed charges,526.4,80,,421.12,percent of total billed charges,78% of total billed charges,513.24,78,,410.592,percent of total billed charges,78% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,592.2,90,,473.76,percent of total billed charges,90% of total billed charges,526.4,80,,421.12,percent of total billed charges,80% of total billed charges,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,559.3,85,,447.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.07,93,,,fee schedule,93% of CMS OPPS rate,519.82,79,,415.86,percent of total billed charges,79% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.07,625.1,
PULSE OXIMETRY OXYGEN SAT SING,410000670,CDM,460,RC,94760,HCPCS,outpatient,,,19,13.3,,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,17.1,90,,13.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,14.67,77.22,,11.74,percent of total billed charges,77.22% of total billed charges,12.56,66.1,,10.05,percent of total billed charges,66.1% of total billed charges,15.77,83,,12.62,percent of total billed charges,83% of total,18.05,95,,14.44,percent of total billed charges ,95% of total billed charges,15.2,80,,12.16,percent of total billed charges,78% of total billed charges,14.82,78,,11.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.97,63,,9.58,percent of total billed charges,63% of total billed charges,16.15,85,,12.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.01,79,,12.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.97,450,
PULSE OXIMETRY OXYGEN SAT MULT,410000672,CDM,460,RC,94761,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
SPIROMETRY,410000679,CDM,460,RC,94010,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.98,160,,,Fee Schedule,160% of CMS OPPS rate,169.79,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.47,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.47,450,
SPIROMETRY/BEDS COMP CHG CP,410060006,CDM,460,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
BROCHIALSPASM EVALUATION CP,410060010,CDM,460,RC,94060,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.18,130,,,Fee Schedule,130% of CMS OPPS 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,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,244.07,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.07,450,
PULSE OX DOWNLOAD NOCTURNAL,410060076,CDM,460,RC,94762,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.97,160,,,Fee Schedule,160% of CMS OPPS rate,169.78,130,,,Fee Schedule,130% of CMS OPPS rate,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,115.68,66.1,,92.54,percent of total billed charges,66.1% of total billed charges,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.46,93,,,fee schedule,93% of CMS OPPS rate,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,110.25,450,
ER SPIROMETRY,450094010,CDM,460,RC,94010,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.98,160,,,Fee Schedule,160% of CMS OPPS rate,169.79,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.47,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.47,450,
OXIMETRY FOR O2 SAT SINGLE,450094760,CDM,460,RC,94760,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
OXIMETRY FOR O2 SAT MULTIPLE,450094761,CDM,460,RC,94761,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
CARBON MONOXIDE DIFFUSION,460000646,CDM,460,RC,94729,HCPCS,outpatient,,,429,300.3,,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,331.27,77.22,,265.02,percent of total billed charges,77.22% of total billed charges,283.57,66.1,,226.86,percent of total billed charges,66.1% of total billed charges,356.07,83,,284.86,percent of total billed charges,83% of total,407.55,95,,326.04,percent of total billed charges ,95% of total billed charges,343.2,80,,274.56,percent of total billed charges,78% of total billed charges,334.62,78,,267.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,386.1,90,,308.88,percent of total billed charges,90% of total billed charges,343.2,80,,274.56,percent of total billed charges,80% of total billed charges,270.27,63,,216.22,percent of total billed charges,63% of total billed charges,364.65,85,,291.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,338.91,79,,271.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,270.27,450,
FRC N2 METHOD,460000647,CDM,460,RC,94727,HCPCS,outpatient,,,569,398.3,,449.51,79,,359.61,percent of total billed charges,79% of total billed charges,512.1,90,,409.68,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.98,160,,,Fee Schedule,160% of CMS OPPS rate,169.79,130,,,Fee Schedule,130% of CMS OPPS rate,358.47,63,,286.78,percent of total billed charges,63% of total billed charges,439.38,77.22,,351.5,percent of total billed charges,77.22% of total billed charges,376.11,66.1,,300.89,percent of total billed charges,66.1% of total billed charges,472.27,83,,377.82,percent of total billed charges,83% of total,540.55,95,,432.44,percent of total billed charges ,95% of total billed charges,455.2,80,,364.16,percent of total billed charges,78% of total billed charges,443.82,78,,355.056,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,358.47,63,,286.78,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,512.1,90,,409.68,percent of total billed charges,90% of total billed charges,455.2,80,,364.16,percent of total billed charges,80% of total billed charges,358.47,63,,286.78,percent of total billed charges,63% of total billed charges,483.65,85,,386.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.47,93,,,fee schedule,93% of CMS OPPS rate,449.51,79,,359.61,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.47,540.55,
BRONCOSPASM EVALUATION,460000648,CDM,460,RC,94060,HCPCS,outpatient,,,658,460.6,,519.82,79,,415.86,percent of total billed charges,79% of total billed charges,592.2,90,,473.76,percent of total billed charges,90% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.18,130,,,Fee Schedule,130% of CMS OPPS rate,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,508.11,77.22,,406.49,percent of total billed charges,77.22% of total billed charges,434.94,66.1,,347.95,percent of total billed charges,66.1% of total billed charges,546.14,83,,436.91,percent of total billed charges,83% of total,625.1,95,,500.08,percent of total billed charges ,95% of total billed charges,526.4,80,,421.12,percent of total billed charges,78% of total billed charges,513.24,78,,410.592,percent of total billed charges,78% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,592.2,90,,473.76,percent of total billed charges,90% of total billed charges,526.4,80,,421.12,percent of total billed charges,80% of total billed charges,414.54,63,,331.63,percent of total billed charges,63% of total billed charges,559.3,85,,447.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.07,93,,,fee schedule,93% of CMS OPPS rate,519.82,79,,415.86,percent of total billed charges,79% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.07,625.1,
PULMONARY STRESS TEST 6 MN WLK,460094618,CDM,460,RC,94618,HCPCS,outpatient,,,317,221.9,,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,285.3,90,,228.24,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,244.79,77.22,,195.83,percent of total billed charges,77.22% of total billed charges,209.54,66.1,,167.63,percent of total billed charges,66.1% of total billed charges,263.11,83,,210.49,percent of total billed charges,83% of total,301.15,95,,240.92,percent of total billed charges ,95% of total billed charges,253.6,80,,202.88,percent of total billed charges,78% of total billed charges,247.26,78,,197.808,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,199.71,63,,159.77,percent of total billed charges,63% of total billed charges,269.45,85,,215.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,250.43,79,,200.34,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
EXERCISE TEST FOR BRONCHOSPASM,460094619,CDM,460,RC,94619,HCPCS,outpatient,,,139,97.3,,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,125.1,90,,100.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,107.34,77.22,,85.87,percent of total billed charges,77.22% of total billed charges,91.88,66.1,,73.5,percent of total billed charges,66.1% of total billed charges,115.37,83,,92.3,percent of total billed charges,83% of total,132.05,95,,105.64,percent of total billed charges ,95% of total billed charges,111.2,80,,88.96,percent of total billed charges,78% of total billed charges,108.42,78,,86.736,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,87.57,63,,70.06,percent of total billed charges,63% of total billed charges,118.15,85,,94.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,109.81,79,,87.85,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
CONTINUOUS PULSE OXIMETRY,730000698,CDM,460,RC,94762,HCPCS,outpatient,,,175,122.5,,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,157.5,90,,126,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.97,160,,,Fee Schedule,160% of CMS OPPS rate,169.78,130,,,Fee Schedule,130% of CMS OPPS rate,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,135.14,77.22,,108.11,percent of total billed charges,77.22% of total billed charges,115.68,66.1,,92.54,percent of total billed charges,66.1% of total billed charges,145.25,83,,116.2,percent of total billed charges,83% of total,166.25,95,,133,percent of total billed charges ,95% of total billed charges,140,80,,112,percent of total billed charges,78% of total billed charges,136.5,78,,109.2,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,110.25,63,,88.2,percent of total billed charges,63% of total billed charges,148.75,85,,119,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.46,93,,,fee schedule,93% of CMS OPPS rate,138.25,79,,110.6,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,110.25,450,
MEAS BLD OXYGEN LVL PULSEOX SI,761094760,CDM,460,RC,94760,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
MEAS BLD OXYG LVL MULT PULSEOX,761094761,CDM,460,RC,94761,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
OBS MEAS BLOOD OXYG LEVEL SING,762094760,CDM,460,RC,94760,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
OBS MEASURE BLD OXYGEN LVL MUL,762094761,CDM,460,RC,94761,HCPCS,outpatient,,,47,32.9,,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,42.3,90,,33.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,36.29,77.22,,29.03,percent of total billed charges,77.22% of total billed charges,31.07,66.1,,24.86,percent of total billed charges,66.1% of total billed charges,39.01,83,,31.21,percent of total billed charges,83% of total,44.65,95,,35.72,percent of total billed charges ,95% of total billed charges,37.6,80,,30.08,percent of total billed charges,78% of total billed charges,36.66,78,,29.328,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,29.61,63,,23.69,percent of total billed charges,63% of total billed charges,39.95,85,,31.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.13,79,,29.7,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.61,450,
NEWBORN HEARING SCREEN,479100100,CDM,471,RC,92650,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,151.2,450,
NB HEARING RE-SCREEN OAE LMTD,479100101,CDM,471,RC,92650,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,151.2,450,
NB HEARING RE-SCREEN AABR LMTD,479100102,CDM,471,RC,92650,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,151.2,450,
CPR BS,230092950,CDM,480,RC,92950,HCPCS,outpatient,,,967,676.9,,763.93,79,,611.14,percent of total billed charges,79% of total billed charges,870.3,90,,696.24,percent of total billed charges,90% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.18,130,,,Fee Schedule,130% of CMS OPPS rate,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,746.72,77.22,,597.38,percent of total billed charges,77.22% of total billed charges,639.19,66.1,,511.35,percent of total billed charges,66.1% of total billed charges,802.61,83,,642.09,percent of total billed charges,83% of total,918.65,95,,734.92,percent of total billed charges ,95% of total billed charges,773.6,80,,618.88,percent of total billed charges,78% of total billed charges,754.26,78,,603.408,percent of total billed charges,78% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,870.3,90,,696.24,percent of total billed charges,90% of total billed charges,773.6,80,,618.88,percent of total billed charges,80% of total billed charges,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,821.95,85,,657.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.07,93,,,fee schedule,93% of CMS OPPS rate,763.93,79,,611.14,percent of total billed charges,79% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.07,918.65,
CPR,450092950,CDM,480,RC,92950,HCPCS,outpatient,,,967,676.9,,763.93,79,,611.14,percent of total billed charges,79% of total billed charges,870.3,90,,696.24,percent of total billed charges,90% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.18,130,,,Fee Schedule,130% of CMS OPPS rate,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,746.72,77.22,,597.38,percent of total billed charges,77.22% of total billed charges,639.19,66.1,,511.35,percent of total billed charges,66.1% of total billed charges,802.61,83,,642.09,percent of total billed charges,83% of total,918.65,95,,734.92,percent of total billed charges ,95% of total billed charges,773.6,80,,618.88,percent of total billed charges,78% of total billed charges,754.26,78,,603.408,percent of total billed charges,78% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,870.3,90,,696.24,percent of total billed charges,90% of total billed charges,773.6,80,,618.88,percent of total billed charges,80% of total billed charges,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,821.95,85,,657.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.07,93,,,fee schedule,93% of CMS OPPS rate,763.93,79,,611.14,percent of total billed charges,79% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.07,918.65,
TRANSCUTANEOUS PACING TEMP,450092953,CDM,480,RC,92953,HCPCS,outpatient,,,561,392.7,,443.19,79,,354.55,percent of total billed charges,79% of total billed charges,504.9,90,,403.92,percent of total billed charges,90% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,870.72,160,,,Fee Schedule,160% of CMS OPPS rate,707.46,130,,,Fee Schedule,130% of CMS OPPS rate,353.43,63,,282.74,percent of total billed charges,63% of total billed charges,433.2,77.22,,346.56,percent of total billed charges,77.22% of total billed charges,370.82,66.1,,296.66,percent of total billed charges,66.1% of total billed charges,465.63,83,,372.5,percent of total billed charges,83% of total,532.95,95,,426.36,percent of total billed charges ,95% of total billed charges,448.8,80,,359.04,percent of total billed charges,78% of total billed charges,437.58,78,,350.064,percent of total billed charges,78% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,353.43,63,,282.74,percent of total billed charges,63% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,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,353.43,63,,282.74,percent of total billed charges,63% of total billed charges,476.85,85,,381.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,506.1,93,,,fee schedule,93% of CMS OPPS rate,443.19,79,,354.55,percent of total billed charges,79% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,353.43,870.72,
EXT CARDIOVERSION ELECTIVE,450092960,CDM,480,RC,92960,HCPCS,outpatient,,,928,649.6,,733.12,79,,586.5,percent of total billed charges,79% of total billed charges,835.2,90,,668.16,percent of total billed charges,90% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,870.72,160,,,Fee Schedule,160% of CMS OPPS rate,707.46,130,,,Fee Schedule,130% of CMS OPPS rate,584.64,63,,467.71,percent of total billed charges,63% of total billed charges,716.6,77.22,,573.28,percent of total billed charges,77.22% of total billed charges,613.41,66.1,,490.73,percent of total billed charges,66.1% of total billed charges,770.24,83,,616.19,percent of total billed charges,83% of total,881.6,95,,705.28,percent of total billed charges ,95% of total billed charges,742.4,80,,593.92,percent of total billed charges,78% of total billed charges,723.84,78,,579.072,percent of total billed charges,78% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,584.64,63,,467.71,percent of total billed charges,63% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,835.2,90,,668.16,percent of total billed charges,90% of total billed charges,742.4,80,,593.92,percent of total billed charges,80% of total billed charges,584.64,63,,467.71,percent of total billed charges,63% of total billed charges,788.8,85,,631.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,506.1,93,,,fee schedule,93% of CMS OPPS rate,733.12,79,,586.5,percent of total billed charges,79% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,450,881.6,
CPR SDC,980092950,CDM,480,RC,92950,HCPCS,outpatient,,,967,676.9,,763.93,79,,611.14,percent of total billed charges,79% of total billed charges,870.3,90,,696.24,percent of total billed charges,90% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.18,130,,,Fee Schedule,130% of CMS OPPS rate,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,746.72,77.22,,597.38,percent of total billed charges,77.22% of total billed charges,639.19,66.1,,511.35,percent of total billed charges,66.1% of total billed charges,802.61,83,,642.09,percent of total billed charges,83% of total,918.65,95,,734.92,percent of total billed charges ,95% of total billed charges,773.6,80,,618.88,percent of total billed charges,78% of total billed charges,754.26,78,,603.408,percent of total billed charges,78% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,870.3,90,,696.24,percent of total billed charges,90% of total billed charges,773.6,80,,618.88,percent of total billed charges,80% of total billed charges,609.21,63,,487.37,percent of total billed charges,63% of total billed charges,821.95,85,,657.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.07,93,,,fee schedule,93% of CMS OPPS rate,763.93,79,,611.14,percent of total billed charges,79% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.07,918.65,
FOLLOWUP M-MODE & 2D,480012003,CDM,483,RC,93308,HCPCS,outpatient,,,509,356.3,,402.11,79,,321.69,percent of total billed charges,79% of total billed charges,458.1,90,,366.48,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,320.67,63,,256.54,percent of total billed charges,63% of total billed charges,393.05,77.22,,314.44,percent of total billed charges,77.22% of total billed charges,336.45,66.1,,269.16,percent of total billed charges,66.1% of total billed charges,422.47,83,,337.98,percent of total billed charges,83% of total,483.55,95,,386.84,percent of total billed charges ,95% of total billed charges,407.2,80,,325.76,percent of total billed charges,78% of total billed charges,397.02,78,,317.616,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,320.67,63,,256.54,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,320.67,63,,256.54,percent of total billed charges,63% of total billed charges,432.65,85,,346.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,402.11,79,,321.69,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,483.55,
FOLLOW-UP SPECTRAL DOPPLER,480012004,CDM,483,RC,93321,HCPCS,outpatient,,,80,56,,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,72,90,,57.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,61.78,77.22,,49.42,percent of total billed charges,77.22% of total billed charges,52.88,66.1,,42.3,percent of total billed charges,66.1% of total billed charges,66.4,83,,53.12,percent of total billed charges,83% of total,76,95,,60.8,percent of total billed charges ,95% of total billed charges,64,80,,51.2,percent of total billed charges,78% of total billed charges,62.4,78,,49.92,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,50.4,63,,40.32,percent of total billed charges,63% of total billed charges,68,85,,54.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,63.2,79,,50.56,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50.4,450,
FOLLOW-UP COLOR DOPPLER,480012005,CDM,483,RC,93325,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.8,450,
ECHO TRANS LTD FOLLOW-UP CP,480012007,CDM,483,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ECHO COMPL WO SPEC OR COLOR FL,480093307,CDM,483,RC,93307,HCPCS,outpatient,,,584,408.8,,461.36,79,,369.09,percent of total billed charges,79% of total billed charges,525.6,90,,420.48,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,367.92,63,,294.34,percent of total billed charges,63% of total billed charges,450.96,77.22,,360.77,percent of total billed charges,77.22% of total billed charges,386.02,66.1,,308.82,percent of total billed charges,66.1% of total billed charges,484.72,83,,387.78,percent of total billed charges,83% of total,554.8,95,,443.84,percent of total billed charges ,95% of total billed charges,467.2,80,,373.76,percent of total billed charges,78% of total billed charges,455.52,78,,364.416,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,367.92,63,,294.34,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,525.6,90,,420.48,percent of total billed charges,90% of total billed charges,467.2,80,,373.76,percent of total billed charges,80% of total billed charges,367.92,63,,294.34,percent of total billed charges,63% of total billed charges,496.4,85,,397.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,461.36,79,,369.09,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,554.8,
ECHO 2D W/DOPPLER & COLOR FLOW,483001288,CDM,483,RC,93306,HCPCS,outpatient,,,1829,1280.3,,1444.91,79,,1155.93,percent of total billed charges,79% of total billed charges,1646.1,90,,1316.88,percent of total billed charges,90% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,738.06,160,,,Fee Schedule,160% of CMS OPPS rate,599.66,130,,,Fee Schedule,130% of CMS OPPS rate,1152.27,63,,921.82,percent of total billed charges,63% of total billed charges,1412.35,77.22,,1129.88,percent of total billed charges,77.22% of total billed charges,1208.97,66.1,,967.18,percent of total billed charges,66.1% of total billed charges,1518.07,83,,1214.46,percent of total billed charges,83% of total,1737.55,95,,1390.04,percent of total billed charges ,95% of total billed charges,1463.2,80,,1170.56,percent of total billed charges,78% of total billed charges,1426.62,78,,1141.296,percent of total billed charges,78% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,1152.27,63,,921.82,percent of total billed charges,63% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,1152.27,63,,921.82,percent of total billed charges,63% of total billed charges,1554.65,85,,1243.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,428.99,93,,,fee schedule,93% of CMS OPPS rate,1444.91,79,,1155.93,percent of total billed charges,79% of total billed charges,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,461.29,100,,,Fee Schedule,100% of CMS OPPS rate,428.99,1737.55,
ECHO LAB NON-BILL CHG,483001294,CDM,483,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ECHO RESCAN NON-BILL CHG,483001295,CDM,483,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
EXCIS MALIG LESION 1.1 TO 2CM,490011642,CDM,490,RC,11642,HCPCS,outpatient,,,896,627.2,,707.84,79,,566.27,percent of total billed charges,79% of total billed charges,806.4,90,,645.12,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,691.89,77.22,,553.51,percent of total billed charges,77.22% of total billed charges,592.26,66.1,,473.81,percent of total billed charges,66.1% of total billed charges,743.68,83,,594.94,percent of total billed charges,83% of total,851.2,95,,680.96,percent of total billed charges ,95% of total billed charges,716.8,80,,573.44,percent of total billed charges,78% of total billed charges,698.88,78,,559.104,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,806.4,90,,645.12,percent of total billed charges,90% of total billed charges,716.8,80,,573.44,percent of total billed charges,80% of total billed charges,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,761.6,85,,609.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,707.84,79,,566.27,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,941.28,
SIMPLE REPAIR LAC < 2.5CM,490012011,CDM,490,RC,12011,HCPCS,outpatient,,,776,543.2,,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,599.23,77.22,,479.38,percent of total billed charges,77.22% of total billed charges,512.94,66.1,,410.35,percent of total billed charges,66.1% of total billed charges,644.08,83,,515.26,percent of total billed charges,83% of total,737.2,95,,589.76,percent of total billed charges ,95% of total billed charges,620.8,80,,496.64,percent of total billed charges,78% of total billed charges,605.28,78,,484.224,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,737.2,
CLSD TX DISTAL RAD FX W/MANIPU,490025605,CDM,490,RC,25605,HCPCS,outpatient,,,2710,1897,,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,2439,90,,1951.2,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2092.66,77.22,,1674.13,percent of total billed charges,77.22% of total billed charges,1791.31,66.1,,1433.05,percent of total billed charges,66.1% of total billed charges,2249.3,83,,1799.44,percent of total billed charges,83% of total,2574.5,95,,2059.6,percent of total billed charges ,95% of total billed charges,2168,80,,1734.4,percent of total billed charges,78% of total billed charges,2113.8,78,,1691.04,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2574.5,
SDC INSERTION OF FOLEY CATH,490051702,CDM,490,RC,51702,HCPCS,outpatient,,,283,198.1,,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,218.53,77.22,,174.82,percent of total billed charges,77.22% of total billed charges,187.06,66.1,,149.65,percent of total billed charges,66.1% of total billed charges,234.89,83,,187.91,percent of total billed charges,83% of total,268.85,95,,215.08,percent of total billed charges ,95% of total billed charges,226.4,80,,181.12,percent of total billed charges,78% of total billed charges,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
NJX AA STRD FEMORAL NERVE,490064447,CDM,490,RC,64447,HCPCS,outpatient,,,520,364,,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,468,90,,374.4,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,401.54,77.22,,321.23,percent of total billed charges,77.22% of total billed charges,343.72,66.1,,274.98,percent of total billed charges,66.1% of total billed charges,431.6,83,,345.28,percent of total billed charges,83% of total,494,95,,395.2,percent of total billed charges ,95% of total billed charges,416,80,,332.8,percent of total billed charges,78% of total billed charges,405.6,78,,324.48,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,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,327.6,63,,262.08,percent of total billed charges,63% of total billed charges,442,85,,353.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,410.8,79,,328.64,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,327.6,925.2,
"SDC REMOVAL VITREOUS,ANT APPRO",490067010,CDM,490,RC,67010,HCPCS,outpatient,,,4397,3077.9,,3473.63,79,,2778.9,percent of total billed charges,79% of total billed charges,3957.3,90,,3165.84,percent of total billed charges,90% of total billed charges,1948.57,100,,,Fee Schedule,100% of CMS OPPS rate,3117.72,160,,,Fee Schedule,160% of CMS OPPS rate,2533.14,130,,,Fee Schedule,130% of CMS OPPS rate,2770.11,63,,2216.09,percent of total billed charges,63% of total billed charges,3395.36,77.22,,2716.29,percent of total billed charges,77.22% of total billed charges,2906.42,66.1,,2325.14,percent of total billed charges,66.1% of total billed charges,3649.51,83,,2919.61,percent of total billed charges,83% of total,4177.15,95,,3341.72,percent of total billed charges ,95% of total billed charges,3517.6,80,,2814.08,percent of total billed charges,78% of total billed charges,3429.66,78,,2743.728,percent of total billed charges,78% of total billed charges,1948.57,100,,,Fee Schedule,100% of CMS OPPS rate,2770.11,63,,2216.09,percent of total billed charges,63% of total billed charges,1948.57,100,,,Fee Schedule,100% of CMS OPPS rate,3957.3,90,,3165.84,percent of total billed charges,90% of total billed charges,3517.6,80,,2814.08,percent of total billed charges,80% of total billed charges,2770.11,63,,2216.09,percent of total billed charges,63% of total billed charges,3737.45,85,,2989.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1812.17,93,,,fee schedule,93% of CMS OPPS rate,3473.63,79,,2778.9,percent of total billed charges,79% of total billed charges,1948.57,100,,,Fee Schedule,100% of CMS OPPS rate,1948.57,100,,,Fee Schedule,100% of CMS OPPS rate,450,4177.15,
SDC TREAT EYELID BY INJECTION,490068200,CDM,490,RC,68200,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,533.06,
DRESS/DEBMT PARTL THN BURN SM,324016020,CDM,510,RC,16020,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,492.1,
DRESS/DEBMT PARTL THN BURN MED,324016025,CDM,510,RC,16025,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
DRESS/DEBMT PARTL THN BURN LG,324016030,CDM,510,RC,16030,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
APPLIC RIG TOT CONTACT LEG CAS,324029445,CDM,510,RC,29445,HCPCS,outpatient,,,691,483.7,,545.89,79,,436.71,percent of total billed charges,79% of total billed charges,621.9,90,,497.52,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,435.33,63,,348.26,percent of total billed charges,63% of total billed charges,533.59,77.22,,426.87,percent of total billed charges,77.22% of total billed charges,456.75,66.1,,365.4,percent of total billed charges,66.1% of total billed charges,573.53,83,,458.82,percent of total billed charges,83% of total,656.45,95,,525.16,percent of total billed charges ,95% of total billed charges,552.8,80,,442.24,percent of total billed charges,78% of total billed charges,538.98,78,,431.184,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,435.33,63,,348.26,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,435.33,63,,348.26,percent of total billed charges,63% of total billed charges,587.35,85,,469.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,545.89,79,,436.71,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,208.83,656.45,
UNNA BOOT APPLICATION,324029580,CDM,510,RC,29580,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
MULT-LAYER VEN WND COMP BEL KN,324029581,CDM,510,RC,29581,HCPCS,outpatient,,,395,276.5,,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,355.5,90,,284.4,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,305.02,77.22,,244.02,percent of total billed charges,77.22% of total billed charges,261.1,66.1,,208.88,percent of total billed charges,66.1% of total billed charges,327.85,83,,262.28,percent of total billed charges,83% of total,375.25,95,,300.2,percent of total billed charges ,95% of total billed charges,316,80,,252.8,percent of total billed charges,78% of total billed charges,308.1,78,,246.48,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.85,63,,199.08,percent of total billed charges,63% of total billed charges,335.75,85,,268.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,312.05,79,,249.64,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
NEW WC LIM EX LEV 2  15 MIN,324099202,CDM,510,RC,99202,HCPCS,outpatient,,,258,180.6,,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,199.23,77.22,,159.38,percent of total billed charges,77.22% of total billed charges,170.54,66.1,,136.43,percent of total billed charges,66.1% of total billed charges,214.14,83,,171.31,percent of total billed charges,83% of total,245.1,95,,196.08,percent of total billed charges ,95% of total billed charges,206.4,80,,165.12,percent of total billed charges,78% of total billed charges,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,162.54,450,
NEW WC INTE EX LEV 3 30 MIN,324099203,CDM,510,RC,99203,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
NEW WC COMP EX LEV 4  45 MIN,324099204,CDM,510,RC,99204,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
EM WC COMP EXAM LEV 5  60 MIN,324099205,CDM,510,RC,99205,HCPCS,outpatient,,,616,431.2,,486.64,79,,389.31,percent of total billed charges,79% of total billed charges,554.4,90,,443.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388.08,63,,310.46,percent of total billed charges,63% of total billed charges,475.68,77.22,,380.54,percent of total billed charges,77.22% of total billed charges,407.18,66.1,,325.74,percent of total billed charges,66.1% of total billed charges,511.28,83,,409.02,percent of total billed charges,83% of total,585.2,95,,468.16,percent of total billed charges ,95% of total billed charges,492.8,80,,394.24,percent of total billed charges,78% of total billed charges,480.48,78,,384.384,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,388.08,63,,310.46,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,388.08,63,,310.46,percent of total billed charges,63% of total billed charges,523.6,85,,418.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,486.64,79,,389.31,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,388.08,585.2,
EM EST WC SIMPLE EXAM LEVEL 1,324099211,CDM,510,RC,99211,HCPCS,outpatient,,,199,139.3,,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.37,63,,100.3,percent of total billed charges,63% of total billed charges,153.67,77.22,,122.94,percent of total billed charges,77.22% of total billed charges,131.54,66.1,,105.23,percent of total billed charges,66.1% of total billed charges,165.17,83,,132.14,percent of total billed charges,83% of total,189.05,95,,151.24,percent of total billed charges ,95% of total billed charges,159.2,80,,127.36,percent of total billed charges,78% of total billed charges,155.22,78,,124.176,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,125.37,63,,100.3,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,125.37,63,,100.3,percent of total billed charges,63% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.37,450,
EM EST WC LTD EX LEV 2  10 MIN,324099212,CDM,510,RC,99212,HCPCS,outpatient,,,258,180.6,,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,199.23,77.22,,159.38,percent of total billed charges,77.22% of total billed charges,170.54,66.1,,136.43,percent of total billed charges,66.1% of total billed charges,214.14,83,,171.31,percent of total billed charges,83% of total,245.1,95,,196.08,percent of total billed charges ,95% of total billed charges,206.4,80,,165.12,percent of total billed charges,78% of total billed charges,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,162.54,450,
EM EST WC INTER EX LEV 3 20 MI,324099213,CDM,510,RC,99213,HCPCS,outpatient,,,258,180.6,,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,232.2,90,,185.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,199.23,77.22,,159.38,percent of total billed charges,77.22% of total billed charges,170.54,66.1,,136.43,percent of total billed charges,66.1% of total billed charges,214.14,83,,171.31,percent of total billed charges,83% of total,245.1,95,,196.08,percent of total billed charges ,95% of total billed charges,206.4,80,,165.12,percent of total billed charges,78% of total billed charges,201.24,78,,160.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,162.54,63,,130.03,percent of total billed charges,63% of total billed charges,219.3,85,,175.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,203.82,79,,163.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,162.54,450,
EM EST WC COMP EX LEV 4 30 MIN,324099214,CDM,510,RC,99214,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,224.74,66.1,,179.79,percent of total billed charges,66.1% of total billed charges,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,214.2,63,,171.36,percent of total billed charges,63% of total billed charges,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,214.2,450,
EM EST WC COMP EX LEV 5 40 MIN,324099215,CDM,510,RC,99215,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
UNNA BOOT BILATERAL APPLICAT,324929580,CDM,510,RC,29580,HCPCS,outpatient,,,593,415.1,,468.47,79,,374.78,percent of total billed charges,79% of total billed charges,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,373.59,63,,298.87,percent of total billed charges,63% of total billed charges,457.91,77.22,,366.33,percent of total billed charges,77.22% of total billed charges,391.97,66.1,,313.58,percent of total billed charges,66.1% of total billed charges,492.19,83,,393.75,percent of total billed charges,83% of total,563.35,95,,450.68,percent of total billed charges ,95% of total billed charges,474.4,80,,379.52,percent of total billed charges,78% of total billed charges,462.54,78,,370.032,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,373.59,63,,298.87,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,373.59,63,,298.87,percent of total billed charges,63% of total billed charges,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,468.47,79,,374.78,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,563.35,
BIL MULT-LAY VEN WND COM BE KN,324929581,CDM,510,RC,29581,HCPCS,outpatient,,,593,415.1,,468.47,79,,374.78,percent of total billed charges,79% of total billed charges,533.7,90,,426.96,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,373.59,63,,298.87,percent of total billed charges,63% of total billed charges,457.91,77.22,,366.33,percent of total billed charges,77.22% of total billed charges,391.97,66.1,,313.58,percent of total billed charges,66.1% of total billed charges,492.19,83,,393.75,percent of total billed charges,83% of total,563.35,95,,450.68,percent of total billed charges ,95% of total billed charges,474.4,80,,379.52,percent of total billed charges,78% of total billed charges,462.54,78,,370.032,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,373.59,63,,298.87,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,373.59,63,,298.87,percent of total billed charges,63% of total billed charges,504.05,85,,403.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,468.47,79,,374.78,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,563.35,
NEW OB EXAM LEV 2  15 MIN,510099202,CDM,510,RC,99202,HCPCS,outpatient,,,176,123.2,,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,158.4,90,,126.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.88,63,,88.7,percent of total billed charges,63% of total billed charges,135.91,77.22,,108.73,percent of total billed charges,77.22% of total billed charges,116.34,66.1,,93.07,percent of total billed charges,66.1% of total billed charges,146.08,83,,116.86,percent of total billed charges,83% of total,167.2,95,,133.76,percent of total billed charges ,95% of total billed charges,140.8,80,,112.64,percent of total billed charges,78% of total billed charges,137.28,78,,109.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,110.88,63,,88.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,110.88,63,,88.7,percent of total billed charges,63% of total billed charges,149.6,85,,119.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,139.04,79,,111.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,110.88,450,
OB INTER EX LEVEL 3  30 MIN,510099203,CDM,510,RC,99203,HCPCS,outpatient,,,230,161,,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,207,90,,165.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,177.61,77.22,,142.09,percent of total billed charges,77.22% of total billed charges,152.03,66.1,,121.62,percent of total billed charges,66.1% of total billed charges,190.9,83,,152.72,percent of total billed charges,83% of total,218.5,95,,174.8,percent of total billed charges ,95% of total billed charges,184,80,,147.2,percent of total billed charges,78% of total billed charges,179.4,78,,143.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,144.9,63,,115.92,percent of total billed charges,63% of total billed charges,195.5,85,,156.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,181.7,79,,145.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,144.9,450,
OB NEW COMP EX LEV 4  45 MIN,510099204,CDM,510,RC,99204,HCPCS,outpatient,,,450,315,,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,405,90,,324,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,347.49,77.22,,277.99,percent of total billed charges,77.22% of total billed charges,297.45,66.1,,237.96,percent of total billed charges,66.1% of total billed charges,373.5,83,,298.8,percent of total billed charges,83% of total,427.5,95,,342,percent of total billed charges ,95% of total billed charges,360,80,,288,percent of total billed charges,78% of total billed charges,351,78,,280.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,283.5,63,,226.8,percent of total billed charges,63% of total billed charges,382.5,85,,306,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,355.5,79,,284.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,283.5,450,
OB COMP EX LEV 5  60 MIN,510099205,CDM,510,RC,99205,HCPCS,outpatient,,,801,560.7,,632.79,79,,506.23,percent of total billed charges,79% of total billed charges,720.9,90,,576.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504.63,63,,403.7,percent of total billed charges,63% of total billed charges,618.53,77.22,,494.82,percent of total billed charges,77.22% of total billed charges,529.46,66.1,,423.57,percent of total billed charges,66.1% of total billed charges,664.83,83,,531.86,percent of total billed charges,83% of total,760.95,95,,608.76,percent of total billed charges ,95% of total billed charges,640.8,80,,512.64,percent of total billed charges,78% of total billed charges,624.78,78,,499.824,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,504.63,63,,403.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,720.9,90,,576.72,percent of total billed charges,90% of total billed charges,640.8,80,,512.64,percent of total billed charges,80% of total billed charges,504.63,63,,403.7,percent of total billed charges,63% of total billed charges,680.85,85,,544.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,632.79,79,,506.23,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,760.95,
EST OB LIM EX LEV 2  10 MIN,510099212,CDM,510,RC,99212,HCPCS,outpatient,,,223,156.1,,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,172.2,77.22,,137.76,percent of total billed charges,77.22% of total billed charges,147.4,66.1,,117.92,percent of total billed charges,66.1% of total billed charges,185.09,83,,148.07,percent of total billed charges,83% of total,211.85,95,,169.48,percent of total billed charges ,95% of total billed charges,178.4,80,,142.72,percent of total billed charges,78% of total billed charges,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,140.49,450,
EST OB INT EX LEV 3  20 MIN,510099213,CDM,510,RC,99213,HCPCS,outpatient,,,223,156.1,,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,200.7,90,,160.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,172.2,77.22,,137.76,percent of total billed charges,77.22% of total billed charges,147.4,66.1,,117.92,percent of total billed charges,66.1% of total billed charges,185.09,83,,148.07,percent of total billed charges,83% of total,211.85,95,,169.48,percent of total billed charges ,95% of total billed charges,178.4,80,,142.72,percent of total billed charges,78% of total billed charges,173.94,78,,139.152,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,140.49,63,,112.39,percent of total billed charges,63% of total billed charges,189.55,85,,151.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,176.17,79,,140.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,140.49,450,
EST OB COMP EX LEV 4  30 MIN,510099214,CDM,510,RC,99214,HCPCS,outpatient,,,294,205.8,,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,264.6,90,,211.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,227.03,77.22,,181.62,percent of total billed charges,77.22% of total billed charges,194.33,66.1,,155.46,percent of total billed charges,66.1% of total billed charges,244.02,83,,195.22,percent of total billed charges,83% of total,279.3,95,,223.44,percent of total billed charges ,95% of total billed charges,235.2,80,,188.16,percent of total billed charges,78% of total billed charges,229.32,78,,183.456,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,185.22,63,,148.18,percent of total billed charges,63% of total billed charges,249.9,85,,199.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,232.26,79,,185.81,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,185.22,450,
EM EST OB EXAM LEV 5  40 MIN,510099215,CDM,510,RC,99215,HCPCS,outpatient,,,389,272.3,,307.31,79,,245.85,percent of total billed charges,79% of total billed charges,350.1,90,,280.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.07,63,,196.06,percent of total billed charges,63% of total billed charges,300.39,77.22,,240.31,percent of total billed charges,77.22% of total billed charges,257.13,66.1,,205.7,percent of total billed charges,66.1% of total billed charges,322.87,83,,258.3,percent of total billed charges,83% of total,369.55,95,,295.64,percent of total billed charges ,95% of total billed charges,311.2,80,,248.96,percent of total billed charges,78% of total billed charges,303.42,78,,242.736,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,245.07,63,,196.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,245.07,63,,196.06,percent of total billed charges,63% of total billed charges,330.65,85,,264.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,307.31,79,,245.85,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,245.07,450,
EM OB PROLONG VISIT EA AD 15MI,510099417,CDM,510,RC,99417,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,97.83,66.1,,78.26,percent of total billed charges,66.1% of total billed charges,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.24,450,
EVAL MANGT OF EST PATIENT,761000211,CDM,510,RC,99211,HCPCS,outpatient,,,155,108.5,,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,119.69,77.22,,95.75,percent of total billed charges,77.22% of total billed charges,102.46,66.1,,81.97,percent of total billed charges,66.1% of total billed charges,128.65,83,,102.92,percent of total billed charges,83% of total,147.25,95,,117.8,percent of total billed charges ,95% of total billed charges,124,80,,99.2,percent of total billed charges,78% of total billed charges,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.65,450,
EM EST OB SIMPLE EXAM LEVEL 1,761001251,CDM,510,RC,99211,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,88.57,66.1,,70.86,percent of total billed charges,66.1% of total billed charges,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,84.42,450,
SDC TREATMENT ROOM EST PAT,761001254,CDM,510,RC,99211,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,88.57,66.1,,70.86,percent of total billed charges,66.1% of total billed charges,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,84.42,450,
TREATMENT ROOM GENERAL,761001259,CDM,510,RC,99211,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,88.57,66.1,,70.86,percent of total billed charges,66.1% of total billed charges,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,84.42,63,,67.54,percent of total billed charges,63% of total billed charges,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,84.42,450,
AMP FACILITY FEE,G0463,CDM,510,RC,G0463,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,176.85,160,,,Fee Schedule,160% of CMS OPPS rate,143.69,130,,,Fee Schedule,130% of CMS OPPS rate,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,102.79,93,,,fee schedule,93% of CMS OPPS rate,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,110.53,100,,,Fee Schedule,100% of CMS OPPS rate,72.45,450,
MRI LOWER EXT WO CONTRAST,610001958,CDM,610,RC,73718,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1387,
MRI INTER AUDITORY CANAL W/O C,610001954,CDM,611,RC,70551,HCPCS,outpatient,,,1578,1104.6,,1246.62,79,,997.3,percent of total billed charges,79% of total billed charges,1420.2,90,,1136.16,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,994.14,63,,795.31,percent of total billed charges,63% of total billed charges,1218.53,77.22,,974.82,percent of total billed charges,77.22% of total billed charges,1043.06,66.1,,834.45,percent of total billed charges,66.1% of total billed charges,1309.74,83,,1047.79,percent of total billed charges,83% of total,1499.1,95,,1199.28,percent of total billed charges ,95% of total billed charges,1262.4,80,,1009.92,percent of total billed charges,78% of total billed charges,1230.84,78,,984.672,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,994.14,63,,795.31,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1420.2,90,,1136.16,percent of total billed charges,90% of total billed charges,1262.4,80,,1009.92,percent of total billed charges,80% of total billed charges,994.14,63,,795.31,percent of total billed charges,63% of total billed charges,1341.3,85,,1073.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1246.62,79,,997.3,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1499.1,
MRI INT AUD CANAL W/W/O CON,610001955,CDM,611,RC,70553,HCPCS,outpatient,,,3973,2781.1,,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3067.95,77.22,,2454.36,percent of total billed charges,77.22% of total billed charges,2626.15,66.1,,2100.92,percent of total billed charges,66.1% of total billed charges,3297.59,83,,2638.07,percent of total billed charges,83% of total,3774.35,95,,3019.48,percent of total billed charges ,95% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,78% of total billed charges,3098.94,78,,2479.152,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3774.35,
MRI INTER AUDITORY CANALS W/WO,610001956,CDM,611,RC,70553,HCPCS,outpatient,,,3973,2781.1,,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3067.95,77.22,,2454.36,percent of total billed charges,77.22% of total billed charges,2626.15,66.1,,2100.92,percent of total billed charges,66.1% of total billed charges,3297.59,83,,2638.07,percent of total billed charges,83% of total,3774.35,95,,3019.48,percent of total billed charges ,95% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,78% of total billed charges,3098.94,78,,2479.152,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3774.35,
MRI BRAIN & PIT GLD W/WO CONT,610001966,CDM,611,RC,70553,HCPCS,outpatient,,,3973,2781.1,,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3067.95,77.22,,2454.36,percent of total billed charges,77.22% of total billed charges,2626.15,66.1,,2100.92,percent of total billed charges,66.1% of total billed charges,3297.59,83,,2638.07,percent of total billed charges,83% of total,3774.35,95,,3019.48,percent of total billed charges ,95% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,78% of total billed charges,3098.94,78,,2479.152,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3774.35,
MRI PITUITARY W/WO CONTRAST,610001975,CDM,611,RC,70553,HCPCS,outpatient,,,3973,2781.1,,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3067.95,77.22,,2454.36,percent of total billed charges,77.22% of total billed charges,2626.15,66.1,,2100.92,percent of total billed charges,66.1% of total billed charges,3297.59,83,,2638.07,percent of total billed charges,83% of total,3774.35,95,,3019.48,percent of total billed charges ,95% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,78% of total billed charges,3098.94,78,,2479.152,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3774.35,
MRI BRAIN W/O CONTRAST,611001901,CDM,611,RC,70551,HCPCS,outpatient,,,1578,1104.6,,1246.62,79,,997.3,percent of total billed charges,79% of total billed charges,1420.2,90,,1136.16,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,994.14,63,,795.31,percent of total billed charges,63% of total billed charges,1218.53,77.22,,974.82,percent of total billed charges,77.22% of total billed charges,1043.06,66.1,,834.45,percent of total billed charges,66.1% of total billed charges,1309.74,83,,1047.79,percent of total billed charges,83% of total,1499.1,95,,1199.28,percent of total billed charges ,95% of total billed charges,1262.4,80,,1009.92,percent of total billed charges,78% of total billed charges,1230.84,78,,984.672,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,994.14,63,,795.31,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1420.2,90,,1136.16,percent of total billed charges,90% of total billed charges,1262.4,80,,1009.92,percent of total billed charges,80% of total billed charges,994.14,63,,795.31,percent of total billed charges,63% of total billed charges,1341.3,85,,1073.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1246.62,79,,997.3,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1499.1,
MRI BRAIN W/ CONTRAST,611001902,CDM,611,RC,70552,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI BRAIN W/WO CONTRAST,611001920,CDM,611,RC,70553,HCPCS,outpatient,,,3973,2781.1,,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3067.95,77.22,,2454.36,percent of total billed charges,77.22% of total billed charges,2626.15,66.1,,2100.92,percent of total billed charges,66.1% of total billed charges,3297.59,83,,2638.07,percent of total billed charges,83% of total,3774.35,95,,3019.48,percent of total billed charges ,95% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,78% of total billed charges,3098.94,78,,2479.152,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3774.35,
MRI BRAIN & PITUITA W/WO CONTR,611001979,CDM,611,RC,70553,HCPCS,outpatient,,,3973,2781.1,,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3067.95,77.22,,2454.36,percent of total billed charges,77.22% of total billed charges,2626.15,66.1,,2100.92,percent of total billed charges,66.1% of total billed charges,3297.59,83,,2638.07,percent of total billed charges,83% of total,3774.35,95,,3019.48,percent of total billed charges ,95% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,78% of total billed charges,3098.94,78,,2479.152,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3774.35,
MRI BRAIN W/WO CONTRAST,611001981,CDM,611,RC,70553,HCPCS,outpatient,,,3973,2781.1,,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,3575.7,90,,2860.56,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3067.95,77.22,,2454.36,percent of total billed charges,77.22% of total billed charges,2626.15,66.1,,2100.92,percent of total billed charges,66.1% of total billed charges,3297.59,83,,2638.07,percent of total billed charges,83% of total,3774.35,95,,3019.48,percent of total billed charges ,95% of total billed charges,3178.4,80,,2542.72,percent of total billed charges,78% of total billed charges,3098.94,78,,2479.152,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2502.99,63,,2002.39,percent of total billed charges,63% of total billed charges,3377.05,85,,2701.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3138.67,79,,2510.94,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3774.35,
OUTSIDE HOSP SERV MRI,612001924,CDM,611,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MRI C-SPINAL CANAL/CONTS W/O,612001908,CDM,612,RC,72141,HCPCS,outpatient,,,2215,1550.5,,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1710.42,77.22,,1368.34,percent of total billed charges,77.22% of total billed charges,1464.12,66.1,,1171.3,percent of total billed charges,66.1% of total billed charges,1838.45,83,,1470.76,percent of total billed charges,83% of total,2104.25,95,,1683.4,percent of total billed charges ,95% of total billed charges,1772,80,,1417.6,percent of total billed charges,78% of total billed charges,1727.7,78,,1382.16,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,1772,80,,1417.6,percent of total billed charges,80% of total billed charges,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1882.75,85,,1506.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2104.25,
MRI C-SPINAL CANAL/CONTS W/,612001909,CDM,612,RC,72142,HCPCS,outpatient,,,2494,1745.8,,1970.26,79,,1576.21,percent of total billed charges,79% of total billed charges,2244.6,90,,1795.68,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1571.22,63,,1256.98,percent of total billed charges,63% of total billed charges,1925.87,77.22,,1540.7,percent of total billed charges,77.22% of total billed charges,1648.53,66.1,,1318.82,percent of total billed charges,66.1% of total billed charges,2070.02,83,,1656.02,percent of total billed charges,83% of total,2369.3,95,,1895.44,percent of total billed charges ,95% of total billed charges,1995.2,80,,1596.16,percent of total billed charges,78% of total billed charges,1945.32,78,,1556.256,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1571.22,63,,1256.98,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2244.6,90,,1795.68,percent of total billed charges,90% of total billed charges,1995.2,80,,1596.16,percent of total billed charges,80% of total billed charges,1571.22,63,,1256.98,percent of total billed charges,63% of total billed charges,2119.9,85,,1695.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1970.26,79,,1576.21,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2369.3,
MRI C-SPINAL CANAL/CONTS W/W/O,612001910,CDM,612,RC,72156,HCPCS,outpatient,,,2676,1873.2,,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2066.41,77.22,,1653.13,percent of total billed charges,77.22% of total billed charges,1768.84,66.1,,1415.07,percent of total billed charges,66.1% of total billed charges,2221.08,83,,1776.86,percent of total billed charges,83% of total,2542.2,95,,2033.76,percent of total billed charges ,95% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,78% of total billed charges,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,80% of total billed charges,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2274.6,85,,1819.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2542.2,
MRI L-SPINAL CANAL/CONTS W/O,612001911,CDM,612,RC,72148,HCPCS,outpatient,,,2215,1550.5,,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1710.42,77.22,,1368.34,percent of total billed charges,77.22% of total billed charges,1464.12,66.1,,1171.3,percent of total billed charges,66.1% of total billed charges,1838.45,83,,1470.76,percent of total billed charges,83% of total,2104.25,95,,1683.4,percent of total billed charges ,95% of total billed charges,1772,80,,1417.6,percent of total billed charges,78% of total billed charges,1727.7,78,,1382.16,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,1772,80,,1417.6,percent of total billed charges,80% of total billed charges,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1882.75,85,,1506.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2104.25,
MRI L-SPINAL CANAL/CONTS W/,612001912,CDM,612,RC,72149,HCPCS,outpatient,,,3183,2228.1,,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2457.91,77.22,,1966.33,percent of total billed charges,77.22% of total billed charges,2103.96,66.1,,1683.17,percent of total billed charges,66.1% of total billed charges,2641.89,83,,2113.51,percent of total billed charges,83% of total,3023.85,95,,2419.08,percent of total billed charges ,95% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,78% of total billed charges,2482.74,78,,1986.192,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,80% of total billed charges,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2705.55,85,,2164.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3023.85,
MRI L-SPINE CANAL/CONTS W/WO,612001913,CDM,612,RC,72158,HCPCS,outpatient,,,2676,1873.2,,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2066.41,77.22,,1653.13,percent of total billed charges,77.22% of total billed charges,1768.84,66.1,,1415.07,percent of total billed charges,66.1% of total billed charges,2221.08,83,,1776.86,percent of total billed charges,83% of total,2542.2,95,,2033.76,percent of total billed charges ,95% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,78% of total billed charges,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,80% of total billed charges,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2274.6,85,,1819.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2542.2,
MRI T-SPINAL CANAL/CONTS W/O,612001914,CDM,612,RC,72146,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1618.8,
MRI T-SPINAL CANAL/CONTS W/,612001915,CDM,612,RC,72147,HCPCS,outpatient,,,2494,1745.8,,1970.26,79,,1576.21,percent of total billed charges,79% of total billed charges,2244.6,90,,1795.68,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1571.22,63,,1256.98,percent of total billed charges,63% of total billed charges,1925.87,77.22,,1540.7,percent of total billed charges,77.22% of total billed charges,1648.53,66.1,,1318.82,percent of total billed charges,66.1% of total billed charges,2070.02,83,,1656.02,percent of total billed charges,83% of total,2369.3,95,,1895.44,percent of total billed charges ,95% of total billed charges,1995.2,80,,1596.16,percent of total billed charges,78% of total billed charges,1945.32,78,,1556.256,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1571.22,63,,1256.98,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2244.6,90,,1795.68,percent of total billed charges,90% of total billed charges,1995.2,80,,1596.16,percent of total billed charges,80% of total billed charges,1571.22,63,,1256.98,percent of total billed charges,63% of total billed charges,2119.9,85,,1695.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1970.26,79,,1576.21,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2369.3,
MRI T-SPINAL CANAL/CONTS W/WO,612001916,CDM,612,RC,72157,HCPCS,outpatient,,,2676,1873.2,,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2066.41,77.22,,1653.13,percent of total billed charges,77.22% of total billed charges,1768.84,66.1,,1415.07,percent of total billed charges,66.1% of total billed charges,2221.08,83,,1776.86,percent of total billed charges,83% of total,2542.2,95,,2033.76,percent of total billed charges ,95% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,78% of total billed charges,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,80% of total billed charges,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2274.6,85,,1819.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2542.2,
MRI L-SPINAL LIMITED,612001921,CDM,612,RC,,,outpatient,,,678,474.6,,535.62,79,,428.5,percent of total billed charges,79% of total billed charges,610.2,90,,488.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.14,63,,341.71,percent of total billed charges,63% of total billed charges,523.55,77.22,,418.84,percent of total billed charges,77.22% of total billed charges,448.16,66.1,,358.53,percent of total billed charges,66.1% of total billed charges,562.74,83,,450.19,percent of total billed charges,83% of total,644.1,95,,515.28,percent of total billed charges ,95% of total billed charges,542.4,80,,433.92,percent of total billed charges,78% of total billed charges,528.84,78,,423.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,427.14,63,,341.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,427.14,63,,341.71,percent of total billed charges,63% of total billed charges,576.3,85,,461.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,535.62,79,,428.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,427.14,644.1,
MRI T-SPINAL LIMITED,612001922,CDM,612,RC,,,outpatient,,,678,474.6,,535.62,79,,428.5,percent of total billed charges,79% of total billed charges,610.2,90,,488.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.14,63,,341.71,percent of total billed charges,63% of total billed charges,523.55,77.22,,418.84,percent of total billed charges,77.22% of total billed charges,448.16,66.1,,358.53,percent of total billed charges,66.1% of total billed charges,562.74,83,,450.19,percent of total billed charges,83% of total,644.1,95,,515.28,percent of total billed charges ,95% of total billed charges,542.4,80,,433.92,percent of total billed charges,78% of total billed charges,528.84,78,,423.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,427.14,63,,341.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,427.14,63,,341.71,percent of total billed charges,63% of total billed charges,576.3,85,,461.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,535.62,79,,428.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,427.14,644.1,
MRI C SPINE LIMITED WO CONTRAS,612001923,CDM,612,RC,72141,HCPCS,outpatient,,,2215,1550.5,,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1710.42,77.22,,1368.34,percent of total billed charges,77.22% of total billed charges,1464.12,66.1,,1171.3,percent of total billed charges,66.1% of total billed charges,1838.45,83,,1470.76,percent of total billed charges,83% of total,2104.25,95,,1683.4,percent of total billed charges ,95% of total billed charges,1772,80,,1417.6,percent of total billed charges,78% of total billed charges,1727.7,78,,1382.16,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1993.5,90,,1594.8,percent of total billed charges,90% of total billed charges,1772,80,,1417.6,percent of total billed charges,80% of total billed charges,1395.45,63,,1116.36,percent of total billed charges,63% of total billed charges,1882.75,85,,1506.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1749.85,79,,1399.88,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2104.25,
MRI BREAST W/WO CONTRAST BILAT,610000501,CDM,614,RC,77049,HCPCS,outpatient,,,4154,2907.8,,3281.66,79,,2625.33,percent of total billed charges,79% of total billed charges,3738.6,90,,2990.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2617.02,63,,2093.62,percent of total billed charges,63% of total billed charges,3207.72,77.22,,2566.18,percent of total billed charges,77.22% of total billed charges,2745.79,66.1,,2196.63,percent of total billed charges,66.1% of total billed charges,3447.82,83,,2758.26,percent of total billed charges,83% of total,3946.3,95,,3157.04,percent of total billed charges ,95% of total billed charges,3323.2,80,,2658.56,percent of total billed charges,78% of total billed charges,3240.12,78,,2592.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2617.02,63,,2093.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3738.6,90,,2990.88,percent of total billed charges,90% of total billed charges,3323.2,80,,2658.56,percent of total billed charges,80% of total billed charges,2617.02,63,,2093.62,percent of total billed charges,63% of total billed charges,3530.9,85,,2824.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3281.66,79,,2625.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3946.3,
MRI BREAST W/O CONTRAST BILAT,610000502,CDM,614,RC,77047,HCPCS,outpatient,,,3360,2352,,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2594.59,77.22,,2075.67,percent of total billed charges,77.22% of total billed charges,2220.96,66.1,,1776.77,percent of total billed charges,66.1% of total billed charges,2788.8,83,,2231.04,percent of total billed charges,83% of total,3192,95,,2553.6,percent of total billed charges ,95% of total billed charges,2688,80,,2150.4,percent of total billed charges,78% of total billed charges,2620.8,78,,2096.64,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,3024,90,,2419.2,percent of total billed charges,90% of total billed charges,2688,80,,2150.4,percent of total billed charges,80% of total billed charges,2116.8,63,,1693.44,percent of total billed charges,63% of total billed charges,2856,85,,2284.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,2654.4,79,,2123.52,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,3192,
MRI ABDOMEN W/O CONTRAST LMTED,610001900,CDM,614,RC,74181,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1618.8,
MRI CHEST W/O CONTRAST,610001903,CDM,614,RC,71550,HCPCS,outpatient,,,2019,1413.3,,1595.01,79,,1276.01,percent of total billed charges,79% of total billed charges,1817.1,90,,1453.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1271.97,63,,1017.58,percent of total billed charges,63% of total billed charges,1559.07,77.22,,1247.26,percent of total billed charges,77.22% of total billed charges,1334.56,66.1,,1067.65,percent of total billed charges,66.1% of total billed charges,1675.77,83,,1340.62,percent of total billed charges,83% of total,1918.05,95,,1534.44,percent of total billed charges ,95% of total billed charges,1615.2,80,,1292.16,percent of total billed charges,78% of total billed charges,1574.82,78,,1259.856,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1271.97,63,,1017.58,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1817.1,90,,1453.68,percent of total billed charges,90% of total billed charges,1615.2,80,,1292.16,percent of total billed charges,80% of total billed charges,1271.97,63,,1017.58,percent of total billed charges,63% of total billed charges,1716.15,85,,1372.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1595.01,79,,1276.01,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1918.05,
MRI LOWER EXTREM O/T JOINT W/O,610001904,CDM,614,RC,73718,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1387,
MRI LOWER EXTREMITY JOINT WO,610001905,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
"MRI ORBIT, FACE, & NECK W/O CO",610001906,CDM,614,RC,70540,HCPCS,outpatient,,,2219,1553.3,,1753.01,79,,1402.41,percent of total billed charges,79% of total billed charges,1997.1,90,,1597.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1397.97,63,,1118.38,percent of total billed charges,63% of total billed charges,1713.51,77.22,,1370.81,percent of total billed charges,77.22% of total billed charges,1466.76,66.1,,1173.41,percent of total billed charges,66.1% of total billed charges,1841.77,83,,1473.42,percent of total billed charges,83% of total,2108.05,95,,1686.44,percent of total billed charges ,95% of total billed charges,1775.2,80,,1420.16,percent of total billed charges,78% of total billed charges,1730.82,78,,1384.656,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1397.97,63,,1118.38,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1997.1,90,,1597.68,percent of total billed charges,90% of total billed charges,1775.2,80,,1420.16,percent of total billed charges,80% of total billed charges,1397.97,63,,1118.38,percent of total billed charges,63% of total billed charges,1886.15,85,,1508.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1753.01,79,,1402.41,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2108.05,
MRI LT HIP W W/O CONTRAST,610001911,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI RT HIP W W/O CONTRAST,610001912,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI LEFT KNEE W W/O CONTRAST,610001913,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI RT KNEE W W/O CONTRAST,610001914,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI LT ANKLE W W/O CONTRAST,610001915,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI RT ANKLE W W/O CONTRAST,610001916,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI TEMPOROMANDIBULAR JOINT,610001917,CDM,614,RC,70336,HCPCS,outpatient,,,1818,1272.6,,1436.22,79,,1148.98,percent of total billed charges,79% of total billed charges,1636.2,90,,1308.96,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1145.34,63,,916.27,percent of total billed charges,63% of total billed charges,1403.86,77.22,,1123.09,percent of total billed charges,77.22% of total billed charges,1201.7,66.1,,961.36,percent of total billed charges,66.1% of total billed charges,1508.94,83,,1207.15,percent of total billed charges,83% of total,1727.1,95,,1381.68,percent of total billed charges ,95% of total billed charges,1454.4,80,,1163.52,percent of total billed charges,78% of total billed charges,1418.04,78,,1134.432,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1145.34,63,,916.27,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,1145.34,63,,916.27,percent of total billed charges,63% of total billed charges,1545.3,85,,1236.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1436.22,79,,1148.98,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1727.1,
MRI UPPER EXTRM O/T JOINT,610001918,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI UPPER EXTRM ANY JOINT,610001919,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI ABDOMEN W&W/O DYE,610001924,CDM,614,RC,74183,HCPCS,outpatient,,,2797,1957.9,,2209.63,79,,1767.7,percent of total billed charges,79% of total billed charges,2517.3,90,,2013.84,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1762.11,63,,1409.69,percent of total billed charges,63% of total billed charges,2159.84,77.22,,1727.87,percent of total billed charges,77.22% of total billed charges,1848.82,66.1,,1479.06,percent of total billed charges,66.1% of total billed charges,2321.51,83,,1857.21,percent of total billed charges,83% of total,2657.15,95,,2125.72,percent of total billed charges ,95% of total billed charges,2237.6,80,,1790.08,percent of total billed charges,78% of total billed charges,2181.66,78,,1745.328,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1762.11,63,,1409.69,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2517.3,90,,2013.84,percent of total billed charges,90% of total billed charges,2237.6,80,,1790.08,percent of total billed charges,80% of total billed charges,1762.11,63,,1409.69,percent of total billed charges,63% of total billed charges,2377.45,85,,1901.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2209.63,79,,1767.7,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2657.15,
MRI ORBITS W/W/O CONTRAST,610001925,CDM,614,RC,70543,HCPCS,outpatient,,,2310,1617,,1824.9,79,,1459.92,percent of total billed charges,79% of total billed charges,2079,90,,1663.2,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1455.3,63,,1164.24,percent of total billed charges,63% of total billed charges,1783.78,77.22,,1427.02,percent of total billed charges,77.22% of total billed charges,1526.91,66.1,,1221.53,percent of total billed charges,66.1% of total billed charges,1917.3,83,,1533.84,percent of total billed charges,83% of total,2194.5,95,,1755.6,percent of total billed charges ,95% of total billed charges,1848,80,,1478.4,percent of total billed charges,78% of total billed charges,1801.8,78,,1441.44,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1455.3,63,,1164.24,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2079,90,,1663.2,percent of total billed charges,90% of total billed charges,1848,80,,1478.4,percent of total billed charges,80% of total billed charges,1455.3,63,,1164.24,percent of total billed charges,63% of total billed charges,1963.5,85,,1570.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1824.9,79,,1459.92,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2194.5,
MRI ANY JT LOW EXT W/WO CONTRA,610001926,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI LW EXT O/T JT WITH CONTRAS,610001927,CDM,614,RC,73719,HCPCS,outpatient,,,1654,1157.8,,1306.66,79,,1045.33,percent of total billed charges,79% of total billed charges,1488.6,90,,1190.88,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,1277.22,77.22,,1021.78,percent of total billed charges,77.22% of total billed charges,1093.29,66.1,,874.63,percent of total billed charges,66.1% of total billed charges,1372.82,83,,1098.26,percent of total billed charges,83% of total,1571.3,95,,1257.04,percent of total billed charges ,95% of total billed charges,1323.2,80,,1058.56,percent of total billed charges,78% of total billed charges,1290.12,78,,1032.096,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1488.6,90,,1190.88,percent of total billed charges,90% of total billed charges,1323.2,80,,1058.56,percent of total billed charges,80% of total billed charges,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,1405.9,85,,1124.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1306.66,79,,1045.33,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1571.3,
MRI PELVIS WITHOUT CONTRAST,610001928,CDM,614,RC,72195,HCPCS,outpatient,,,1909,1336.3,,1508.11,79,,1206.49,percent of total billed charges,79% of total billed charges,1718.1,90,,1374.48,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,1474.13,77.22,,1179.3,percent of total billed charges,77.22% of total billed charges,1261.85,66.1,,1009.48,percent of total billed charges,66.1% of total billed charges,1584.47,83,,1267.58,percent of total billed charges,83% of total,1813.55,95,,1450.84,percent of total billed charges ,95% of total billed charges,1527.2,80,,1221.76,percent of total billed charges,78% of total billed charges,1489.02,78,,1191.216,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1718.1,90,,1374.48,percent of total billed charges,90% of total billed charges,1527.2,80,,1221.76,percent of total billed charges,80% of total billed charges,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,1622.65,85,,1298.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1508.11,79,,1206.49,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1813.55,
MRI UP EXT O/T JT WO CONTRAST,610001929,CDM,614,RC,73218,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1502.9,
MRI UP EXT O/T JT WITH CONT,610001930,CDM,614,RC,73219,HCPCS,outpatient,,,2829,1980.3,,2234.91,79,,1787.93,percent of total billed charges,79% of total billed charges,2546.1,90,,2036.88,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1782.27,63,,1425.82,percent of total billed charges,63% of total billed charges,2184.55,77.22,,1747.64,percent of total billed charges,77.22% of total billed charges,1869.97,66.1,,1495.98,percent of total billed charges,66.1% of total billed charges,2348.07,83,,1878.46,percent of total billed charges,83% of total,2687.55,95,,2150.04,percent of total billed charges ,95% of total billed charges,2263.2,80,,1810.56,percent of total billed charges,78% of total billed charges,2206.62,78,,1765.296,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1782.27,63,,1425.82,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,1782.27,63,,1425.82,percent of total billed charges,63% of total billed charges,2404.65,85,,1923.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2234.91,79,,1787.93,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2687.55,
MRI ABDOMEN WITH CONTRAST,610001931,CDM,614,RC,74182,HCPCS,outpatient,,,2839,1987.3,,2242.81,79,,1794.25,percent of total billed charges,79% of total billed charges,2555.1,90,,2044.08,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1788.57,63,,1430.86,percent of total billed charges,63% of total billed charges,2192.28,77.22,,1753.82,percent of total billed charges,77.22% of total billed charges,1876.58,66.1,,1501.26,percent of total billed charges,66.1% of total billed charges,2356.37,83,,1885.1,percent of total billed charges,83% of total,2697.05,95,,2157.64,percent of total billed charges ,95% of total billed charges,2271.2,80,,1816.96,percent of total billed charges,78% of total billed charges,2214.42,78,,1771.536,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1788.57,63,,1430.86,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2555.1,90,,2044.08,percent of total billed charges,90% of total billed charges,2271.2,80,,1816.96,percent of total billed charges,80% of total billed charges,1788.57,63,,1430.86,percent of total billed charges,63% of total billed charges,2413.15,85,,1930.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2242.81,79,,1794.25,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2697.05,
MRI CHEST W/CONTRAST,610001932,CDM,614,RC,71551,HCPCS,outpatient,,,2447,1712.9,,1933.13,79,,1546.5,percent of total billed charges,79% of total billed charges,2202.3,90,,1761.84,percent of total billed charges,90% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,1071.19,160,,,Fee Schedule,160% of CMS OPPS rate,870.35,130,,,Fee Schedule,130% of CMS OPPS rate,1541.61,63,,1233.29,percent of total billed charges,63% of total billed charges,1889.57,77.22,,1511.66,percent of total billed charges,77.22% of total billed charges,1617.47,66.1,,1293.98,percent of total billed charges,66.1% of total billed charges,2031.01,83,,1624.81,percent of total billed charges,83% of total,2324.65,95,,1859.72,percent of total billed charges ,95% of total billed charges,1957.6,80,,1566.08,percent of total billed charges,78% of total billed charges,1908.66,78,,1526.928,percent of total billed charges,78% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,1541.61,63,,1233.29,percent of total billed charges,63% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,2202.3,90,,1761.84,percent of total billed charges,90% of total billed charges,1957.6,80,,1566.08,percent of total billed charges,80% of total billed charges,1541.61,63,,1233.29,percent of total billed charges,63% of total billed charges,2079.95,85,,1663.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,622.63,93,,,fee schedule,93% of CMS OPPS rate,1933.13,79,,1546.5,percent of total billed charges,79% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,450,2324.65,
MRI CHEST W/WO CONTRAST,610001933,CDM,614,RC,71552,HCPCS,outpatient,,,4127,2888.9,,3260.33,79,,2608.26,percent of total billed charges,79% of total billed charges,3714.3,90,,2971.44,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,2600.01,63,,2080.01,percent of total billed charges,63% of total billed charges,3186.87,77.22,,2549.5,percent of total billed charges,77.22% of total billed charges,2727.95,66.1,,2182.36,percent of total billed charges,66.1% of total billed charges,3425.41,83,,2740.33,percent of total billed charges,83% of total,3920.65,95,,3136.52,percent of total billed charges ,95% of total billed charges,3301.6,80,,2641.28,percent of total billed charges,78% of total billed charges,3219.06,78,,2575.248,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2600.01,63,,2080.01,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,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,2600.01,63,,2080.01,percent of total billed charges,63% of total billed charges,3507.95,85,,2806.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,3260.33,79,,2608.26,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,3920.65,
MRI NECK W/O CONTRAST,610001934,CDM,614,RC,70540,HCPCS,outpatient,,,2219,1553.3,,1753.01,79,,1402.41,percent of total billed charges,79% of total billed charges,1997.1,90,,1597.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1397.97,63,,1118.38,percent of total billed charges,63% of total billed charges,1713.51,77.22,,1370.81,percent of total billed charges,77.22% of total billed charges,1466.76,66.1,,1173.41,percent of total billed charges,66.1% of total billed charges,1841.77,83,,1473.42,percent of total billed charges,83% of total,2108.05,95,,1686.44,percent of total billed charges ,95% of total billed charges,1775.2,80,,1420.16,percent of total billed charges,78% of total billed charges,1730.82,78,,1384.656,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1397.97,63,,1118.38,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1997.1,90,,1597.68,percent of total billed charges,90% of total billed charges,1775.2,80,,1420.16,percent of total billed charges,80% of total billed charges,1397.97,63,,1118.38,percent of total billed charges,63% of total billed charges,1886.15,85,,1508.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1753.01,79,,1402.41,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2108.05,
MRI NECK W/CONTRAST,610001935,CDM,614,RC,70542,HCPCS,outpatient,,,2619,1833.3,,2069.01,79,,1655.21,percent of total billed charges,79% of total billed charges,2357.1,90,,1885.68,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1649.97,63,,1319.98,percent of total billed charges,63% of total billed charges,2022.39,77.22,,1617.91,percent of total billed charges,77.22% of total billed charges,1731.16,66.1,,1384.93,percent of total billed charges,66.1% of total billed charges,2173.77,83,,1739.02,percent of total billed charges,83% of total,2488.05,95,,1990.44,percent of total billed charges ,95% of total billed charges,2095.2,80,,1676.16,percent of total billed charges,78% of total billed charges,2042.82,78,,1634.256,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1649.97,63,,1319.98,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2357.1,90,,1885.68,percent of total billed charges,90% of total billed charges,2095.2,80,,1676.16,percent of total billed charges,80% of total billed charges,1649.97,63,,1319.98,percent of total billed charges,63% of total billed charges,2226.15,85,,1780.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2069.01,79,,1655.21,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2488.05,
MRI NECK W/WO CONTRAST,610001936,CDM,614,RC,70543,HCPCS,outpatient,,,2310,1617,,1824.9,79,,1459.92,percent of total billed charges,79% of total billed charges,2079,90,,1663.2,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1455.3,63,,1164.24,percent of total billed charges,63% of total billed charges,1783.78,77.22,,1427.02,percent of total billed charges,77.22% of total billed charges,1526.91,66.1,,1221.53,percent of total billed charges,66.1% of total billed charges,1917.3,83,,1533.84,percent of total billed charges,83% of total,2194.5,95,,1755.6,percent of total billed charges ,95% of total billed charges,1848,80,,1478.4,percent of total billed charges,78% of total billed charges,1801.8,78,,1441.44,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1455.3,63,,1164.24,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2079,90,,1663.2,percent of total billed charges,90% of total billed charges,1848,80,,1478.4,percent of total billed charges,80% of total billed charges,1455.3,63,,1164.24,percent of total billed charges,63% of total billed charges,1963.5,85,,1570.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1824.9,79,,1459.92,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2194.5,
MRI PELVIS WITH CONTRAST,610001937,CDM,614,RC,72196,HCPCS,outpatient,,,2446,1712.2,,1932.34,79,,1545.87,percent of total billed charges,79% of total billed charges,2201.4,90,,1761.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1540.98,63,,1232.78,percent of total billed charges,63% of total billed charges,1888.8,77.22,,1511.04,percent of total billed charges,77.22% of total billed charges,1616.81,66.1,,1293.45,percent of total billed charges,66.1% of total billed charges,2030.18,83,,1624.14,percent of total billed charges,83% of total,2323.7,95,,1858.96,percent of total billed charges ,95% of total billed charges,1956.8,80,,1565.44,percent of total billed charges,78% of total billed charges,1907.88,78,,1526.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1540.98,63,,1232.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2201.4,90,,1761.12,percent of total billed charges,90% of total billed charges,1956.8,80,,1565.44,percent of total billed charges,80% of total billed charges,1540.98,63,,1232.78,percent of total billed charges,63% of total billed charges,2079.1,85,,1663.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1932.34,79,,1545.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2323.7,
MRI PELVIS W/WO CONTRAST,610001938,CDM,614,RC,72197,HCPCS,outpatient,,,2676,1873.2,,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2066.41,77.22,,1653.13,percent of total billed charges,77.22% of total billed charges,1768.84,66.1,,1415.07,percent of total billed charges,66.1% of total billed charges,2221.08,83,,1776.86,percent of total billed charges,83% of total,2542.2,95,,2033.76,percent of total billed charges ,95% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,78% of total billed charges,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,80% of total billed charges,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2274.6,85,,1819.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2542.2,
MRI UPPER EXTREM W CONTRAST,610001939,CDM,614,RC,73222,HCPCS,outpatient,,,3189,2232.3,,2519.31,79,,2015.45,percent of total billed charges,79% of total billed charges,2870.1,90,,2296.08,percent of total billed charges,90% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,1071.19,160,,,Fee Schedule,160% of CMS OPPS rate,870.35,130,,,Fee Schedule,130% of CMS OPPS rate,2009.07,63,,1607.26,percent of total billed charges,63% of total billed charges,2462.55,77.22,,1970.04,percent of total billed charges,77.22% of total billed charges,2107.93,66.1,,1686.34,percent of total billed charges,66.1% of total billed charges,2646.87,83,,2117.5,percent of total billed charges,83% of total,3029.55,95,,2423.64,percent of total billed charges ,95% of total billed charges,2551.2,80,,2040.96,percent of total billed charges,78% of total billed charges,2487.42,78,,1989.936,percent of total billed charges,78% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,2009.07,63,,1607.26,percent of total billed charges,63% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,2870.1,90,,2296.08,percent of total billed charges,90% of total billed charges,2551.2,80,,2040.96,percent of total billed charges,80% of total billed charges,2009.07,63,,1607.26,percent of total billed charges,63% of total billed charges,2710.65,85,,2168.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,622.63,93,,,fee schedule,93% of CMS OPPS rate,2519.31,79,,2015.45,percent of total billed charges,79% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,450,3029.55,
MRI UPPER EXTREM W/WO CONTRAST,610001940,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI PELVIS LIMITED,610001941,CDM,614,RC,72195,HCPCS,outpatient,,,1909,1336.3,,1508.11,79,,1206.49,percent of total billed charges,79% of total billed charges,1718.1,90,,1374.48,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,1474.13,77.22,,1179.3,percent of total billed charges,77.22% of total billed charges,1261.85,66.1,,1009.48,percent of total billed charges,66.1% of total billed charges,1584.47,83,,1267.58,percent of total billed charges,83% of total,1813.55,95,,1450.84,percent of total billed charges ,95% of total billed charges,1527.2,80,,1221.76,percent of total billed charges,78% of total billed charges,1489.02,78,,1191.216,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1718.1,90,,1374.48,percent of total billed charges,90% of total billed charges,1527.2,80,,1221.76,percent of total billed charges,80% of total billed charges,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,1622.65,85,,1298.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1508.11,79,,1206.49,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1813.55,
MRI LT HIP WO CONTRAST,610001942,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
MRI RT HIP WO CONTRAST,610001943,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
MRI LT KNEE WO CONTRAST,610001944,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
MRI RT KNEE WO CONTRAST,610001945,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
MRI LT ANKLE WO CONTRAST,610001946,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
MRI RT ANKLE WO CONTRAST,610001947,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
MRI SHLDER RT ARTHROGRAM W/WO,610001957,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI SHLDER ARTHROGRAM W/WO LT,610001959,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI ADRENAL GLAND W/O CONTRAST,610001963,CDM,614,RC,74181,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1618.8,
MRI ADRENAL GLAD W/WO CONT,610001965,CDM,614,RC,74183,HCPCS,outpatient,,,2797,1957.9,,2209.63,79,,1767.7,percent of total billed charges,79% of total billed charges,2517.3,90,,2013.84,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1762.11,63,,1409.69,percent of total billed charges,63% of total billed charges,2159.84,77.22,,1727.87,percent of total billed charges,77.22% of total billed charges,1848.82,66.1,,1479.06,percent of total billed charges,66.1% of total billed charges,2321.51,83,,1857.21,percent of total billed charges,83% of total,2657.15,95,,2125.72,percent of total billed charges ,95% of total billed charges,2237.6,80,,1790.08,percent of total billed charges,78% of total billed charges,2181.66,78,,1745.328,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1762.11,63,,1409.69,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2517.3,90,,2013.84,percent of total billed charges,90% of total billed charges,2237.6,80,,1790.08,percent of total billed charges,80% of total billed charges,1762.11,63,,1409.69,percent of total billed charges,63% of total billed charges,2377.45,85,,1901.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2209.63,79,,1767.7,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2657.15,
MRI LOWER EXT OTH THAN JT W/WO,610001967,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
MRI LOW EXT JT W/O CONT BILATE,610001968,CDM,614,RC,73721,HCPCS,outpatient,,,1898,1328.6,,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1465.64,77.22,,1172.51,percent of total billed charges,77.22% of total billed charges,1254.58,66.1,,1003.66,percent of total billed charges,66.1% of total billed charges,1575.34,83,,1260.27,percent of total billed charges,83% of total,1803.1,95,,1442.48,percent of total billed charges ,95% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,78% of total billed charges,1480.44,78,,1184.352,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1708.2,90,,1366.56,percent of total billed charges,90% of total billed charges,1518.4,80,,1214.72,percent of total billed charges,80% of total billed charges,1195.74,63,,956.59,percent of total billed charges,63% of total billed charges,1613.3,85,,1290.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1499.42,79,,1199.54,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1803.1,
MRI LOW EXT JT W/WO C RT ARTHR,610001969,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI LOW EXT JT W/WO CO LT ARTH,610001970,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI OUTISIDE SERVICES,610001971,CDM,614,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MRI UPPER EXT/NO JNT W/WO CONT,610001972,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI MRCP & ABD W/O CONTRAST,610001978,CDM,614,RC,74181,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1618.8,
MRI BRACHIAL PLEXUS W/O CONTRA,610001979,CDM,614,RC,71550,HCPCS,outpatient,,,2019,1413.3,,1595.01,79,,1276.01,percent of total billed charges,79% of total billed charges,1817.1,90,,1453.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1271.97,63,,1017.58,percent of total billed charges,63% of total billed charges,1559.07,77.22,,1247.26,percent of total billed charges,77.22% of total billed charges,1334.56,66.1,,1067.65,percent of total billed charges,66.1% of total billed charges,1675.77,83,,1340.62,percent of total billed charges,83% of total,1918.05,95,,1534.44,percent of total billed charges ,95% of total billed charges,1615.2,80,,1292.16,percent of total billed charges,78% of total billed charges,1574.82,78,,1259.856,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1271.97,63,,1017.58,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1817.1,90,,1453.68,percent of total billed charges,90% of total billed charges,1615.2,80,,1292.16,percent of total billed charges,80% of total billed charges,1271.97,63,,1017.58,percent of total billed charges,63% of total billed charges,1716.15,85,,1372.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1595.01,79,,1276.01,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1918.05,
MRI LOW EXT O/T JT BILAT W/O C,610001981,CDM,614,RC,73718,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1387,
MRI SACRUM & COCCYX WO CONTRAS,610001983,CDM,614,RC,72195,HCPCS,outpatient,,,1909,1336.3,,1508.11,79,,1206.49,percent of total billed charges,79% of total billed charges,1718.1,90,,1374.48,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,1474.13,77.22,,1179.3,percent of total billed charges,77.22% of total billed charges,1261.85,66.1,,1009.48,percent of total billed charges,66.1% of total billed charges,1584.47,83,,1267.58,percent of total billed charges,83% of total,1813.55,95,,1450.84,percent of total billed charges ,95% of total billed charges,1527.2,80,,1221.76,percent of total billed charges,78% of total billed charges,1489.02,78,,1191.216,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1718.1,90,,1374.48,percent of total billed charges,90% of total billed charges,1527.2,80,,1221.76,percent of total billed charges,80% of total billed charges,1202.67,63,,962.14,percent of total billed charges,63% of total billed charges,1622.65,85,,1298.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1508.11,79,,1206.49,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1813.55,
MRI SACRUM & COCCYX W/WO CONTR,610001984,CDM,614,RC,72197,HCPCS,outpatient,,,2676,1873.2,,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2066.41,77.22,,1653.13,percent of total billed charges,77.22% of total billed charges,1768.84,66.1,,1415.07,percent of total billed charges,66.1% of total billed charges,2221.08,83,,1776.86,percent of total billed charges,83% of total,2542.2,95,,2033.76,percent of total billed charges ,95% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,78% of total billed charges,2087.28,78,,1669.824,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2408.4,90,,1926.72,percent of total billed charges,90% of total billed charges,2140.8,80,,1712.64,percent of total billed charges,80% of total billed charges,1685.88,63,,1348.7,percent of total billed charges,63% of total billed charges,2274.6,85,,1819.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2114.04,79,,1691.23,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2542.2,
MRI LOW EXT JOINT W/WO CONT BI,610001985,CDM,614,RC,73723,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
MRI IMAG POST PROC SPECTROSCOP,610001987,CDM,614,RC,76376,HCPCS,outpatient,,,573,401.1,,452.67,79,,362.14,percent of total billed charges,79% of total billed charges,515.7,90,,412.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.99,63,,288.79,percent of total billed charges,63% of total billed charges,442.47,77.22,,353.98,percent of total billed charges,77.22% of total billed charges,378.75,66.1,,303,percent of total billed charges,66.1% of total billed charges,475.59,83,,380.47,percent of total billed charges,83% of total,544.35,95,,435.48,percent of total billed charges ,95% of total billed charges,458.4,80,,366.72,percent of total billed charges,78% of total billed charges,446.94,78,,357.552,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,360.99,63,,288.79,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,360.99,63,,288.79,percent of total billed charges,63% of total billed charges,487.05,85,,389.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,452.67,79,,362.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,360.99,544.35,
MRI RGHT WRIST ARTHROG W/WO CO,610001988,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI ABD W/O CONT MRCP LMTD CP,610001989,CDM,614,RC,74181,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS 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,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,450,
MRI LOWER EXTREMITY JT W/WO CT,610001990,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
BILAT UPPER EXT JT W/O CONTRAS,610001997,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI RT FEMUR WO CONTRAST,610001998,CDM,614,RC,73718,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1387,
MRI RT TIB/FIB WO CONTRAST,610002000,CDM,614,RC,73718,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1387,
MRI LT FOOT WO CONTRAST,610002001,CDM,614,RC,73718,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1387,
MRI RT FOOT WO CONTRAST,610002002,CDM,614,RC,73718,HCPCS,outpatient,,,1460,1022,,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1127.41,77.22,,901.93,percent of total billed charges,77.22% of total billed charges,965.06,66.1,,772.05,percent of total billed charges,66.1% of total billed charges,1211.8,83,,969.44,percent of total billed charges,83% of total,1387,95,,1109.6,percent of total billed charges ,95% of total billed charges,1168,80,,934.4,percent of total billed charges,78% of total billed charges,1138.8,78,,911.04,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1314,90,,1051.2,percent of total billed charges,90% of total billed charges,1168,80,,934.4,percent of total billed charges,80% of total billed charges,919.8,63,,735.84,percent of total billed charges,63% of total billed charges,1241,85,,992.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1153.4,79,,922.72,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1387,
MRI LT FEMUR W/WO CONTRAST,610002011,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
MRI RT FEMUR W/WO CONTRAST,610002012,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
MRI LT TIB/FIB W/WO CONTRAST,610002013,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
MRI RT TIB/FIB W/WO CONTRAST,610002014,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
MRI LT FOOT W/WO CONTRAST,610002015,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
MRI RT FOOT W/WO CONTRAST,610002016,CDM,614,RC,73720,HCPCS,outpatient,,,2646,1852.2,,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2043.24,77.22,,1634.59,percent of total billed charges,77.22% of total billed charges,1749.01,66.1,,1399.21,percent of total billed charges,66.1% of total billed charges,2196.18,83,,1756.94,percent of total billed charges,83% of total,2513.7,95,,2010.96,percent of total billed charges ,95% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,78% of total billed charges,2063.88,78,,1651.104,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2381.4,90,,1905.12,percent of total billed charges,90% of total billed charges,2116.8,80,,1693.44,percent of total billed charges,80% of total billed charges,1666.98,63,,1333.58,percent of total billed charges,63% of total billed charges,2249.1,85,,1799.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,2090.34,79,,1672.27,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2513.7,
MRI RT ELBOW W/CONTRAST,610002020,CDM,614,RC,73222,HCPCS,outpatient,,,3189,2232.3,,2519.31,79,,2015.45,percent of total billed charges,79% of total billed charges,2870.1,90,,2296.08,percent of total billed charges,90% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,1071.19,160,,,Fee Schedule,160% of CMS OPPS rate,870.35,130,,,Fee Schedule,130% of CMS OPPS rate,2009.07,63,,1607.26,percent of total billed charges,63% of total billed charges,2462.55,77.22,,1970.04,percent of total billed charges,77.22% of total billed charges,2107.93,66.1,,1686.34,percent of total billed charges,66.1% of total billed charges,2646.87,83,,2117.5,percent of total billed charges,83% of total,3029.55,95,,2423.64,percent of total billed charges ,95% of total billed charges,2551.2,80,,2040.96,percent of total billed charges,78% of total billed charges,2487.42,78,,1989.936,percent of total billed charges,78% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,2009.07,63,,1607.26,percent of total billed charges,63% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,2870.1,90,,2296.08,percent of total billed charges,90% of total billed charges,2551.2,80,,2040.96,percent of total billed charges,80% of total billed charges,2009.07,63,,1607.26,percent of total billed charges,63% of total billed charges,2710.65,85,,2168.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,622.63,93,,,fee schedule,93% of CMS OPPS rate,2519.31,79,,2015.45,percent of total billed charges,79% of total billed charges,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,669.5,100,,,Fee Schedule,100% of CMS OPPS rate,450,3029.55,
MRI LT SHOULDER W/O CONTRAST,610002023,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI RT SHOULDER W/O CONTRAST,610002024,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI LT ELBOW W/O CONTRAST,610002025,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI RT ELBOW W/O CONTRAST,610002026,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI LT WRIST W/O CONTRAST,610002027,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI RT WRIST W/O CONTRAST,610002028,CDM,614,RC,73221,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,2277.15,
MRI LT SHOULDER W W/O CONTRAST,610002029,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI RT SHOULDER W W/O CONTRAST,610002030,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI LT ELBOW W W/O CONTRAST,610002031,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI LT WRIST W W/O CONTRAST,610002033,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI RT WRIST W W/O CONTRAST,610002034,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI LT HUMERUS W W/O CONTRAST,610002038,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI RT HUMERUS W W/O CONTRAST,610002039,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI LT FOREARM W W/O CONTRAST,610002040,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI RT FOREARM W W/O CONTRAST,610002041,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI LT HAND W W/O CONTRAST,610002042,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI RT HAND W W/O CONTRAST,610002043,CDM,614,RC,73220,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI LT HUMERUS W/O CONTRAST,610002050,CDM,614,RC,73218,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1502.9,
MRI RT HUMERUS W/O CONTRAST,610002051,CDM,614,RC,73218,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1502.9,
MRI LT FOREARM W/O CONTRAST,610002052,CDM,614,RC,73218,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1502.9,
MRI RT FOREARM W/O CONTRAST,610002053,CDM,614,RC,73218,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1502.9,
MRI LT HAND W/O CONTRAST,610002054,CDM,614,RC,73218,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1502.9,
MRI RT HAND W/O CONTRAST,610002055,CDM,614,RC,73218,HCPCS,outpatient,,,1582,1107.4,,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,1423.8,90,,1139.04,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1221.62,77.22,,977.3,percent of total billed charges,77.22% of total billed charges,1045.7,66.1,,836.56,percent of total billed charges,66.1% of total billed charges,1313.06,83,,1050.45,percent of total billed charges,83% of total,1502.9,95,,1202.32,percent of total billed charges ,95% of total billed charges,1265.6,80,,1012.48,percent of total billed charges,78% of total billed charges,1233.96,78,,987.168,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,996.66,63,,797.33,percent of total billed charges,63% of total billed charges,1344.7,85,,1075.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1249.78,79,,999.82,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1502.9,
MRI LOWER EXT W CONTRAST,610002056,CDM,614,RC,73719,HCPCS,outpatient,,,1654,1157.8,,1306.66,79,,1045.33,percent of total billed charges,79% of total billed charges,1488.6,90,,1190.88,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,1277.22,77.22,,1021.78,percent of total billed charges,77.22% of total billed charges,1093.29,66.1,,874.63,percent of total billed charges,66.1% of total billed charges,1372.82,83,,1098.26,percent of total billed charges,83% of total,1571.3,95,,1257.04,percent of total billed charges ,95% of total billed charges,1323.2,80,,1058.56,percent of total billed charges,78% of total billed charges,1290.12,78,,1032.096,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1488.6,90,,1190.88,percent of total billed charges,90% of total billed charges,1323.2,80,,1058.56,percent of total billed charges,80% of total billed charges,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,1405.9,85,,1124.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1306.66,79,,1045.33,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1571.3,
MRI ARTHROG LT ELB W/WO CONTRA,610002057,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI ARTHRO RT ELB W/WOCONTRAST,610002058,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRI LT WRIST ARTHRO W/WO CONTR,61001987,CDM,614,RC,73223,HCPCS,outpatient,,,2068,1447.6,,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1596.91,77.22,,1277.53,percent of total billed charges,77.22% of total billed charges,1366.95,66.1,,1093.56,percent of total billed charges,66.1% of total billed charges,1716.44,83,,1373.15,percent of total billed charges,83% of total,1964.6,95,,1571.68,percent of total billed charges ,95% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,78% of total billed charges,1613.04,78,,1290.432,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1861.2,90,,1488.96,percent of total billed charges,90% of total billed charges,1654.4,80,,1323.52,percent of total billed charges,80% of total billed charges,1302.84,63,,1042.27,percent of total billed charges,63% of total billed charges,1757.8,85,,1406.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1633.72,79,,1306.98,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1964.6,
MRA CHEST   CP,610080810,CDM,614,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MRA ABDOMEN (MRI) W/O CONTRAST,615001951,CDM,614,RC,74181,HCPCS,outpatient,,,1704,1192.8,,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1315.83,77.22,,1052.66,percent of total billed charges,77.22% of total billed charges,1126.34,66.1,,901.07,percent of total billed charges,66.1% of total billed charges,1414.32,83,,1131.46,percent of total billed charges,83% of total,1618.8,95,,1295.04,percent of total billed charges ,95% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,78% of total billed charges,1329.12,78,,1063.296,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1533.6,90,,1226.88,percent of total billed charges,90% of total billed charges,1363.2,80,,1090.56,percent of total billed charges,80% of total billed charges,1073.52,63,,858.82,percent of total billed charges,63% of total billed charges,1448.4,85,,1158.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1346.16,79,,1076.93,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1618.8,
MRA BRAIN W/O CONTRAST,611001980,CDM,615,RC,70544,HCPCS,outpatient,,,1217,851.9,,961.43,79,,769.14,percent of total billed charges,79% of total billed charges,1095.3,90,,876.24,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,939.77,77.22,,751.82,percent of total billed charges,77.22% of total billed charges,804.44,66.1,,643.55,percent of total billed charges,66.1% of total billed charges,1010.11,83,,808.09,percent of total billed charges,83% of total,1156.15,95,,924.92,percent of total billed charges ,95% of total billed charges,973.6,80,,778.88,percent of total billed charges,78% of total billed charges,949.26,78,,759.408,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,1034.45,85,,827.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,961.43,79,,769.14,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1156.15,
MRA HEAD W/O CONTRAST,615001950,CDM,615,RC,70544,HCPCS,outpatient,,,1217,851.9,,961.43,79,,769.14,percent of total billed charges,79% of total billed charges,1095.3,90,,876.24,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,939.77,77.22,,751.82,percent of total billed charges,77.22% of total billed charges,804.44,66.1,,643.55,percent of total billed charges,66.1% of total billed charges,1010.11,83,,808.09,percent of total billed charges,83% of total,1156.15,95,,924.92,percent of total billed charges ,95% of total billed charges,973.6,80,,778.88,percent of total billed charges,78% of total billed charges,949.26,78,,759.408,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,1034.45,85,,827.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,961.43,79,,769.14,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1156.15,
MRA NECK W/O CONTRAST,615001952,CDM,615,RC,70547,HCPCS,outpatient,,,1217,851.9,,961.43,79,,769.14,percent of total billed charges,79% of total billed charges,1095.3,90,,876.24,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,939.77,77.22,,751.82,percent of total billed charges,77.22% of total billed charges,804.44,66.1,,643.55,percent of total billed charges,66.1% of total billed charges,1010.11,83,,808.09,percent of total billed charges,83% of total,1156.15,95,,924.92,percent of total billed charges ,95% of total billed charges,973.6,80,,778.88,percent of total billed charges,78% of total billed charges,949.26,78,,759.408,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,766.71,63,,613.37,percent of total billed charges,63% of total billed charges,1034.45,85,,827.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,961.43,79,,769.14,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1156.15,
MRA CAROTID ARTERY W CONTRAST,615001954,CDM,615,RC,70548,HCPCS,outpatient,,,2253,1577.1,,1779.87,79,,1423.9,percent of total billed charges,79% of total billed charges,2027.7,90,,1622.16,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1419.39,63,,1135.51,percent of total billed charges,63% of total billed charges,1739.77,77.22,,1391.82,percent of total billed charges,77.22% of total billed charges,1489.23,66.1,,1191.38,percent of total billed charges,66.1% of total billed charges,1869.99,83,,1495.99,percent of total billed charges,83% of total,2140.35,95,,1712.28,percent of total billed charges ,95% of total billed charges,1802.4,80,,1441.92,percent of total billed charges,78% of total billed charges,1757.34,78,,1405.872,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1419.39,63,,1135.51,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,2027.7,90,,1622.16,percent of total billed charges,90% of total billed charges,1802.4,80,,1441.92,percent of total billed charges,80% of total billed charges,1419.39,63,,1135.51,percent of total billed charges,63% of total billed charges,1915.05,85,,1532.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1779.87,79,,1423.9,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,2140.35,
MRA CAROTID ARTERY W/WO CONTRA,615001955,CDM,615,RC,70549,HCPCS,outpatient,,,1946,1362.2,,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,514.51,160,,,Fee Schedule,160% of CMS OPPS rate,418.03,130,,,Fee Schedule,130% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1502.7,77.22,,1202.16,percent of total billed charges,77.22% of total billed charges,1286.31,66.1,,1029.05,percent of total billed charges,66.1% of total billed charges,1615.18,83,,1292.14,percent of total billed charges,83% of total,1848.7,95,,1478.96,percent of total billed charges ,95% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,78% of total billed charges,1517.88,78,,1214.304,percent of total billed charges,78% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,1751.4,90,,1401.12,percent of total billed charges,90% of total billed charges,1556.8,80,,1245.44,percent of total billed charges,80% of total billed charges,1225.98,63,,980.78,percent of total billed charges,63% of total billed charges,1654.1,85,,1323.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,299.06,93,,,fee schedule,93% of CMS OPPS rate,1537.34,79,,1229.87,percent of total billed charges,79% of total billed charges,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,321.57,100,,,Fee Schedule,100% of CMS OPPS rate,299.06,1848.7,
TRIPL STUDY BRAIN/CAROTID CP,615080011,CDM,615,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
MRA LOWER EXTREMITY LEFT,610001973,CDM,616,RC,73725,HCPCS,outpatient,,,2992,2094.4,,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2310.42,77.22,,1848.34,percent of total billed charges,77.22% of total billed charges,1977.71,66.1,,1582.17,percent of total billed charges,66.1% of total billed charges,2483.36,83,,1986.69,percent of total billed charges,83% of total,2842.4,95,,2273.92,percent of total billed charges ,95% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,78% of total billed charges,2333.76,78,,1867.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,80% of total billed charges,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2543.2,85,,2034.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2842.4,
MRA LOWER EXTREMITY RIGHT,610001974,CDM,616,RC,73725,HCPCS,outpatient,,,2992,2094.4,,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2310.42,77.22,,1848.34,percent of total billed charges,77.22% of total billed charges,1977.71,66.1,,1582.17,percent of total billed charges,66.1% of total billed charges,2483.36,83,,1986.69,percent of total billed charges,83% of total,2842.4,95,,2273.92,percent of total billed charges ,95% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,78% of total billed charges,2333.76,78,,1867.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,80% of total billed charges,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2543.2,85,,2034.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2842.4,
MRA LOWER EXTREMITY BILATERAL,610001976,CDM,616,RC,73725,HCPCS,outpatient,,,2992,2094.4,,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2310.42,77.22,,1848.34,percent of total billed charges,77.22% of total billed charges,1977.71,66.1,,1582.17,percent of total billed charges,66.1% of total billed charges,2483.36,83,,1986.69,percent of total billed charges,83% of total,2842.4,95,,2273.92,percent of total billed charges ,95% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,78% of total billed charges,2333.76,78,,1867.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,80% of total billed charges,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2543.2,85,,2034.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2842.4,
MRA LOWER EXT W & W/O CONT BIL,610001991,CDM,616,RC,73725,HCPCS,outpatient,,,2992,2094.4,,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2310.42,77.22,,1848.34,percent of total billed charges,77.22% of total billed charges,1977.71,66.1,,1582.17,percent of total billed charges,66.1% of total billed charges,2483.36,83,,1986.69,percent of total billed charges,83% of total,2842.4,95,,2273.92,percent of total billed charges ,95% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,78% of total billed charges,2333.76,78,,1867.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,80% of total billed charges,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2543.2,85,,2034.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2842.4,
MRA LOWER EXT W & W/O CONT LT,610001992,CDM,616,RC,73725,HCPCS,outpatient,,,2992,2094.4,,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2310.42,77.22,,1848.34,percent of total billed charges,77.22% of total billed charges,1977.71,66.1,,1582.17,percent of total billed charges,66.1% of total billed charges,2483.36,83,,1986.69,percent of total billed charges,83% of total,2842.4,95,,2273.92,percent of total billed charges ,95% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,78% of total billed charges,2333.76,78,,1867.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,80% of total billed charges,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2543.2,85,,2034.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2842.4,
MRA LOWER EXT W CONT RT,610001993,CDM,616,RC,73725,HCPCS,outpatient,,,2992,2094.4,,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2310.42,77.22,,1848.34,percent of total billed charges,77.22% of total billed charges,1977.71,66.1,,1582.17,percent of total billed charges,66.1% of total billed charges,2483.36,83,,1986.69,percent of total billed charges,83% of total,2842.4,95,,2273.92,percent of total billed charges ,95% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,78% of total billed charges,2333.76,78,,1867.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2692.8,90,,2154.24,percent of total billed charges,90% of total billed charges,2393.6,80,,1914.88,percent of total billed charges,80% of total billed charges,1884.96,63,,1507.97,percent of total billed charges,63% of total billed charges,2543.2,85,,2034.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2363.68,79,,1890.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2842.4,
MRA AORTA,610001960,CDM,618,RC,71555,HCPCS,outpatient,,,2775,1942.5,,2192.25,79,,1753.8,percent of total billed charges,79% of total billed charges,2497.5,90,,1998,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,2142.86,77.22,,1714.29,percent of total billed charges,77.22% of total billed charges,1834.28,66.1,,1467.42,percent of total billed charges,66.1% of total billed charges,2303.25,83,,1842.6,percent of total billed charges,83% of total,2636.25,95,,2109,percent of total billed charges ,95% of total billed charges,2220,80,,1776,percent of total billed charges,78% of total billed charges,2164.5,78,,1731.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2497.5,90,,1998,percent of total billed charges,90% of total billed charges,2220,80,,1776,percent of total billed charges,80% of total billed charges,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,2358.75,85,,1887,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2192.25,79,,1753.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2636.25,
MRA UPPER EXTREMITY RT,610001961,CDM,618,RC,73225,HCPCS,outpatient,,,2663,1864.1,,2103.77,79,,1683.02,percent of total billed charges,79% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,2056.37,77.22,,1645.1,percent of total billed charges,77.22% of total billed charges,1760.24,66.1,,1408.19,percent of total billed charges,66.1% of total billed charges,2210.29,83,,1768.23,percent of total billed charges,83% of total,2529.85,95,,2023.88,percent of total billed charges ,95% of total billed charges,2130.4,80,,1704.32,percent of total billed charges,78% of total billed charges,2077.14,78,,1661.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2103.77,79,,1683.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2529.85,
MRA UPPER EXTREMITY LT,610001962,CDM,618,RC,73225,HCPCS,outpatient,,,2663,1864.1,,2103.77,79,,1683.02,percent of total billed charges,79% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,2056.37,77.22,,1645.1,percent of total billed charges,77.22% of total billed charges,1760.24,66.1,,1408.19,percent of total billed charges,66.1% of total billed charges,2210.29,83,,1768.23,percent of total billed charges,83% of total,2529.85,95,,2023.88,percent of total billed charges ,95% of total billed charges,2130.4,80,,1704.32,percent of total billed charges,78% of total billed charges,2077.14,78,,1661.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2103.77,79,,1683.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2529.85,
MRA UPPER EXT BILATRAL,610001977,CDM,618,RC,73225,HCPCS,outpatient,,,2663,1864.1,,2103.77,79,,1683.02,percent of total billed charges,79% of total billed charges,2396.7,90,,1917.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,2056.37,77.22,,1645.1,percent of total billed charges,77.22% of total billed charges,1760.24,66.1,,1408.19,percent of total billed charges,66.1% of total billed charges,2210.29,83,,1768.23,percent of total billed charges,83% of total,2529.85,95,,2023.88,percent of total billed charges ,95% of total billed charges,2130.4,80,,1704.32,percent of total billed charges,78% of total billed charges,2077.14,78,,1661.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1677.69,63,,1342.15,percent of total billed charges,63% of total billed charges,2263.55,85,,1810.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2103.77,79,,1683.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2529.85,
MRA PELVIS W/WO CONTRAST,610001980,CDM,618,RC,72198,HCPCS,outpatient,,,2083,1458.1,,1645.57,79,,1316.46,percent of total billed charges,79% of total billed charges,1874.7,90,,1499.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1312.29,63,,1049.83,percent of total billed charges,63% of total billed charges,1608.49,77.22,,1286.79,percent of total billed charges,77.22% of total billed charges,1376.86,66.1,,1101.49,percent of total billed charges,66.1% of total billed charges,1728.89,83,,1383.11,percent of total billed charges,83% of total,1978.85,95,,1583.08,percent of total billed charges ,95% of total billed charges,1666.4,80,,1333.12,percent of total billed charges,78% of total billed charges,1624.74,78,,1299.792,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1312.29,63,,1049.83,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1874.7,90,,1499.76,percent of total billed charges,90% of total billed charges,1666.4,80,,1333.12,percent of total billed charges,80% of total billed charges,1312.29,63,,1049.83,percent of total billed charges,63% of total billed charges,1770.55,85,,1416.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1645.57,79,,1316.46,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1978.85,
MRA CHEST,610001982,CDM,618,RC,71555,HCPCS,outpatient,,,2775,1942.5,,2192.25,79,,1753.8,percent of total billed charges,79% of total billed charges,2497.5,90,,1998,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,2142.86,77.22,,1714.29,percent of total billed charges,77.22% of total billed charges,1834.28,66.1,,1467.42,percent of total billed charges,66.1% of total billed charges,2303.25,83,,1842.6,percent of total billed charges,83% of total,2636.25,95,,2109,percent of total billed charges ,95% of total billed charges,2220,80,,1776,percent of total billed charges,78% of total billed charges,2164.5,78,,1731.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2497.5,90,,1998,percent of total billed charges,90% of total billed charges,2220,80,,1776,percent of total billed charges,80% of total billed charges,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,2358.75,85,,1887,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2192.25,79,,1753.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2636.25,
MRI ABDOMEN W/WO CONTRAST,610001986,CDM,618,RC,74185,HCPCS,outpatient,,,2817,1971.9,,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2175.29,77.22,,1740.23,percent of total billed charges,77.22% of total billed charges,1862.04,66.1,,1489.63,percent of total billed charges,66.1% of total billed charges,2338.11,83,,1870.49,percent of total billed charges,83% of total,2676.15,95,,2140.92,percent of total billed charges ,95% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,78% of total billed charges,2197.26,78,,1757.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,80% of total billed charges,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2394.45,85,,1915.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2676.15,
MRA ABDOMEN W/WO CONTRAST,615001953,CDM,618,RC,74185,HCPCS,outpatient,,,2817,1971.9,,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2175.29,77.22,,1740.23,percent of total billed charges,77.22% of total billed charges,1862.04,66.1,,1489.63,percent of total billed charges,66.1% of total billed charges,2338.11,83,,1870.49,percent of total billed charges,83% of total,2676.15,95,,2140.92,percent of total billed charges ,95% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,78% of total billed charges,2197.26,78,,1757.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,80% of total billed charges,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2394.45,85,,1915.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2676.15,
MRI/MRA ANGIO ABD W/CONTRAST,615001958,CDM,618,RC,74185,HCPCS,outpatient,,,2817,1971.9,,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2175.29,77.22,,1740.23,percent of total billed charges,77.22% of total billed charges,1862.04,66.1,,1489.63,percent of total billed charges,66.1% of total billed charges,2338.11,83,,1870.49,percent of total billed charges,83% of total,2676.15,95,,2140.92,percent of total billed charges ,95% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,78% of total billed charges,2197.26,78,,1757.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,80% of total billed charges,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2394.45,85,,1915.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2676.15,
MRA ABDOMINAL AORTA,615001959,CDM,618,RC,74185,HCPCS,outpatient,,,2817,1971.9,,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2175.29,77.22,,1740.23,percent of total billed charges,77.22% of total billed charges,1862.04,66.1,,1489.63,percent of total billed charges,66.1% of total billed charges,2338.11,83,,1870.49,percent of total billed charges,83% of total,2676.15,95,,2140.92,percent of total billed charges ,95% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,78% of total billed charges,2197.26,78,,1757.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2535.3,90,,2028.24,percent of total billed charges,90% of total billed charges,2253.6,80,,1802.88,percent of total billed charges,80% of total billed charges,1774.71,63,,1419.77,percent of total billed charges,63% of total billed charges,2394.45,85,,1915.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2225.43,79,,1780.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2676.15,
MRA THORACIC WITH W/O CONTRAST,615001960,CDM,618,RC,71555,HCPCS,outpatient,,,2775,1942.5,,2192.25,79,,1753.8,percent of total billed charges,79% of total billed charges,2497.5,90,,1998,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,2142.86,77.22,,1714.29,percent of total billed charges,77.22% of total billed charges,1834.28,66.1,,1467.42,percent of total billed charges,66.1% of total billed charges,2303.25,83,,1842.6,percent of total billed charges,83% of total,2636.25,95,,2109,percent of total billed charges ,95% of total billed charges,2220,80,,1776,percent of total billed charges,78% of total billed charges,2164.5,78,,1731.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2497.5,90,,1998,percent of total billed charges,90% of total billed charges,2220,80,,1776,percent of total billed charges,80% of total billed charges,1748.25,63,,1398.6,percent of total billed charges,63% of total billed charges,2358.75,85,,1887,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2192.25,79,,1753.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2636.25,
MRI EXAM KIT,270006025,CDM,621,RC,,,outpatient,,,101,70.7,,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,90.9,90,,72.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,77.99,77.22,,62.39,percent of total billed charges,77.22% of total billed charges,66.76,66.1,,53.41,percent of total billed charges,66.1% of total billed charges,83.83,83,,67.06,percent of total billed charges,83% of total,95.95,95,,76.76,percent of total billed charges ,95% of total billed charges,80.8,80,,64.64,percent of total billed charges,78% of total billed charges,78.78,78,,63.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63.63,63,,50.9,percent of total billed charges,63% of total billed charges,85.85,85,,68.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79.79,79,,63.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.63,450,
BASW EXAM KIT,270050018,CDM,621,RC,,,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
AXIOFILL 1000MG MIMEDX,250000015,CDM,636,RC,J3590,HCPCS,outpatient,,,3970,2779,,3136.3,79,,2509.04,percent of total billed charges,79% of total billed charges,3573,90,,2858.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2200000,100,,,fee schedule,100% of GA fee schedule,3065.63,77.22,,2452.5,percent of total billed charges,77.22% of total billed charges,2310000,105,,,fee schedule,105% of GA fee schedule,3295.1,83,,2636.08,percent of total billed charges,83% of total,3771.5,95,,3017.2,percent of total billed charges ,95% of total billed charges,3176,80,,2540.8,percent of total billed charges,78% of total billed charges,3096.6,78,,2477.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2200000,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,3573,90,,2858.4,percent of total billed charges,90% of total billed charges,3176,80,,2540.8,percent of total billed charges,80% of total billed charges,2200000,100,,,fee schedule,100% of GA fee schedule,3374.5,85,,2699.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3136.3,79,,2509.04,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2310000,
BICILLIN L-A 1.2MMU TUBEX,250015115,CDM,636,RC,J0561,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,38.99,160,,,Fee Schedule,160% of CMS OPPS rate,31.68,130,,,Fee Schedule,130% of CMS OPPS rate,24.37,100,,,fee schedule,100% of GA fee schedule,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,25.59,105,,,fee schedule,105% of GA fee schedule,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,24.37,100,,,fee schedule,100% of GA fee schedule,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,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,24.37,100,,,fee schedule,100% of GA fee schedule,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.66,93,,,fee schedule,93% of CMS OPPS rate,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,22.66,450,
"BICILLIN LA 600,000 UNIT",250015116,CDM,636,RC,J0561,HCPCS,outpatient,,,61,42.7,,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,54.9,90,,43.92,percent of total billed charges,90% of total billed charges,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,38.99,160,,,Fee Schedule,160% of CMS OPPS rate,31.68,130,,,Fee Schedule,130% of CMS OPPS rate,24.37,100,,,fee schedule,100% of GA fee schedule,47.1,77.22,,37.68,percent of total billed charges,77.22% of total billed charges,25.59,105,,,fee schedule,105% of GA fee schedule,50.63,83,,40.5,percent of total billed charges,83% of total,57.95,95,,46.36,percent of total billed charges ,95% of total billed charges,48.8,80,,39.04,percent of total billed charges,78% of total billed charges,47.58,78,,38.064,percent of total billed charges,78% of total billed charges,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,24.37,100,,,fee schedule,100% of GA fee schedule,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,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,24.37,100,,,fee schedule,100% of GA fee schedule,51.85,85,,41.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.66,93,,,fee schedule,93% of CMS OPPS rate,48.19,79,,38.55,percent of total billed charges,79% of total billed charges,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,24.37,100,,,Fee Schedule,100% of CMS OPPS rate,22.66,450,
ERYTHROMYCIN 500MG IV,250015345,CDM,636,RC,J1364,HCPCS,outpatient,,,151,105.7,,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,135.9,90,,108.72,percent of total billed charges,90% of total billed charges,57.37,100,,,Fee Schedule,100% of CMS OPPS rate,91.79,160,,,Fee Schedule,160% of CMS OPPS rate,74.58,130,,,Fee Schedule,130% of CMS OPPS rate,65.38,100,,,fee schedule,100% of GA fee schedule,116.6,77.22,,93.28,percent of total billed charges,77.22% of total billed charges,68.65,105,,,fee schedule,105% of GA fee schedule,125.33,83,,100.26,percent of total billed charges,83% of total,143.45,95,,114.76,percent of total billed charges ,95% of total billed charges,120.8,80,,96.64,percent of total billed charges,78% of total billed charges,117.78,78,,94.224,percent of total billed charges,78% of total billed charges,57.37,100,,,Fee Schedule,100% of CMS OPPS rate,65.38,100,,,fee schedule,100% of GA fee schedule,57.37,100,,,Fee Schedule,100% of CMS OPPS rate,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,65.38,100,,,fee schedule,100% of GA fee schedule,128.35,85,,102.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,53.35,93,,,fee schedule,93% of CMS OPPS rate,119.29,79,,95.43,percent of total billed charges,79% of total billed charges,57.37,100,,,Fee Schedule,100% of CMS OPPS rate,57.37,100,,,Fee Schedule,100% of CMS OPPS rate,53.35,450,
GLUCAGON INJECTION 1MG AMP,250015393,CDM,636,RC,J1610,HCPCS,outpatient,,,547,382.9,,432.13,79,,345.7,percent of total billed charges,79% of total billed charges,492.3,90,,393.84,percent of total billed charges,90% of total billed charges,192.3,100,,,Fee Schedule,100% of CMS OPPS rate,307.68,160,,,Fee Schedule,160% of CMS OPPS rate,249.99,130,,,Fee Schedule,130% of CMS OPPS rate,192.3,100,,,fee schedule,100% of GA fee schedule,422.39,77.22,,337.91,percent of total billed charges,77.22% of total billed charges,201.92,105,,,fee schedule,105% of GA fee schedule,454.01,83,,363.21,percent of total billed charges,83% of total,519.65,95,,415.72,percent of total billed charges ,95% of total billed charges,437.6,80,,350.08,percent of total billed charges,78% of total billed charges,426.66,78,,341.328,percent of total billed charges,78% of total billed charges,192.3,100,,,Fee Schedule,100% of CMS OPPS rate,192.3,100,,,fee schedule,100% of GA fee schedule,192.3,100,,,Fee Schedule,100% of CMS OPPS rate,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,192.3,100,,,fee schedule,100% of GA fee schedule,464.95,85,,371.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,178.83,93,,,fee schedule,93% of CMS OPPS rate,432.13,79,,345.7,percent of total billed charges,79% of total billed charges,192.3,100,,,Fee Schedule,100% of CMS OPPS rate,192.3,100,,,Fee Schedule,100% of CMS OPPS rate,178.83,519.65,
LANOXIN .5GM AMP,250015492,CDM,636,RC,J1160,HCPCS,outpatient,,,36,25.2,,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,32.4,90,,25.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.72,100,,,fee schedule,100% of GA fee schedule,27.8,77.22,,22.24,percent of total billed charges,77.22% of total billed charges,16.51,105,,,fee schedule,105% of GA fee schedule,29.88,83,,23.9,percent of total billed charges,83% of total,34.2,95,,27.36,percent of total billed charges ,95% of total billed charges,28.8,80,,23.04,percent of total billed charges,78% of total billed charges,28.08,78,,22.464,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.72,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,15.72,100,,,fee schedule,100% of GA fee schedule,30.6,85,,24.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,28.44,79,,22.75,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.72,450,
METHYLENE BLUE AMP,250015564,CDM,636,RC,Q9968,HCPCS,outpatient,,,62,43.4,,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,55.8,90,,44.64,percent of total billed charges,90% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,13.64,160,,,Fee Schedule,160% of CMS OPPS rate,11.08,130,,,Fee Schedule,130% of CMS OPPS rate,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,47.88,77.22,,38.3,percent of total billed charges,77.22% of total billed charges,40.98,66.1,,32.78,percent of total billed charges,66.1% of total billed charges,51.46,83,,41.17,percent of total billed charges,83% of total,58.9,95,,47.12,percent of total billed charges ,95% of total billed charges,49.6,80,,39.68,percent of total billed charges,78% of total billed charges,48.36,78,,38.688,percent of total billed charges,78% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,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,39.06,63,,31.25,percent of total billed charges,63% of total billed charges,52.7,85,,42.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.93,93,,,fee schedule,93% of CMS OPPS rate,48.98,79,,39.18,percent of total billed charges,79% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,7.93,450,
PREMARIN INJ 25 MG/5 ML VIAL,250015757,CDM,636,RC,J1410,HCPCS,outpatient,,,185,129.5,,146.15,79,,116.92,percent of total billed charges,79% of total billed charges,166.5,90,,133.2,percent of total billed charges,90% of total billed charges,382.79,100,,,Fee Schedule,100% of CMS OPPS rate,612.46,160,,,Fee Schedule,160% of CMS OPPS rate,497.62,130,,,Fee Schedule,130% of CMS OPPS rate,382.79,100,,,fee schedule,100% of GA fee schedule,142.86,77.22,,114.29,percent of total billed charges,77.22% of total billed charges,401.93,105,,,fee schedule,105% of GA fee schedule,153.55,83,,122.84,percent of total billed charges,83% of total,175.75,95,,140.6,percent of total billed charges ,95% of total billed charges,148,80,,118.4,percent of total billed charges,78% of total billed charges,144.3,78,,115.44,percent of total billed charges,78% of total billed charges,382.79,100,,,Fee Schedule,100% of CMS OPPS rate,382.79,100,,,fee schedule,100% of GA fee schedule,382.79,100,,,Fee Schedule,100% of CMS OPPS rate,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,382.79,100,,,fee schedule,100% of GA fee schedule,157.25,85,,125.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,355.99,93,,,fee schedule,93% of CMS OPPS rate,146.15,79,,116.92,percent of total billed charges,79% of total billed charges,382.79,100,,,Fee Schedule,100% of CMS OPPS rate,382.79,100,,,Fee Schedule,100% of CMS OPPS rate,142.86,612.46,
PROTOPAM CHL 1GM VIAL,250015777,CDM,636,RC,J2730,HCPCS,outpatient,,,238,166.6,,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,214.2,90,,171.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,183.78,77.22,,147.02,percent of total billed charges,77.22% of total billed charges,157.32,66.1,,125.86,percent of total billed charges,66.1% of total billed charges,197.54,83,,158.03,percent of total billed charges,83% of total,226.1,95,,180.88,percent of total billed charges ,95% of total billed charges,190.4,80,,152.32,percent of total billed charges,78% of total billed charges,185.64,78,,148.512,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,149.94,63,,119.95,percent of total billed charges,63% of total billed charges,202.3,85,,161.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,188.02,79,,150.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,149.94,450,
TETANUS PED DT <7YRS,250015900,CDM,636,RC,90702,HCPCS,outpatient,,,53,37.1,,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,47.7,90,,38.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,40.93,77.22,,32.74,percent of total billed charges,77.22% of total billed charges,35.03,66.1,,28.02,percent of total billed charges,66.1% of total billed charges,43.99,83,,35.19,percent of total billed charges,83% of total,50.35,95,,40.28,percent of total billed charges ,95% of total billed charges,42.4,80,,33.92,percent of total billed charges,78% of total billed charges,41.34,78,,33.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,33.39,63,,26.71,percent of total billed charges,63% of total billed charges,45.05,85,,36.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,41.87,79,,33.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.39,450,
TETANUS IMMUNE GLOB 250U,250015901,CDM,636,RC,J1670,HCPCS,outpatient,,,181,126.7,,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,162.9,90,,130.32,percent of total billed charges,90% of total billed charges,581.78,100,,,Fee Schedule,100% of CMS OPPS rate,930.84,160,,,Fee Schedule,160% of CMS OPPS rate,756.31,130,,,Fee Schedule,130% of CMS OPPS rate,581.78,100,,,fee schedule,100% of GA fee schedule,139.77,77.22,,111.82,percent of total billed charges,77.22% of total billed charges,610.87,105,,,fee schedule,105% of GA fee schedule,150.23,83,,120.18,percent of total billed charges,83% of total,171.95,95,,137.56,percent of total billed charges ,95% of total billed charges,144.8,80,,115.84,percent of total billed charges,78% of total billed charges,141.18,78,,112.944,percent of total billed charges,78% of total billed charges,581.78,100,,,Fee Schedule,100% of CMS OPPS rate,581.78,100,,,fee schedule,100% of GA fee schedule,581.78,100,,,Fee Schedule,100% of CMS OPPS rate,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,581.78,100,,,fee schedule,100% of GA fee schedule,153.85,85,,123.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,541.04,93,,,fee schedule,93% of CMS OPPS rate,142.99,79,,114.39,percent of total billed charges,79% of total billed charges,581.78,100,,,Fee Schedule,100% of CMS OPPS rate,581.78,100,,,Fee Schedule,100% of CMS OPPS rate,139.77,930.84,
NEUPOGEN 1MCG/FILGRASTIM G-CSF,250016226,CDM,636,RC,J1442,HCPCS,outpatient,,,713,499.1,,563.27,79,,450.62,percent of total billed charges,79% of total billed charges,641.7,90,,513.36,percent of total billed charges,90% of total billed charges,1,100,,,Fee Schedule,100% of CMS OPPS rate,1.6,160,,,Fee Schedule,160% of CMS OPPS rate,1.3,130,,,Fee Schedule,130% of CMS OPPS rate,1,100,,,fee schedule,100% of GA fee schedule,550.58,77.22,,440.46,percent of total billed charges,77.22% of total billed charges,1.05,105,,,fee schedule,105% of GA fee schedule,591.79,83,,473.43,percent of total billed charges,83% of total,677.35,95,,541.88,percent of total billed charges ,95% of total billed charges,570.4,80,,456.32,percent of total billed charges,78% of total billed charges,556.14,78,,444.912,percent of total billed charges,78% of total billed charges,1,100,,,Fee Schedule,100% of CMS OPPS rate,1,100,,,fee schedule,100% of GA fee schedule,1,100,,,Fee Schedule,100% of CMS OPPS rate,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,1,100,,,fee schedule,100% of GA fee schedule,606.05,85,,484.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,0.93,93,,,fee schedule,93% of CMS OPPS rate,563.27,79,,450.62,percent of total billed charges,79% of total billed charges,1,100,,,Fee Schedule,100% of CMS OPPS rate,1,100,,,Fee Schedule,100% of CMS OPPS rate,0.93,677.35,
DDAVP 4MCG/ML INJ 10 ML,250016238,CDM,636,RC,J2597,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,8.67,160,,,Fee Schedule,160% of CMS OPPS rate,7.04,130,,,Fee Schedule,130% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.04,93,,,fee schedule,93% of CMS OPPS rate,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,5.04,450,
ACTIVASE 100MG VIAL,250016254,CDM,636,RC,J2997,HCPCS,outpatient,,,8187,5730.9,,6467.73,79,,5174.18,percent of total billed charges,79% of total billed charges,7368.3,90,,5894.64,percent of total billed charges,90% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,146.35,160,,,Fee Schedule,160% of CMS OPPS rate,118.91,130,,,Fee Schedule,130% of CMS OPPS rate,5157.81,63,,4126.25,percent of total billed charges,63% of total billed charges,6322,77.22,,5057.6,percent of total billed charges,77.22% of total billed charges,5411.61,66.1,,4329.29,percent of total billed charges,66.1% of total billed charges,6795.21,83,,5436.17,percent of total billed charges,83% of total,7777.65,95,,6222.12,percent of total billed charges ,95% of total billed charges,6549.6,80,,5239.68,percent of total billed charges,78% of total billed charges,6385.86,78,,5108.688,percent of total billed charges,78% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,5157.81,63,,4126.25,percent of total billed charges,63% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,7368.3,90,,5894.64,percent of total billed charges,90% of total billed charges,6549.6,80,,5239.68,percent of total billed charges,80% of total billed charges,5157.81,63,,4126.25,percent of total billed charges,63% of total billed charges,6958.95,85,,5567.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.06,93,,,fee schedule,93% of CMS OPPS rate,6467.73,79,,5174.18,percent of total billed charges,79% of total billed charges,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,85.06,7777.65,
"EPOETIN  10,000 UNITS",250016711,CDM,636,RC,J0885,HCPCS,outpatient,,,552,386.4,,436.08,79,,348.86,percent of total billed charges,79% of total billed charges,496.8,90,,397.44,percent of total billed charges,90% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,12.04,160,,,Fee Schedule,160% of CMS OPPS rate,9.77,130,,,Fee Schedule,130% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,426.25,77.22,,341,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,458.16,83,,366.53,percent of total billed charges,83% of total,524.4,95,,419.52,percent of total billed charges ,95% of total billed charges,441.6,80,,353.28,percent of total billed charges,78% of total billed charges,430.56,78,,344.448,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,496.8,90,,397.44,percent of total billed charges,90% of total billed charges,441.6,80,,353.28,percent of total billed charges,80% of total billed charges,7.53,100,,,fee schedule,100% of GA fee schedule,469.2,85,,375.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7,93,,,fee schedule,93% of CMS OPPS rate,436.08,79,,348.86,percent of total billed charges,79% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7,524.4,
HEPATITIS B IMMUNE GLOBULN,250016906,CDM,636,RC,90371,HCPCS,outpatient,,,639,447.3,,504.81,79,,403.85,percent of total billed charges,79% of total billed charges,575.1,90,,460.08,percent of total billed charges,90% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,223.88,160,,,Fee Schedule,160% of CMS OPPS rate,181.9,130,,,Fee Schedule,130% of CMS OPPS rate,139.93,100,,,fee schedule,100% of GA fee schedule,493.44,77.22,,394.75,percent of total billed charges,77.22% of total billed charges,146.93,105,,,fee schedule,105% of GA fee schedule,530.37,83,,424.3,percent of total billed charges,83% of total,607.05,95,,485.64,percent of total billed charges ,95% of total billed charges,511.2,80,,408.96,percent of total billed charges,78% of total billed charges,498.42,78,,398.736,percent of total billed charges,78% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,139.93,100,,,fee schedule,100% of GA fee schedule,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,575.1,90,,460.08,percent of total billed charges,90% of total billed charges,511.2,80,,408.96,percent of total billed charges,80% of total billed charges,139.93,100,,,fee schedule,100% of GA fee schedule,543.15,85,,434.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,130.13,93,,,fee schedule,93% of CMS OPPS rate,504.81,79,,403.85,percent of total billed charges,79% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,130.13,607.05,
PEDVAX HIB INJ U/D,250016993,CDM,636,RC,90647,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,109.73,66.1,,87.78,percent of total billed charges,66.1% of total billed charges,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,104.58,63,,83.66,percent of total billed charges,63% of total billed charges,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,104.58,450,
PROCRIT 4000N/ML INJ,250016994,CDM,636,RC,J0885,HCPCS,outpatient,,,212,148.4,,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,190.8,90,,152.64,percent of total billed charges,90% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,12.04,160,,,Fee Schedule,160% of CMS OPPS rate,9.77,130,,,Fee Schedule,130% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,163.71,77.22,,130.97,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,175.96,83,,140.77,percent of total billed charges,83% of total,201.4,95,,161.12,percent of total billed charges ,95% of total billed charges,169.6,80,,135.68,percent of total billed charges,78% of total billed charges,165.36,78,,132.288,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,7.53,100,,,fee schedule,100% of GA fee schedule,180.2,85,,144.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7,93,,,fee schedule,93% of CMS OPPS rate,167.48,79,,133.98,percent of total billed charges,79% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7,450,
PNEUMOCOCCAL VACC 23 VALENT,250017198,CDM,636,RC,90732,HCPCS,outpatient,,,475,332.5,,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,427.5,90,,342,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.47,100,,,fee schedule,100% of GA fee schedule,366.8,77.22,,293.44,percent of total billed charges,77.22% of total billed charges,140.14,105,,,fee schedule,105% of GA fee schedule,394.25,83,,315.4,percent of total billed charges,83% of total,451.25,95,,361,percent of total billed charges ,95% of total billed charges,380,80,,304,percent of total billed charges,78% of total billed charges,370.5,78,,296.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,133.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,427.5,90,,342,percent of total billed charges,90% of total billed charges,380,80,,304,percent of total billed charges,80% of total billed charges,133.47,100,,,fee schedule,100% of GA fee schedule,403.75,85,,323,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,375.25,79,,300.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.47,451.25,
EPOETIN ALFA 40000 U/ML VIAL,250017216,CDM,636,RC,J0885,HCPCS,outpatient,,,1941,1358.7,,1533.39,79,,1226.71,percent of total billed charges,79% of total billed charges,1746.9,90,,1397.52,percent of total billed charges,90% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,12.04,160,,,Fee Schedule,160% of CMS OPPS rate,9.77,130,,,Fee Schedule,130% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,1498.84,77.22,,1199.07,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,1611.03,83,,1288.82,percent of total billed charges,83% of total,1843.95,95,,1475.16,percent of total billed charges ,95% of total billed charges,1552.8,80,,1242.24,percent of total billed charges,78% of total billed charges,1513.98,78,,1211.184,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,7.53,100,,,fee schedule,100% of GA fee schedule,1649.85,85,,1319.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7,93,,,fee schedule,93% of CMS OPPS rate,1533.39,79,,1226.71,percent of total billed charges,79% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7,1843.95,
HEPATITIS B IMMUNE GLOB 5ML,250017350,CDM,636,RC,90371,HCPCS,outpatient,,,2617,1831.9,,2067.43,79,,1653.94,percent of total billed charges,79% of total billed charges,2355.3,90,,1884.24,percent of total billed charges,90% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,223.88,160,,,Fee Schedule,160% of CMS OPPS rate,181.9,130,,,Fee Schedule,130% of CMS OPPS rate,139.93,100,,,fee schedule,100% of GA fee schedule,2020.85,77.22,,1616.68,percent of total billed charges,77.22% of total billed charges,146.93,105,,,fee schedule,105% of GA fee schedule,2172.11,83,,1737.69,percent of total billed charges,83% of total,2486.15,95,,1988.92,percent of total billed charges ,95% of total billed charges,2093.6,80,,1674.88,percent of total billed charges,78% of total billed charges,2041.26,78,,1633.008,percent of total billed charges,78% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,139.93,100,,,fee schedule,100% of GA fee schedule,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,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,139.93,100,,,fee schedule,100% of GA fee schedule,2224.45,85,,1779.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,130.13,93,,,fee schedule,93% of CMS OPPS rate,2067.43,79,,1653.94,percent of total billed charges,79% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,130.13,2486.15,
TENECTEPLASE 50 MG/KIT,250017372,CDM,636,RC,J3101,HCPCS,outpatient,,,10692,7484.4,,8446.68,79,,6757.34,percent of total billed charges,79% of total billed charges,9622.8,90,,7698.24,percent of total billed charges,90% of total billed charges,157.72,100,,,Fee Schedule,100% of CMS OPPS rate,252.35,160,,,Fee Schedule,160% of CMS OPPS rate,205.03,130,,,Fee Schedule,130% of CMS OPPS rate,6735.96,63,,5388.77,percent of total billed charges,63% of total billed charges,8256.36,77.22,,6605.09,percent of total billed charges,77.22% of total billed charges,7067.41,66.1,,5653.93,percent of total billed charges,66.1% of total billed charges,8874.36,83,,7099.49,percent of total billed charges,83% of total,10157.4,95,,8125.92,percent of total billed charges ,95% of total billed charges,8553.6,80,,6842.88,percent of total billed charges,78% of total billed charges,8339.76,78,,6671.808,percent of total billed charges,78% of total billed charges,157.72,100,,,Fee Schedule,100% of CMS OPPS rate,6735.96,63,,5388.77,percent of total billed charges,63% of total billed charges,157.72,100,,,Fee Schedule,100% of CMS OPPS rate,9622.8,90,,7698.24,percent of total billed charges,90% of total billed charges,8553.6,80,,6842.88,percent of total billed charges,80% of total billed charges,6735.96,63,,5388.77,percent of total billed charges,63% of total billed charges,9088.2,85,,7270.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,146.66,93,,,fee schedule,93% of CMS OPPS rate,8446.68,79,,6757.34,percent of total billed charges,79% of total billed charges,157.72,100,,,Fee Schedule,100% of CMS OPPS rate,157.72,100,,,Fee Schedule,100% of CMS OPPS rate,146.66,10157.4,
"ANTIVENIN,CROTALIDAE 10ML VIAL",250017421,CDM,636,RC,J0840,HCPCS,outpatient,,,4165,2915.5,,3290.35,79,,2632.28,percent of total billed charges,79% of total billed charges,3748.5,90,,2998.8,percent of total billed charges,90% of total billed charges,1762.35,100,,,Fee Schedule,100% of CMS OPPS rate,2819.76,160,,,Fee Schedule,160% of CMS OPPS rate,2291.05,130,,,Fee Schedule,130% of CMS OPPS rate,2623.95,63,,2099.16,percent of total billed charges,63% of total billed charges,3216.21,77.22,,2572.97,percent of total billed charges,77.22% of total billed charges,2753.07,66.1,,2202.46,percent of total billed charges,66.1% of total billed charges,3456.95,83,,2765.56,percent of total billed charges,83% of total,3956.75,95,,3165.4,percent of total billed charges ,95% of total billed charges,3332,80,,2665.6,percent of total billed charges,78% of total billed charges,3248.7,78,,2598.96,percent of total billed charges,78% of total billed charges,1762.35,100,,,Fee Schedule,100% of CMS OPPS rate,2623.95,63,,2099.16,percent of total billed charges,63% of total billed charges,1762.35,100,,,Fee Schedule,100% of CMS OPPS rate,3748.5,90,,2998.8,percent of total billed charges,90% of total billed charges,3332,80,,2665.6,percent of total billed charges,80% of total billed charges,2623.95,63,,2099.16,percent of total billed charges,63% of total billed charges,3540.25,85,,2832.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1638.98,93,,,fee schedule,93% of CMS OPPS rate,3290.35,79,,2632.28,percent of total billed charges,79% of total billed charges,1762.35,100,,,Fee Schedule,100% of CMS OPPS rate,1762.35,100,,,Fee Schedule,100% of CMS OPPS rate,450,3956.75,
MICONAZOLE NITRATE CR KIT,250017485,CDM,636,RC,A9270,HCPCS,outpatient,,,203,142.1,,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,182.7,90,,146.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,156.76,77.22,,125.41,percent of total billed charges,77.22% of total billed charges,134.18,66.1,,107.34,percent of total billed charges,66.1% of total billed charges,168.49,83,,134.79,percent of total billed charges,83% of total,192.85,95,,154.28,percent of total billed charges ,95% of total billed charges,162.4,80,,129.92,percent of total billed charges,78% of total billed charges,158.34,78,,126.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,127.89,63,,102.31,percent of total billed charges,63% of total billed charges,172.55,85,,138.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,160.37,79,,128.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.89,450,
HEPATITIS B IMMUNE GLOB 0.5ML,250017487,CDM,636,RC,90371,HCPCS,outpatient,,,373,261.1,,294.67,79,,235.74,percent of total billed charges,79% of total billed charges,335.7,90,,268.56,percent of total billed charges,90% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,223.88,160,,,Fee Schedule,160% of CMS OPPS rate,181.9,130,,,Fee Schedule,130% of CMS OPPS rate,139.93,100,,,fee schedule,100% of GA fee schedule,288.03,77.22,,230.42,percent of total billed charges,77.22% of total billed charges,146.93,105,,,fee schedule,105% of GA fee schedule,309.59,83,,247.67,percent of total billed charges,83% of total,354.35,95,,283.48,percent of total billed charges ,95% of total billed charges,298.4,80,,238.72,percent of total billed charges,78% of total billed charges,290.94,78,,232.752,percent of total billed charges,78% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,139.93,100,,,fee schedule,100% of GA fee schedule,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,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,139.93,100,,,fee schedule,100% of GA fee schedule,317.05,85,,253.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,130.13,93,,,fee schedule,93% of CMS OPPS rate,294.67,79,,235.74,percent of total billed charges,79% of total billed charges,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,139.93,100,,,Fee Schedule,100% of CMS OPPS rate,130.13,450,
EPOETIN ALFA 1000 U/VIAL,250017496,CDM,636,RC,J0885,HCPCS,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,12.04,160,,,Fee Schedule,160% of CMS OPPS rate,9.77,130,,,Fee Schedule,130% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,7.53,100,,,fee schedule,100% of GA fee schedule,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7,93,,,fee schedule,93% of CMS OPPS rate,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7,450,
REMICADE 100MG,250017509,CDM,636,RC,J1745,HCPCS,outpatient,,,1979,1385.3,,1563.41,79,,1250.73,percent of total billed charges,79% of total billed charges,1781.1,90,,1424.88,percent of total billed charges,90% of total billed charges,32.22,100,,,Fee Schedule,100% of CMS OPPS rate,51.55,160,,,Fee Schedule,160% of CMS OPPS rate,41.88,130,,,Fee Schedule,130% of CMS OPPS rate,32.22,100,,,fee schedule,100% of GA fee schedule,1528.18,77.22,,1222.54,percent of total billed charges,77.22% of total billed charges,33.83,105,,,fee schedule,105% of GA fee schedule,1642.57,83,,1314.06,percent of total billed charges,83% of total,1880.05,95,,1504.04,percent of total billed charges ,95% of total billed charges,1583.2,80,,1266.56,percent of total billed charges,78% of total billed charges,1543.62,78,,1234.896,percent of total billed charges,78% of total billed charges,32.22,100,,,Fee Schedule,100% of CMS OPPS rate,32.22,100,,,fee schedule,100% of GA fee schedule,32.22,100,,,Fee Schedule,100% of CMS OPPS rate,1781.1,90,,1424.88,percent of total billed charges,90% of total billed charges,1583.2,80,,1266.56,percent of total billed charges,80% of total billed charges,32.22,100,,,fee schedule,100% of GA fee schedule,1682.15,85,,1345.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,29.96,93,,,fee schedule,93% of CMS OPPS rate,1563.41,79,,1250.73,percent of total billed charges,79% of total billed charges,32.22,100,,,Fee Schedule,100% of CMS OPPS rate,32.22,100,,,Fee Schedule,100% of CMS OPPS rate,29.96,1880.05,
HEP B VIR VACC RECOMB 20MCG/ML,250019048,CDM,636,RC,90740,HCPCS,outpatient,,,129,90.3,,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,116.1,90,,92.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,99.61,77.22,,79.69,percent of total billed charges,77.22% of total billed charges,85.27,66.1,,68.22,percent of total billed charges,66.1% of total billed charges,107.07,83,,85.66,percent of total billed charges,83% of total,122.55,95,,98.04,percent of total billed charges ,95% of total billed charges,103.2,80,,82.56,percent of total billed charges,78% of total billed charges,100.62,78,,80.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,81.27,63,,65.02,percent of total billed charges,63% of total billed charges,109.65,85,,87.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,101.91,79,,81.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.27,450,
HAPATITIS B IMMUNE GLOBUL 1ML,250019066,CDM,636,RC,J1571,HCPCS,outpatient,,,522,365.4,,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,469.8,90,,375.84,percent of total billed charges,90% of total billed charges,68.66,100,,,Fee Schedule,100% of CMS OPPS rate,109.85,160,,,Fee Schedule,160% of CMS OPPS rate,89.25,130,,,Fee Schedule,130% of CMS OPPS rate,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,403.09,77.22,,322.47,percent of total billed charges,77.22% of total billed charges,345.04,66.1,,276.03,percent of total billed charges,66.1% of total billed charges,433.26,83,,346.61,percent of total billed charges,83% of total,495.9,95,,396.72,percent of total billed charges ,95% of total billed charges,417.6,80,,334.08,percent of total billed charges,78% of total billed charges,407.16,78,,325.728,percent of total billed charges,78% of total billed charges,68.66,100,,,Fee Schedule,100% of CMS OPPS rate,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,68.66,100,,,Fee Schedule,100% of CMS OPPS rate,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,328.86,63,,263.09,percent of total billed charges,63% of total billed charges,443.7,85,,354.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,63.85,93,,,fee schedule,93% of CMS OPPS rate,412.38,79,,329.9,percent of total billed charges,79% of total billed charges,68.66,100,,,Fee Schedule,100% of CMS OPPS rate,68.66,100,,,Fee Schedule,100% of CMS OPPS rate,63.85,495.9,
DESMOPRESSIN ACETATE 4MCG/ML V,250019069,CDM,636,RC,J2597,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,8.67,160,,,Fee Schedule,160% of CMS OPPS rate,7.04,130,,,Fee Schedule,130% of CMS OPPS rate,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.04,93,,,fee schedule,93% of CMS OPPS rate,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,5.42,100,,,Fee Schedule,100% of CMS OPPS rate,5.04,450,
"MEASLES,MUMPS&RUBELLA VACCINE",250019075,CDM,636,RC,90707,HCPCS,outpatient,,,188,131.6,,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,169.2,90,,135.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.49,100,,,fee schedule,100% of GA fee schedule,145.17,77.22,,116.14,percent of total billed charges,77.22% of total billed charges,97.11,105,,,fee schedule,105% of GA fee schedule,156.04,83,,124.83,percent of total billed charges,83% of total,178.6,95,,142.88,percent of total billed charges ,95% of total billed charges,150.4,80,,120.32,percent of total billed charges,78% of total billed charges,146.64,78,,117.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,92.49,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,92.49,100,,,fee schedule,100% of GA fee schedule,159.8,85,,127.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,148.52,79,,118.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.49,450,
"RABIES VAC,PF CHICK-EMB CELL",250019076,CDM,636,RC,90675,HCPCS,outpatient,,,891,623.7,,703.89,79,,563.11,percent of total billed charges,79% of total billed charges,801.9,90,,641.52,percent of total billed charges,90% of total billed charges,350.14,100,,,Fee Schedule,100% of CMS OPPS rate,560.22,160,,,Fee Schedule,160% of CMS OPPS rate,455.18,130,,,Fee Schedule,130% of CMS OPPS rate,350.14,100,,,fee schedule,100% of GA fee schedule,688.03,77.22,,550.42,percent of total billed charges,77.22% of total billed charges,367.65,105,,,fee schedule,105% of GA fee schedule,739.53,83,,591.62,percent of total billed charges,83% of total,846.45,95,,677.16,percent of total billed charges ,95% of total billed charges,712.8,80,,570.24,percent of total billed charges,78% of total billed charges,694.98,78,,555.984,percent of total billed charges,78% of total billed charges,350.14,100,,,Fee Schedule,100% of CMS OPPS rate,350.14,100,,,fee schedule,100% of GA fee schedule,350.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,350.14,100,,,fee schedule,100% of GA fee schedule,757.35,85,,605.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,325.63,93,,,fee schedule,93% of CMS OPPS rate,703.89,79,,563.11,percent of total billed charges,79% of total billed charges,350.14,100,,,Fee Schedule,100% of CMS OPPS rate,350.14,100,,,Fee Schedule,100% of CMS OPPS rate,325.63,846.45,
RABIES IMMUNE GLOBULIN/THIMER,250019112,CDM,636,RC,90375,HCPCS,outpatient,,,966,676.2,,763.14,79,,610.51,percent of total billed charges,79% of total billed charges,869.4,90,,695.52,percent of total billed charges,90% of total billed charges,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,460.33,160,,,Fee Schedule,160% of CMS OPPS rate,374.02,130,,,Fee Schedule,130% of CMS OPPS rate,287.71,100,,,fee schedule,100% of GA fee schedule,745.95,77.22,,596.76,percent of total billed charges,77.22% of total billed charges,302.1,105,,,fee schedule,105% of GA fee schedule,801.78,83,,641.42,percent of total billed charges,83% of total,917.7,95,,734.16,percent of total billed charges ,95% of total billed charges,772.8,80,,618.24,percent of total billed charges,78% of total billed charges,753.48,78,,602.784,percent of total billed charges,78% of total billed charges,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,287.71,100,,,fee schedule,100% of GA fee schedule,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,869.4,90,,695.52,percent of total billed charges,90% of total billed charges,772.8,80,,618.24,percent of total billed charges,80% of total billed charges,287.71,100,,,fee schedule,100% of GA fee schedule,821.1,85,,656.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,267.57,93,,,fee schedule,93% of CMS OPPS rate,763.14,79,,610.51,percent of total billed charges,79% of total billed charges,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,267.57,917.7,
HEP B PEDS 10MCG/0.5ML VIAL,250019175,CDM,636,RC,90744,HCPCS,outpatient,,,109,76.3,,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,98.1,90,,78.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,84.17,77.22,,67.34,percent of total billed charges,77.22% of total billed charges,72.05,66.1,,57.64,percent of total billed charges,66.1% of total billed charges,90.47,83,,72.38,percent of total billed charges,83% of total,103.55,95,,82.84,percent of total billed charges ,95% of total billed charges,87.2,80,,69.76,percent of total billed charges,78% of total billed charges,85.02,78,,68.016,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,68.67,63,,54.94,percent of total billed charges,63% of total billed charges,92.65,85,,74.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,86.11,79,,68.89,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.67,450,
TETANUS/DIPHTHERIA TOX AD 0.5M,250019204,CDM,636,RC,90714,HCPCS,outpatient,,,82,57.4,,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,73.8,90,,59.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.51,100,,,fee schedule,100% of GA fee schedule,63.32,77.22,,50.66,percent of total billed charges,77.22% of total billed charges,34.14,105,,,fee schedule,105% of GA fee schedule,68.06,83,,54.45,percent of total billed charges,83% of total,77.9,95,,62.32,percent of total billed charges ,95% of total billed charges,65.6,80,,52.48,percent of total billed charges,78% of total billed charges,63.96,78,,51.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,32.51,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,32.51,100,,,fee schedule,100% of GA fee schedule,69.7,85,,55.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.78,79,,51.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.51,450,
EPOETIN ALFA 20000 UNITS/ML VI,250019268,CDM,636,RC,J0885,HCPCS,outpatient,,,1014,709.8,,801.06,79,,640.85,percent of total billed charges,79% of total billed charges,912.6,90,,730.08,percent of total billed charges,90% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,12.04,160,,,Fee Schedule,160% of CMS OPPS rate,9.77,130,,,Fee Schedule,130% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,783.01,77.22,,626.41,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,841.62,83,,673.3,percent of total billed charges,83% of total,963.3,95,,770.64,percent of total billed charges ,95% of total billed charges,811.2,80,,648.96,percent of total billed charges,78% of total billed charges,790.92,78,,632.736,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,912.6,90,,730.08,percent of total billed charges,90% of total billed charges,811.2,80,,648.96,percent of total billed charges,80% of total billed charges,7.53,100,,,fee schedule,100% of GA fee schedule,861.9,85,,689.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7,93,,,fee schedule,93% of CMS OPPS rate,801.06,79,,640.85,percent of total billed charges,79% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7,963.3,
EPOETIN ALFA 3000 U/ML VIAL,250019376,CDM,636,RC,J0885,HCPCS,outpatient,,,144,100.8,,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,129.6,90,,103.68,percent of total billed charges,90% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,12.04,160,,,Fee Schedule,160% of CMS OPPS rate,9.77,130,,,Fee Schedule,130% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,111.2,77.22,,88.96,percent of total billed charges,77.22% of total billed charges,7.91,105,,,fee schedule,105% of GA fee schedule,119.52,83,,95.62,percent of total billed charges,83% of total,136.8,95,,109.44,percent of total billed charges ,95% of total billed charges,115.2,80,,92.16,percent of total billed charges,78% of total billed charges,112.32,78,,89.856,percent of total billed charges,78% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,fee schedule,100% of GA fee schedule,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,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,7.53,100,,,fee schedule,100% of GA fee schedule,122.4,85,,97.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7,93,,,fee schedule,93% of CMS OPPS rate,113.76,79,,91.01,percent of total billed charges,79% of total billed charges,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7.53,100,,,Fee Schedule,100% of CMS OPPS rate,7,450,
PHENTOLAMINE MESYLATE 5MG/VIAL,250019413,CDM,636,RC,J2760,HCPCS,outpatient,,,196,137.2,,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,176.4,90,,141.12,percent of total billed charges,90% of total billed charges,367.12,100,,,Fee Schedule,100% of CMS OPPS rate,587.39,160,,,Fee Schedule,160% of CMS OPPS rate,477.25,130,,,Fee Schedule,130% of CMS OPPS rate,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,151.35,77.22,,121.08,percent of total billed charges,77.22% of total billed charges,129.56,66.1,,103.65,percent of total billed charges,66.1% of total billed charges,162.68,83,,130.14,percent of total billed charges,83% of total,186.2,95,,148.96,percent of total billed charges ,95% of total billed charges,156.8,80,,125.44,percent of total billed charges,78% of total billed charges,152.88,78,,122.304,percent of total billed charges,78% of total billed charges,367.12,100,,,Fee Schedule,100% of CMS OPPS rate,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,367.12,100,,,Fee Schedule,100% of CMS OPPS rate,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,123.48,63,,98.78,percent of total billed charges,63% of total billed charges,166.6,85,,133.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,341.42,93,,,fee schedule,93% of CMS OPPS rate,154.84,79,,123.87,percent of total billed charges,79% of total billed charges,367.12,100,,,Fee Schedule,100% of CMS OPPS rate,367.12,100,,,Fee Schedule,100% of CMS OPPS rate,123.48,587.39,
FERUMOXYTOL 510 MG/17 ML VIAL,250019500,CDM,636,RC,Q0138,HCPCS,outpatient,,,1235,864.5,,975.65,79,,780.52,percent of total billed charges,79% of total billed charges,1111.5,90,,889.2,percent of total billed charges,90% of total billed charges,0.34,100,,,Fee Schedule,100% of CMS OPPS rate,0.54,160,,,Fee Schedule,160% of CMS OPPS rate,0.44,130,,,Fee Schedule,130% of CMS OPPS rate,0.34,100,,,fee schedule,100% of GA fee schedule,953.67,77.22,,762.94,percent of total billed charges,77.22% of total billed charges,0.36,105,,,fee schedule,105% of GA fee schedule,1025.05,83,,820.04,percent of total billed charges,83% of total,1173.25,95,,938.6,percent of total billed charges ,95% of total billed charges,988,80,,790.4,percent of total billed charges,78% of total billed charges,963.3,78,,770.64,percent of total billed charges,78% of total billed charges,0.34,100,,,Fee Schedule,100% of CMS OPPS rate,0.34,100,,,fee schedule,100% of GA fee schedule,0.34,100,,,Fee Schedule,100% of CMS OPPS rate,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,0.34,100,,,fee schedule,100% of GA fee schedule,1049.75,85,,839.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,0.31,93,,,fee schedule,93% of CMS OPPS rate,975.65,79,,780.52,percent of total billed charges,79% of total billed charges,0.34,100,,,Fee Schedule,100% of CMS OPPS rate,0.34,100,,,Fee Schedule,100% of CMS OPPS rate,0.31,1173.25,
DENOSUMAB 60 MG/1 ML (PROLIA),250019503,CDM,636,RC,J0897,HCPCS,outpatient,,,2007,1404.9,,1585.53,79,,1268.42,percent of total billed charges,79% of total billed charges,1806.3,90,,1445.04,percent of total billed charges,90% of total billed charges,26.96,100,,,Fee Schedule,100% of CMS OPPS rate,43.13,160,,,Fee Schedule,160% of CMS OPPS rate,35.04,130,,,Fee Schedule,130% of CMS OPPS rate,26.96,100,,,fee schedule,100% of GA fee schedule,1549.81,77.22,,1239.85,percent of total billed charges,77.22% of total billed charges,28.31,105,,,fee schedule,105% of GA fee schedule,1665.81,83,,1332.65,percent of total billed charges,83% of total,1906.65,95,,1525.32,percent of total billed charges ,95% of total billed charges,1605.6,80,,1284.48,percent of total billed charges,78% of total billed charges,1565.46,78,,1252.368,percent of total billed charges,78% of total billed charges,26.96,100,,,Fee Schedule,100% of CMS OPPS rate,26.96,100,,,fee schedule,100% of GA fee schedule,26.96,100,,,Fee Schedule,100% of CMS OPPS rate,1806.3,90,,1445.04,percent of total billed charges,90% of total billed charges,1605.6,80,,1284.48,percent of total billed charges,80% of total billed charges,26.96,100,,,fee schedule,100% of GA fee schedule,1705.95,85,,1364.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,25.07,93,,,fee schedule,93% of CMS OPPS rate,1585.53,79,,1268.42,percent of total billed charges,79% of total billed charges,26.96,100,,,Fee Schedule,100% of CMS OPPS rate,26.96,100,,,Fee Schedule,100% of CMS OPPS rate,25.07,1906.65,
OMNIPAQUE 350 MG/ML 50 ML,250019518,CDM,636,RC,Q9967,HCPCS,outpatient,,,54,37.8,,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,48.6,90,,38.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,41.7,77.22,,33.36,percent of total billed charges,77.22% of total billed charges,35.69,66.1,,28.55,percent of total billed charges,66.1% of total billed charges,44.82,83,,35.86,percent of total billed charges,83% of total,51.3,95,,41.04,percent of total billed charges ,95% of total billed charges,43.2,80,,34.56,percent of total billed charges,78% of total billed charges,42.12,78,,33.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,34.02,63,,27.22,percent of total billed charges,63% of total billed charges,45.9,85,,36.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,42.66,79,,34.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.02,450,
OMNIPAQUE 350 MG/ML 75ML,250019519,CDM,636,RC,Q9967,HCPCS,outpatient,,,70,49,,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,63,90,,50.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,54.05,77.22,,43.24,percent of total billed charges,77.22% of total billed charges,46.27,66.1,,37.02,percent of total billed charges,66.1% of total billed charges,58.1,83,,46.48,percent of total billed charges,83% of total,66.5,95,,53.2,percent of total billed charges ,95% of total billed charges,56,80,,44.8,percent of total billed charges,78% of total billed charges,54.6,78,,43.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.1,63,,35.28,percent of total billed charges,63% of total billed charges,59.5,85,,47.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,55.3,79,,44.24,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.1,450,
METHYLENE BLUE 10MG/1ML VIAL,250019567,CDM,636,RC,Q9968,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,13.64,160,,,Fee Schedule,160% of CMS OPPS rate,11.08,130,,,Fee Schedule,130% of CMS OPPS rate,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.93,93,,,fee schedule,93% of CMS OPPS rate,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,7.93,450,
ADACEL INJ 0.5ML VIAL,250019569,CDM,636,RC,90715,HCPCS,outpatient,,,165,115.5,,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,148.5,90,,118.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.52,100,,,fee schedule,100% of GA fee schedule,127.41,77.22,,101.93,percent of total billed charges,77.22% of total billed charges,40.45,105,,,fee schedule,105% of GA fee schedule,136.95,83,,109.56,percent of total billed charges,83% of total,156.75,95,,125.4,percent of total billed charges ,95% of total billed charges,132,80,,105.6,percent of total billed charges,78% of total billed charges,128.7,78,,102.96,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.52,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,38.52,100,,,fee schedule,100% of GA fee schedule,140.25,85,,112.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,130.35,79,,104.28,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.52,450,
IMMUN GLOB GAMMA 5GM PRIVIGEN,250019588,CDM,636,RC,J1459,HCPCS,outpatient,,,1346,942.2,,1063.34,79,,850.67,percent of total billed charges,79% of total billed charges,1211.4,90,,969.12,percent of total billed charges,90% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,77.72,160,,,Fee Schedule,160% of CMS OPPS rate,63.15,130,,,Fee Schedule,130% of CMS OPPS rate,48.58,100,,,fee schedule,100% of GA fee schedule,1039.38,77.22,,831.5,percent of total billed charges,77.22% of total billed charges,51.01,105,,,fee schedule,105% of GA fee schedule,1117.18,83,,893.74,percent of total billed charges,83% of total,1278.7,95,,1022.96,percent of total billed charges ,95% of total billed charges,1076.8,80,,861.44,percent of total billed charges,78% of total billed charges,1049.88,78,,839.904,percent of total billed charges,78% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,48.58,100,,,fee schedule,100% of GA fee schedule,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,1211.4,90,,969.12,percent of total billed charges,90% of total billed charges,1076.8,80,,861.44,percent of total billed charges,80% of total billed charges,48.58,100,,,fee schedule,100% of GA fee schedule,1144.1,85,,915.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.17,93,,,fee schedule,93% of CMS OPPS rate,1063.34,79,,850.67,percent of total billed charges,79% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,45.17,1278.7,
IMMUN GLOB GAMMA 10GM PRIVIGEN,250019589,CDM,636,RC,J1459,HCPCS,outpatient,,,2690,1883,,2125.1,79,,1700.08,percent of total billed charges,79% of total billed charges,2421,90,,1936.8,percent of total billed charges,90% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,77.72,160,,,Fee Schedule,160% of CMS OPPS rate,63.15,130,,,Fee Schedule,130% of CMS OPPS rate,48.58,100,,,fee schedule,100% of GA fee schedule,2077.22,77.22,,1661.78,percent of total billed charges,77.22% of total billed charges,51.01,105,,,fee schedule,105% of GA fee schedule,2232.7,83,,1786.16,percent of total billed charges,83% of total,2555.5,95,,2044.4,percent of total billed charges ,95% of total billed charges,2152,80,,1721.6,percent of total billed charges,78% of total billed charges,2098.2,78,,1678.56,percent of total billed charges,78% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,48.58,100,,,fee schedule,100% of GA fee schedule,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,2421,90,,1936.8,percent of total billed charges,90% of total billed charges,2152,80,,1721.6,percent of total billed charges,80% of total billed charges,48.58,100,,,fee schedule,100% of GA fee schedule,2286.5,85,,1829.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.17,93,,,fee schedule,93% of CMS OPPS rate,2125.1,79,,1700.08,percent of total billed charges,79% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,45.17,2555.5,
IMMUN GLOB GAMMA 20GM PRIVIGEN,250019590,CDM,636,RC,J1459,HCPCS,outpatient,,,5378,3764.6,,4248.62,79,,3398.9,percent of total billed charges,79% of total billed charges,4840.2,90,,3872.16,percent of total billed charges,90% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,77.72,160,,,Fee Schedule,160% of CMS OPPS rate,63.15,130,,,Fee Schedule,130% of CMS OPPS rate,48.58,100,,,fee schedule,100% of GA fee schedule,4152.89,77.22,,3322.31,percent of total billed charges,77.22% of total billed charges,51.01,105,,,fee schedule,105% of GA fee schedule,4463.74,83,,3570.99,percent of total billed charges,83% of total,5109.1,95,,4087.28,percent of total billed charges ,95% of total billed charges,4302.4,80,,3441.92,percent of total billed charges,78% of total billed charges,4194.84,78,,3355.872,percent of total billed charges,78% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,48.58,100,,,fee schedule,100% of GA fee schedule,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,4840.2,90,,3872.16,percent of total billed charges,90% of total billed charges,4302.4,80,,3441.92,percent of total billed charges,80% of total billed charges,48.58,100,,,fee schedule,100% of GA fee schedule,4571.3,85,,3657.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,45.17,93,,,fee schedule,93% of CMS OPPS rate,4248.62,79,,3398.9,percent of total billed charges,79% of total billed charges,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,48.58,100,,,Fee Schedule,100% of CMS OPPS rate,45.17,5109.1,
"MENING VAC A,C,Y,W-135 DIP",250019607,CDM,636,RC,90733,HCPCS,outpatient,,,529,370.3,,417.91,79,,334.33,percent of total billed charges,79% of total billed charges,476.1,90,,380.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333.27,63,,266.62,percent of total billed charges,63% of total billed charges,408.49,77.22,,326.79,percent of total billed charges,77.22% of total billed charges,349.67,66.1,,279.74,percent of total billed charges,66.1% of total billed charges,439.07,83,,351.26,percent of total billed charges,83% of total,502.55,95,,402.04,percent of total billed charges ,95% of total billed charges,423.2,80,,338.56,percent of total billed charges,78% of total billed charges,412.62,78,,330.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,333.27,63,,266.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,333.27,63,,266.62,percent of total billed charges,63% of total billed charges,449.65,85,,359.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,417.91,79,,334.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,333.27,502.55,
DAPTOMYCIN 500MG VIAL,250019611,CDM,636,RC,J0878,HCPCS,outpatient,,,779,545.3,,615.41,79,,492.33,percent of total billed charges,79% of total billed charges,701.1,90,,560.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,601.54,77.22,,481.23,percent of total billed charges,77.22% of total billed charges,0.03,105,,,fee schedule,105% of GA fee schedule,646.57,83,,517.26,percent of total billed charges,83% of total,740.05,95,,592.04,percent of total billed charges ,95% of total billed charges,623.2,80,,498.56,percent of total billed charges,78% of total billed charges,607.62,78,,486.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,701.1,90,,560.88,percent of total billed charges,90% of total billed charges,623.2,80,,498.56,percent of total billed charges,80% of total billed charges,0.03,100,,,fee schedule,100% of GA fee schedule,662.15,85,,529.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,615.41,79,,492.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,740.05,
ZOSTER VACCINE LIVE/PF19400 UN,250019643,CDM,636,RC,90736,HCPCS,outpatient,,,410,287,,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,369,90,,295.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,316.6,77.22,,253.28,percent of total billed charges,77.22% of total billed charges,271.01,66.1,,216.81,percent of total billed charges,66.1% of total billed charges,340.3,83,,272.24,percent of total billed charges,83% of total,389.5,95,,311.6,percent of total billed charges ,95% of total billed charges,328,80,,262.4,percent of total billed charges,78% of total billed charges,319.8,78,,255.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,258.3,63,,206.64,percent of total billed charges,63% of total billed charges,348.5,85,,278.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,323.9,79,,259.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,258.3,450,
PNEUMOC 13-VAL CONJ-DIP CP,250019671,CDM,636,RC,90670,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.99,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,270.89,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.99,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.99,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.99,450,
DIPHTH PERTUSS TET VAC 0.5M 7>,250019672,CDM,636,RC,90715,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.52,100,,,fee schedule,100% of GA fee schedule,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,40.45,105,,,fee schedule,105% of GA fee schedule,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.52,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,38.52,100,,,fee schedule,100% of GA fee schedule,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.52,450,
OLANZAPINE 10 MG VIAL IM ONLY,250019683,CDM,636,RC,J2358,HCPCS,outpatient,,,79,55.3,,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,71.1,90,,56.88,percent of total billed charges,90% of total billed charges,2.92,100,,,Fee Schedule,100% of CMS OPPS rate,4.67,160,,,Fee Schedule,160% of CMS OPPS rate,3.79,130,,,Fee Schedule,130% of CMS OPPS rate,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,61,77.22,,48.8,percent of total billed charges,77.22% of total billed charges,52.22,66.1,,41.78,percent of total billed charges,66.1% of total billed charges,65.57,83,,52.46,percent of total billed charges,83% of total,75.05,95,,60.04,percent of total billed charges ,95% of total billed charges,63.2,80,,50.56,percent of total billed charges,78% of total billed charges,61.62,78,,49.296,percent of total billed charges,78% of total billed charges,2.92,100,,,Fee Schedule,100% of CMS OPPS rate,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,2.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,49.77,63,,39.82,percent of total billed charges,63% of total billed charges,67.15,85,,53.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.71,93,,,fee schedule,93% of CMS OPPS rate,62.41,79,,49.93,percent of total billed charges,79% of total billed charges,2.92,100,,,Fee Schedule,100% of CMS OPPS rate,2.92,100,,,Fee Schedule,100% of CMS OPPS rate,2.71,450,
FLU VAC QUAD 2016-17(36M+) CP,250019707,CDM,636,RC,90686,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FLU VAC QUAD 2016-17(36M+)PF60,250019708,CDM,636,RC,90674,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
VEDOLIZUMAB 300 MG VIAL,250019721,CDM,636,RC,J3380,HCPCS,outpatient,,,11571,8099.7,,9141.09,79,,7312.87,percent of total billed charges,79% of total billed charges,10413.9,90,,8331.12,percent of total billed charges,90% of total billed charges,22.26,100,,,Fee Schedule,100% of CMS OPPS rate,35.61,160,,,Fee Schedule,160% of CMS OPPS rate,28.93,130,,,Fee Schedule,130% of CMS OPPS rate,22.26,100,,,fee schedule,100% of GA fee schedule,8935.13,77.22,,7148.1,percent of total billed charges,77.22% of total billed charges,23.37,105,,,fee schedule,105% of GA fee schedule,9603.93,83,,7683.14,percent of total billed charges,83% of total,10992.45,95,,8793.96,percent of total billed charges ,95% of total billed charges,9256.8,80,,7405.44,percent of total billed charges,78% of total billed charges,9025.38,78,,7220.304,percent of total billed charges,78% of total billed charges,22.26,100,,,Fee Schedule,100% of CMS OPPS rate,22.26,100,,,fee schedule,100% of GA fee schedule,22.26,100,,,Fee Schedule,100% of CMS OPPS rate,10413.9,90,,8331.12,percent of total billed charges,90% of total billed charges,9256.8,80,,7405.44,percent of total billed charges,80% of total billed charges,22.26,100,,,fee schedule,100% of GA fee schedule,9835.35,85,,7868.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,20.7,93,,,fee schedule,93% of CMS OPPS rate,9141.09,79,,7312.87,percent of total billed charges,79% of total billed charges,22.26,100,,,Fee Schedule,100% of CMS OPPS rate,22.26,100,,,Fee Schedule,100% of CMS OPPS rate,20.7,10992.45,
DIGOXIN IN WASTED AMT 0.25MG,250019722,CDM,636,RC,J1160,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.72,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,16.51,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.72,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.72,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.72,450,
FLU VAC QS 2016-17 36M+/PF60,250019723,CDM,636,RC,90686,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
FERRIC CARBOXYMALTOSE 1MG,250019726,CDM,636,RC,J1439,HCPCS,outpatient,,,2597,1817.9,,2051.63,79,,1641.3,percent of total billed charges,79% of total billed charges,2337.3,90,,1869.84,percent of total billed charges,90% of total billed charges,1.1,100,,,Fee Schedule,100% of CMS OPPS rate,1.76,160,,,Fee Schedule,160% of CMS OPPS rate,1.43,130,,,Fee Schedule,130% of CMS OPPS rate,1.1,100,,,fee schedule,100% of GA fee schedule,2005.4,77.22,,1604.32,percent of total billed charges,77.22% of total billed charges,1.16,105,,,fee schedule,105% of GA fee schedule,2155.51,83,,1724.41,percent of total billed charges,83% of total,2467.15,95,,1973.72,percent of total billed charges ,95% of total billed charges,2077.6,80,,1662.08,percent of total billed charges,78% of total billed charges,2025.66,78,,1620.528,percent of total billed charges,78% of total billed charges,1.1,100,,,Fee Schedule,100% of CMS OPPS rate,1.1,100,,,fee schedule,100% of GA fee schedule,1.1,100,,,Fee Schedule,100% of CMS OPPS rate,2337.3,90,,1869.84,percent of total billed charges,90% of total billed charges,2077.6,80,,1662.08,percent of total billed charges,80% of total billed charges,1.1,100,,,fee schedule,100% of GA fee schedule,2207.45,85,,1765.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1.02,93,,,fee schedule,93% of CMS OPPS rate,2051.63,79,,1641.3,percent of total billed charges,79% of total billed charges,1.1,100,,,Fee Schedule,100% of CMS OPPS rate,1.1,100,,,Fee Schedule,100% of CMS OPPS rate,1.02,2467.15,
CEFTAROLINE FOSAMIL ACET 400MG,250019727,CDM,636,RC,J0712,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,6.3,160,,,Fee Schedule,160% of CMS OPPS rate,5.12,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.66,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,3.66,450,
ACTIVASE WASTED AMT 100MG VIAL,250019738,CDM,636,RC,J2997,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,146.35,160,,,Fee Schedule,160% of CMS OPPS rate,118.91,130,,,Fee Schedule,130% of CMS OPPS 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,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,85.06,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,91.47,100,,,Fee Schedule,100% of CMS OPPS rate,85.06,450,
FLU VAC QUAD 2017-18(36M+)PF60,250019744,CDM,636,RC,90686,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.91,450,
CINQAIR/RESLIZ WASTE AMT 100MG,250019745,CDM,636,RC,J2786,HCPCS,outpatient,,,1746,1222.2,,1379.34,79,,1103.47,percent of total billed charges,79% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,16.48,160,,,Fee Schedule,160% of CMS OPPS rate,13.4,130,,,Fee Schedule,130% of CMS OPPS rate,10.31,100,,,fee schedule,100% of GA fee schedule,1348.26,77.22,,1078.61,percent of total billed charges,77.22% of total billed charges,10.83,105,,,fee schedule,105% of GA fee schedule,1449.18,83,,1159.34,percent of total billed charges,83% of total,1658.7,95,,1326.96,percent of total billed charges ,95% of total billed charges,1396.8,80,,1117.44,percent of total billed charges,78% of total billed charges,1361.88,78,,1089.504,percent of total billed charges,78% of total billed charges,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,10.31,100,,,fee schedule,100% of GA fee schedule,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,10.31,100,,,fee schedule,100% of GA fee schedule,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.58,93,,,fee schedule,93% of CMS OPPS rate,1379.34,79,,1103.47,percent of total billed charges,79% of total billed charges,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,9.58,1658.7,
CINQAIR/RESLIZUMAB 100MG VIAL,250019746,CDM,636,RC,J2786,HCPCS,outpatient,,,1746,1222.2,,1379.34,79,,1103.47,percent of total billed charges,79% of total billed charges,1571.4,90,,1257.12,percent of total billed charges,90% of total billed charges,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,16.48,160,,,Fee Schedule,160% of CMS OPPS rate,13.4,130,,,Fee Schedule,130% of CMS OPPS rate,10.31,100,,,fee schedule,100% of GA fee schedule,1348.26,77.22,,1078.61,percent of total billed charges,77.22% of total billed charges,10.83,105,,,fee schedule,105% of GA fee schedule,1449.18,83,,1159.34,percent of total billed charges,83% of total,1658.7,95,,1326.96,percent of total billed charges ,95% of total billed charges,1396.8,80,,1117.44,percent of total billed charges,78% of total billed charges,1361.88,78,,1089.504,percent of total billed charges,78% of total billed charges,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,10.31,100,,,fee schedule,100% of GA fee schedule,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,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,10.31,100,,,fee schedule,100% of GA fee schedule,1484.1,85,,1187.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,9.58,93,,,fee schedule,93% of CMS OPPS rate,1379.34,79,,1103.47,percent of total billed charges,79% of total billed charges,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,10.31,100,,,Fee Schedule,100% of CMS OPPS rate,9.58,1658.7,
DAPTOMYCIN IN WASTE 500MG VIAL,250019760,CDM,636,RC,J0878,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,0.03,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.03,450,
HEP B PEDIATRIC STATE VACCINE,250019761,CDM,636,RC,90744,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FLU VAC QUAL (5YR+)PF 60M,250019765,CDM,636,RC,90686,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
GOSERELIN ACETATE 3.6MG IMPLAN,250019769,CDM,636,RC,J9202,HCPCS,outpatient,,,1229,860.3,,970.91,79,,776.73,percent of total billed charges,79% of total billed charges,1106.1,90,,884.88,percent of total billed charges,90% of total billed charges,674.77,100,,,Fee Schedule,100% of CMS OPPS rate,1079.63,160,,,Fee Schedule,160% of CMS OPPS rate,877.2,130,,,Fee Schedule,130% of CMS OPPS rate,774.27,63,,619.42,percent of total billed charges,63% of total billed charges,949.03,77.22,,759.22,percent of total billed charges,77.22% of total billed charges,812.37,66.1,,649.9,percent of total billed charges,66.1% of total billed charges,1020.07,83,,816.06,percent of total billed charges,83% of total,1167.55,95,,934.04,percent of total billed charges ,95% of total billed charges,983.2,80,,786.56,percent of total billed charges,78% of total billed charges,958.62,78,,766.896,percent of total billed charges,78% of total billed charges,674.77,100,,,Fee Schedule,100% of CMS OPPS rate,774.27,63,,619.42,percent of total billed charges,63% of total billed charges,674.77,100,,,Fee Schedule,100% of CMS OPPS rate,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,774.27,63,,619.42,percent of total billed charges,63% of total billed charges,1044.65,85,,835.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,627.53,93,,,fee schedule,93% of CMS OPPS rate,970.91,79,,776.73,percent of total billed charges,79% of total billed charges,674.77,100,,,Fee Schedule,100% of CMS OPPS rate,674.77,100,,,Fee Schedule,100% of CMS OPPS rate,450,1167.55,
LILETTA INTRAUTERINE DEVICE,250019774,CDM,636,RC,J7297,HCPCS,outpatient,,,1390,973,,1098.1,79,,878.48,percent of total billed charges,79% of total billed charges,1251,90,,1000.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,887.36,100,,,fee schedule,100% of GA fee schedule,1073.36,77.22,,858.69,percent of total billed charges,77.22% of total billed charges,931.73,105,,,fee schedule,105% of GA fee schedule,1153.7,83,,922.96,percent of total billed charges,83% of total,1320.5,95,,1056.4,percent of total billed charges ,95% of total billed charges,1112,80,,889.6,percent of total billed charges,78% of total billed charges,1084.2,78,,867.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,887.36,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1251,90,,1000.8,percent of total billed charges,90% of total billed charges,1112,80,,889.6,percent of total billed charges,80% of total billed charges,887.36,100,,,fee schedule,100% of GA fee schedule,1181.5,85,,945.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1098.1,79,,878.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1320.5,
FLU VAC QS2018-19 (6M+) PF60,250019775,CDM,636,RC,90686,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
MIRENA INTRAUTERINE DEVICE,250019777,CDM,636,RC,J7298,HCPCS,outpatient,,,1350,945,,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,1215,90,,972,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.79,100,,,fee schedule,100% of GA fee schedule,1042.47,77.22,,833.98,percent of total billed charges,77.22% of total billed charges,1214.63,105,,,fee schedule,105% of GA fee schedule,1120.5,83,,896.4,percent of total billed charges,83% of total,1282.5,95,,1026,percent of total billed charges ,95% of total billed charges,1080,80,,864,percent of total billed charges,78% of total billed charges,1053,78,,842.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1156.79,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1215,90,,972,percent of total billed charges,90% of total billed charges,1080,80,,864,percent of total billed charges,80% of total billed charges,1156.79,100,,,fee schedule,100% of GA fee schedule,1147.5,85,,918,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1066.5,79,,853.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1282.5,
KYLEENA INTRAUTERINE DEVICE,250019778,CDM,636,RC,J7296,HCPCS,outpatient,,,1200,840,,948,79,,758.4,percent of total billed charges,79% of total billed charges,1080,90,,864,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.79,100,,,fee schedule,100% of GA fee schedule,926.64,77.22,,741.31,percent of total billed charges,77.22% of total billed charges,1214.63,105,,,fee schedule,105% of GA fee schedule,996,83,,796.8,percent of total billed charges,83% of total,1140,95,,912,percent of total billed charges ,95% of total billed charges,960,80,,768,percent of total billed charges,78% of total billed charges,936,78,,748.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1156.79,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1080,90,,864,percent of total billed charges,90% of total billed charges,960,80,,768,percent of total billed charges,80% of total billed charges,1156.79,100,,,fee schedule,100% of GA fee schedule,1020,85,,816,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,948,79,,758.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1214.63,
SKYLA INTRAUTERINE DEVICE,250019779,CDM,636,RC,J7301,HCPCS,outpatient,,,900,630,,711,79,,568.8,percent of total billed charges,79% of total billed charges,810,90,,648,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,963.22,100,,,fee schedule,100% of GA fee schedule,694.98,77.22,,555.98,percent of total billed charges,77.22% of total billed charges,1011.38,105,,,fee schedule,105% of GA fee schedule,747,83,,597.6,percent of total billed charges,83% of total,855,95,,684,percent of total billed charges ,95% of total billed charges,720,80,,576,percent of total billed charges,78% of total billed charges,702,78,,561.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,963.22,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,963.22,100,,,fee schedule,100% of GA fee schedule,765,85,,612,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,711,79,,568.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1011.38,
FLU VACC QS2018-19 (36M+) PF60,250019780,CDM,636,RC,90686,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
NEXPLANON ETONOGESTREL IMPLANT,250019781,CDM,636,RC,J7307,HCPCS,outpatient,,,1200,840,,948,79,,758.4,percent of total billed charges,79% of total billed charges,1080,90,,864,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.28,100,,,fee schedule,100% of GA fee schedule,926.64,77.22,,741.31,percent of total billed charges,77.22% of total billed charges,1214.09,105,,,fee schedule,105% of GA fee schedule,996,83,,796.8,percent of total billed charges,83% of total,1140,95,,912,percent of total billed charges ,95% of total billed charges,960,80,,768,percent of total billed charges,78% of total billed charges,936,78,,748.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1156.28,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1080,90,,864,percent of total billed charges,90% of total billed charges,960,80,,768,percent of total billed charges,80% of total billed charges,1156.28,100,,,fee schedule,100% of GA fee schedule,1020,85,,816,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,948,79,,758.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1214.09,
RABIES IMMUNE GLOBULIN/PF 300U,250019789,CDM,636,RC,90375,HCPCS,outpatient,,,1442,1009.4,,1139.18,79,,911.34,percent of total billed charges,79% of total billed charges,1297.8,90,,1038.24,percent of total billed charges,90% of total billed charges,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,460.33,160,,,Fee Schedule,160% of CMS OPPS rate,374.02,130,,,Fee Schedule,130% of CMS OPPS rate,287.71,100,,,fee schedule,100% of GA fee schedule,1113.51,77.22,,890.81,percent of total billed charges,77.22% of total billed charges,302.1,105,,,fee schedule,105% of GA fee schedule,1196.86,83,,957.49,percent of total billed charges,83% of total,1369.9,95,,1095.92,percent of total billed charges ,95% of total billed charges,1153.6,80,,922.88,percent of total billed charges,78% of total billed charges,1124.76,78,,899.808,percent of total billed charges,78% of total billed charges,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,287.71,100,,,fee schedule,100% of GA fee schedule,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,1297.8,90,,1038.24,percent of total billed charges,90% of total billed charges,1153.6,80,,922.88,percent of total billed charges,80% of total billed charges,287.71,100,,,fee schedule,100% of GA fee schedule,1225.7,85,,980.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,267.57,93,,,fee schedule,93% of CMS OPPS rate,1139.18,79,,911.34,percent of total billed charges,79% of total billed charges,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,287.7,100,,,Fee Schedule,100% of CMS OPPS rate,267.57,1369.9,
FLU VAC QS18-19 (4Y+)CELL/PF60,250019790,CDM,636,RC,90686,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
RHO(D) IMMUNE GLOBULIN 1.5 UNI,250019793,CDM,636,RC,J2790,HCPCS,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.14,100,,,fee schedule,100% of GA fee schedule,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,84.15,105,,,fee schedule,105% of GA fee schedule,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,80.14,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,80.14,100,,,fee schedule,100% of GA fee schedule,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.14,450,
DALBAVANCIN HCL 500 MG VIAL,250019797,CDM,636,RC,J0875,HCPCS,outpatient,,,4088,2861.6,,3229.52,79,,2583.62,percent of total billed charges,79% of total billed charges,3679.2,90,,2943.36,percent of total billed charges,90% of total billed charges,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,24.97,160,,,Fee Schedule,160% of CMS OPPS rate,20.29,130,,,Fee Schedule,130% of CMS OPPS rate,15.61,100,,,fee schedule,100% of GA fee schedule,3156.75,77.22,,2525.4,percent of total billed charges,77.22% of total billed charges,16.39,105,,,fee schedule,105% of GA fee schedule,3393.04,83,,2714.43,percent of total billed charges,83% of total,3883.6,95,,3106.88,percent of total billed charges ,95% of total billed charges,3270.4,80,,2616.32,percent of total billed charges,78% of total billed charges,3188.64,78,,2550.912,percent of total billed charges,78% of total billed charges,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,15.61,100,,,fee schedule,100% of GA fee schedule,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,3679.2,90,,2943.36,percent of total billed charges,90% of total billed charges,3270.4,80,,2616.32,percent of total billed charges,80% of total billed charges,15.61,100,,,fee schedule,100% of GA fee schedule,3474.8,85,,2779.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,14.51,93,,,fee schedule,93% of CMS OPPS rate,3229.52,79,,2583.62,percent of total billed charges,79% of total billed charges,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,14.51,3883.6,
NEXPLANON ETONOGESTRL IMP LARC,2500197LC,CDM,636,RC,J7307,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.28,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1214.09,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.28,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1156.28,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1214.09,
DALBAVANCIN WASTE AMT 500MG,250019802,CDM,636,RC,J0875,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,24.97,160,,,Fee Schedule,160% of CMS OPPS rate,20.29,130,,,Fee Schedule,130% of CMS OPPS rate,15.61,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,16.39,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,15.61,100,,,fee schedule,100% of GA fee schedule,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.61,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,14.51,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,15.61,100,,,Fee Schedule,100% of CMS OPPS rate,14.51,450,
FLU VAC QS2019-20 (6M+) PF60,250019804,CDM,636,RC,90686,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
FLU VAC QS19-20 36MOS UP/PF 60,250019811,CDM,636,RC,90686,HCPCS,outpatient,,,27,18.9,,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,24.3,90,,19.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,20.85,77.22,,16.68,percent of total billed charges,77.22% of total billed charges,17.85,66.1,,14.28,percent of total billed charges,66.1% of total billed charges,22.41,83,,17.93,percent of total billed charges,83% of total,25.65,95,,20.52,percent of total billed charges ,95% of total billed charges,21.6,80,,17.28,percent of total billed charges,78% of total billed charges,21.06,78,,16.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,17.01,63,,13.61,percent of total billed charges,63% of total billed charges,22.95,85,,18.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.33,79,,17.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.01,450,
ABATACEPT/MALTOSE 250 MG VIAL,250019824,CDM,636,RC,J0129,HCPCS,outpatient,,,3132,2192.4,,2474.28,79,,1979.42,percent of total billed charges,79% of total billed charges,2818.8,90,,2255.04,percent of total billed charges,90% of total billed charges,43.44,100,,,Fee Schedule,100% of CMS OPPS rate,69.5,160,,,Fee Schedule,160% of CMS OPPS rate,56.47,130,,,Fee Schedule,130% of CMS OPPS rate,43.44,100,,,fee schedule,100% of GA fee schedule,2418.53,77.22,,1934.82,percent of total billed charges,77.22% of total billed charges,45.61,105,,,fee schedule,105% of GA fee schedule,2599.56,83,,2079.65,percent of total billed charges,83% of total,2975.4,95,,2380.32,percent of total billed charges ,95% of total billed charges,2505.6,80,,2004.48,percent of total billed charges,78% of total billed charges,2442.96,78,,1954.368,percent of total billed charges,78% of total billed charges,43.44,100,,,Fee Schedule,100% of CMS OPPS rate,43.44,100,,,fee schedule,100% of GA fee schedule,43.44,100,,,Fee Schedule,100% of CMS OPPS rate,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,43.44,100,,,fee schedule,100% of GA fee schedule,2662.2,85,,2129.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,40.39,93,,,fee schedule,93% of CMS OPPS rate,2474.28,79,,1979.42,percent of total billed charges,79% of total billed charges,43.44,100,,,Fee Schedule,100% of CMS OPPS rate,43.44,100,,,Fee Schedule,100% of CMS OPPS rate,40.39,2975.4,
TOCILIZUMAB 400 MG/20 ML VIAL,250019826,CDM,636,RC,J3262,HCPCS,outpatient,,,5119,3583.3,,4044.01,79,,3235.21,percent of total billed charges,79% of total billed charges,4607.1,90,,3685.68,percent of total billed charges,90% of total billed charges,5.96,100,,,Fee Schedule,100% of CMS OPPS rate,9.52,160,,,Fee Schedule,160% of CMS OPPS rate,7.74,130,,,Fee Schedule,130% of CMS OPPS rate,5.96,100,,,fee schedule,100% of GA fee schedule,3952.89,77.22,,3162.31,percent of total billed charges,77.22% of total billed charges,6.26,105,,,fee schedule,105% of GA fee schedule,4248.77,83,,3399.02,percent of total billed charges,83% of total,4863.05,95,,3890.44,percent of total billed charges ,95% of total billed charges,4095.2,80,,3276.16,percent of total billed charges,78% of total billed charges,3992.82,78,,3194.256,percent of total billed charges,78% of total billed charges,5.96,100,,,Fee Schedule,100% of CMS OPPS rate,5.96,100,,,fee schedule,100% of GA fee schedule,5.96,100,,,Fee Schedule,100% of CMS OPPS rate,4607.1,90,,3685.68,percent of total billed charges,90% of total billed charges,4095.2,80,,3276.16,percent of total billed charges,80% of total billed charges,5.96,100,,,fee schedule,100% of GA fee schedule,4351.15,85,,3480.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,5.54,93,,,fee schedule,93% of CMS OPPS rate,4044.01,79,,3235.21,percent of total billed charges,79% of total billed charges,5.96,100,,,Fee Schedule,100% of CMS OPPS rate,5.96,100,,,Fee Schedule,100% of CMS OPPS rate,5.54,4863.05,
FERRIC SUBSULFATE 8 GM SOLN GM,250019829,CDM,636,RC,,,outpatient,,,27.8,19.46,,21.96,79,,17.57,percent of total billed charges,79% of total billed charges,25.02,90,,20.02,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.51,63,,14.01,percent of total billed charges,63% of total billed charges,21.47,77.22,,17.18,percent of total billed charges,77.22% of total billed charges,18.38,66.1,,14.7,percent of total billed charges,66.1% of total billed charges,23.07,83,,18.46,percent of total billed charges,83% of total,26.41,95,,21.13,percent of total billed charges ,95% of total billed charges,22.24,80,,17.79,percent of total billed charges,78% of total billed charges,21.68,78,,17.344,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.51,63,,14.01,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,25.02,90,,20.02,percent of total billed charges,90% of total billed charges,22.24,80,,17.79,percent of total billed charges,80% of total billed charges,17.51,63,,14.01,percent of total billed charges,63% of total billed charges,23.63,85,,18.904,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.96,79,,17.57,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.51,450,
FLU VAC QS2020-21 36MOS+ PF 60,250019832,CDM,636,RC,90686,HCPCS,outpatient,,,26.65,18.66,,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,20.58,77.22,,16.46,percent of total billed charges,77.22% of total billed charges,17.62,66.1,,14.1,percent of total billed charges,66.1% of total billed charges,22.12,83,,17.7,percent of total billed charges,83% of total,25.32,95,,20.26,percent of total billed charges ,95% of total billed charges,21.32,80,,17.06,percent of total billed charges,78% of total billed charges,20.79,78,,16.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,21.32,80,,17.06,percent of total billed charges,80% of total billed charges,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,22.65,85,,18.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.79,450,
IMIPENEM CILAST SOD 0250G VIAL,250019835,CDM,636,RC,J0743,HCPCS,outpatient,,,27.75,19.43,,21.92,79,,17.54,percent of total billed charges,79% of total billed charges,24.98,90,,19.98,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.96,100,,,fee schedule,100% of GA fee schedule,21.43,77.22,,17.14,percent of total billed charges,77.22% of total billed charges,7.31,105,,,fee schedule,105% of GA fee schedule,23.03,83,,18.42,percent of total billed charges,83% of total,26.36,95,,21.09,percent of total billed charges ,95% of total billed charges,22.2,80,,17.76,percent of total billed charges,78% of total billed charges,21.65,78,,17.32,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,6.96,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,24.98,90,,19.98,percent of total billed charges,90% of total billed charges,22.2,80,,17.76,percent of total billed charges,80% of total billed charges,6.96,100,,,fee schedule,100% of GA fee schedule,23.59,85,,18.872,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.92,79,,17.54,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,6.96,450,
METHYLENE BLUE 50 MG/10 ML AMP,250019837,CDM,636,RC,Q9968,HCPCS,outpatient,,,579.7,405.79,,457.96,79,,366.37,percent of total billed charges,79% of total billed charges,521.73,90,,417.38,percent of total billed charges,90% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,13.64,160,,,Fee Schedule,160% of CMS OPPS rate,11.08,130,,,Fee Schedule,130% of CMS OPPS rate,365.21,63,,292.17,percent of total billed charges,63% of total billed charges,447.64,77.22,,358.11,percent of total billed charges,77.22% of total billed charges,383.18,66.1,,306.54,percent of total billed charges,66.1% of total billed charges,481.15,83,,384.92,percent of total billed charges,83% of total,550.72,95,,440.58,percent of total billed charges ,95% of total billed charges,463.76,80,,371.01,percent of total billed charges,78% of total billed charges,452.17,78,,361.736,percent of total billed charges,78% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,365.21,63,,292.17,percent of total billed charges,63% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,521.73,90,,417.38,percent of total billed charges,90% of total billed charges,463.76,80,,371.01,percent of total billed charges,80% of total billed charges,365.21,63,,292.17,percent of total billed charges,63% of total billed charges,492.75,85,,394.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,7.93,93,,,fee schedule,93% of CMS OPPS rate,457.96,79,,366.37,percent of total billed charges,79% of total billed charges,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,8.52,100,,,Fee Schedule,100% of CMS OPPS rate,7.93,550.72,
FILGRASTIM-SNDZ 480 MCG/0.8 ML,250019840,CDM,636,RC,Q5101,HCPCS,outpatient,,,629.95,440.97,,497.66,79,,398.13,percent of total billed charges,79% of total billed charges,566.96,90,,453.57,percent of total billed charges,90% of total billed charges,0.36,100,,,Fee Schedule,100% of CMS OPPS rate,0.56,160,,,Fee Schedule,160% of CMS OPPS rate,0.46,130,,,Fee Schedule,130% of CMS OPPS rate,0.36,100,,,fee schedule,100% of GA fee schedule,486.45,77.22,,389.16,percent of total billed charges,77.22% of total billed charges,0.38,105,,,fee schedule,105% of GA fee schedule,522.86,83,,418.29,percent of total billed charges,83% of total,598.45,95,,478.76,percent of total billed charges ,95% of total billed charges,503.96,80,,403.17,percent of total billed charges,78% of total billed charges,491.36,78,,393.088,percent of total billed charges,78% of total billed charges,0.36,100,,,Fee Schedule,100% of CMS OPPS rate,0.36,100,,,fee schedule,100% of GA fee schedule,0.36,100,,,Fee Schedule,100% of CMS OPPS rate,566.96,90,,453.57,percent of total billed charges,90% of total billed charges,503.96,80,,403.17,percent of total billed charges,80% of total billed charges,0.36,100,,,fee schedule,100% of GA fee schedule,535.46,85,,428.368,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,0.33,93,,,fee schedule,93% of CMS OPPS rate,497.66,79,,398.13,percent of total billed charges,79% of total billed charges,0.36,100,,,Fee Schedule,100% of CMS OPPS rate,0.36,100,,,Fee Schedule,100% of CMS OPPS rate,0.33,598.45,
COVID MODERNA VACCINE,250019841,CDM,636,RC,91301,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FLU VAC QS2021-22 36MOS+ PF 60,250019859,CDM,636,RC,90686,HCPCS,outpatient,,,26.65,18.66,,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,20.58,77.22,,16.46,percent of total billed charges,77.22% of total billed charges,17.62,66.1,,14.1,percent of total billed charges,66.1% of total billed charges,22.12,83,,17.7,percent of total billed charges,83% of total,25.32,95,,20.26,percent of total billed charges ,95% of total billed charges,21.32,80,,17.06,percent of total billed charges,78% of total billed charges,20.79,78,,16.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,21.32,80,,17.06,percent of total billed charges,80% of total billed charges,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,22.65,85,,18.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.79,450,
COVID-19 VAC AD26 JANSSEN PF.5,250019866,CDM,636,RC,91303,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HUM PROTHROMBIN CPLX/PPC 4FACT,250019870,CDM,636,RC,J7168,HCPCS,outpatient,,,6374.1,4461.87,,5035.54,79,,4028.43,percent of total billed charges,79% of total billed charges,5736.69,90,,4589.35,percent of total billed charges,90% of total billed charges,2.24,100,,,Fee Schedule,100% of CMS OPPS rate,3.58,160,,,Fee Schedule,160% of CMS OPPS rate,2.91,130,,,Fee Schedule,130% of CMS OPPS rate,4015.68,63,,3212.54,percent of total billed charges,63% of total billed charges,4922.08,77.22,,3937.66,percent of total billed charges,77.22% of total billed charges,4213.28,66.1,,3370.62,percent of total billed charges,66.1% of total billed charges,5290.5,83,,4232.4,percent of total billed charges,83% of total,6055.4,95,,4844.32,percent of total billed charges ,95% of total billed charges,5099.28,80,,4079.42,percent of total billed charges,78% of total billed charges,4971.8,78,,3977.44,percent of total billed charges,78% of total billed charges,2.24,100,,,Fee Schedule,100% of CMS OPPS rate,4015.68,63,,3212.54,percent of total billed charges,63% of total billed charges,2.24,100,,,Fee Schedule,100% of CMS OPPS rate,5736.69,90,,4589.35,percent of total billed charges,90% of total billed charges,5099.28,80,,4079.42,percent of total billed charges,80% of total billed charges,4015.68,63,,3212.54,percent of total billed charges,63% of total billed charges,5417.99,85,,4334.392,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2.08,93,,,fee schedule,93% of CMS OPPS rate,5035.54,79,,4028.43,percent of total billed charges,79% of total billed charges,2.24,100,,,Fee Schedule,100% of CMS OPPS rate,2.24,100,,,Fee Schedule,100% of CMS OPPS rate,2.08,6055.4,
MENING B VAC 4-COMP 0.5,250019871,CDM,636,RC,90620,HCPCS,outpatient,,,466.8,326.76,,368.77,79,,295.02,percent of total billed charges,79% of total billed charges,420.12,90,,336.1,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.75,100,,,fee schedule,100% of GA fee schedule,360.46,77.22,,288.37,percent of total billed charges,77.22% of total billed charges,234.94,105,,,fee schedule,105% of GA fee schedule,387.44,83,,309.95,percent of total billed charges,83% of total,443.46,95,,354.77,percent of total billed charges ,95% of total billed charges,373.44,80,,298.75,percent of total billed charges,78% of total billed charges,364.1,78,,291.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,223.75,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,420.12,90,,336.1,percent of total billed charges,90% of total billed charges,373.44,80,,298.75,percent of total billed charges,80% of total billed charges,223.75,100,,,fee schedule,100% of GA fee schedule,396.78,85,,317.424,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,368.77,79,,295.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,223.75,450,
MENING A CONJ VAC 2OF2/PF 10MC,250019872,CDM,636,RC,90734,HCPCS,outpatient,,,340.75,238.53,,269.19,79,,215.35,percent of total billed charges,79% of total billed charges,306.68,90,,245.34,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.35,100,,,fee schedule,100% of GA fee schedule,263.13,77.22,,210.5,percent of total billed charges,77.22% of total billed charges,165.22,105,,,fee schedule,105% of GA fee schedule,282.82,83,,226.26,percent of total billed charges,83% of total,323.71,95,,258.97,percent of total billed charges ,95% of total billed charges,272.6,80,,218.08,percent of total billed charges,78% of total billed charges,265.79,78,,212.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.35,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,306.68,90,,245.34,percent of total billed charges,90% of total billed charges,272.6,80,,218.08,percent of total billed charges,80% of total billed charges,157.35,100,,,fee schedule,100% of GA fee schedule,289.64,85,,231.712,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,269.19,79,,215.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.35,450,
BEBTELOVIMAB 175 MG/2ML VIAL,250019890,CDM,636,RC,M0222,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307.58,100,,,Fee Schedule,100% of CMS OPPS rate,492.15,160,,,Fee Schedule,160% of CMS OPPS rate,399.87,130,,,Fee Schedule,130% of CMS OPPS 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,307.58,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,307.58,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,286.06,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,307.58,100,,,Fee Schedule,100% of CMS OPPS rate,307.58,100,,,Fee Schedule,100% of CMS OPPS rate,286.06,492.15,
DIAZEPAM 5MG/1 ML/10ML VIAL,250019895,CDM,636,RC,J3360,HCPCS,outpatient,,,178.6,125.02,,141.09,79,,112.87,percent of total billed charges,79% of total billed charges,160.74,90,,128.59,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.83,100,,,fee schedule,100% of GA fee schedule,137.91,77.22,,110.33,percent of total billed charges,77.22% of total billed charges,6.12,105,,,fee schedule,105% of GA fee schedule,148.24,83,,118.59,percent of total billed charges,83% of total,169.67,95,,135.74,percent of total billed charges ,95% of total billed charges,142.88,80,,114.3,percent of total billed charges,78% of total billed charges,139.31,78,,111.448,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5.83,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,160.74,90,,128.59,percent of total billed charges,90% of total billed charges,142.88,80,,114.3,percent of total billed charges,80% of total billed charges,5.83,100,,,fee schedule,100% of GA fee schedule,151.81,85,,121.448,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,141.09,79,,112.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,5.83,450,
MIRENA INTRAUTERINE DEVIC LARC,2500198LC,CDM,636,RC,J7298,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.79,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1214.63,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.79,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1156.79,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1214.63,
COVID-19 VAC BIVALENT/MOD/PF,250019902,CDM,636,RC,91313,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
FILGRASTIM-TBO 480 MCG/0.8 ML,250019909,CDM,636,RC,J1442,HCPCS,outpatient,,,974.15,681.91,,769.58,79,,615.66,percent of total billed charges,79% of total billed charges,876.74,90,,701.39,percent of total billed charges,90% of total billed charges,1,100,,,Fee Schedule,100% of CMS OPPS rate,1.6,160,,,Fee Schedule,160% of CMS OPPS rate,1.3,130,,,Fee Schedule,130% of CMS OPPS rate,1,100,,,fee schedule,100% of GA fee schedule,752.24,77.22,,601.79,percent of total billed charges,77.22% of total billed charges,1.05,105,,,fee schedule,105% of GA fee schedule,808.54,83,,646.83,percent of total billed charges,83% of total,925.44,95,,740.35,percent of total billed charges ,95% of total billed charges,779.32,80,,623.46,percent of total billed charges,78% of total billed charges,759.84,78,,607.872,percent of total billed charges,78% of total billed charges,1,100,,,Fee Schedule,100% of CMS OPPS rate,1,100,,,fee schedule,100% of GA fee schedule,1,100,,,Fee Schedule,100% of CMS OPPS rate,876.74,90,,701.39,percent of total billed charges,90% of total billed charges,779.32,80,,623.46,percent of total billed charges,80% of total billed charges,1,100,,,fee schedule,100% of GA fee schedule,828.03,85,,662.424,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,0.93,93,,,fee schedule,93% of CMS OPPS rate,769.58,79,,615.66,percent of total billed charges,79% of total billed charges,1,100,,,Fee Schedule,100% of CMS OPPS rate,1,100,,,Fee Schedule,100% of CMS OPPS rate,0.93,925.44,
FLU VAC QS2023-24 36MOS+ PF 60,250019915,CDM,636,RC,90688,HCPCS,outpatient,,,26.65,18.66,,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,20.58,77.22,,16.46,percent of total billed charges,77.22% of total billed charges,17.62,66.1,,14.1,percent of total billed charges,66.1% of total billed charges,22.12,83,,17.7,percent of total billed charges,83% of total,25.32,95,,20.26,percent of total billed charges ,95% of total billed charges,21.32,80,,17.06,percent of total billed charges,78% of total billed charges,20.79,78,,16.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,21.32,80,,17.06,percent of total billed charges,80% of total billed charges,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,22.65,85,,18.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.79,450,
FLU VAC QS2023-24 (6M+) PF 60,250019916,CDM,636,RC,90688,HCPCS,outpatient,,,26.65,18.66,,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,20.58,77.22,,16.46,percent of total billed charges,77.22% of total billed charges,17.62,66.1,,14.1,percent of total billed charges,66.1% of total billed charges,22.12,83,,17.7,percent of total billed charges,83% of total,25.32,95,,20.26,percent of total billed charges ,95% of total billed charges,21.32,80,,17.06,percent of total billed charges,78% of total billed charges,20.79,78,,16.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,23.99,90,,19.19,percent of total billed charges,90% of total billed charges,21.32,80,,17.06,percent of total billed charges,80% of total billed charges,16.79,63,,13.43,percent of total billed charges,63% of total billed charges,22.65,85,,18.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,21.05,79,,16.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.79,450,
NOREPINEPHRINE BIT/0.9%/1MG,250019922,CDM,636,RC,J0171,HCPCS,outpatient,,,81.65,57.16,,64.5,79,,51.6,percent of total billed charges,79% of total billed charges,73.49,90,,58.79,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,63.05,77.22,,50.44,percent of total billed charges,77.22% of total billed charges,0.87,105,,,fee schedule,105% of GA fee schedule,67.77,83,,54.22,percent of total billed charges,83% of total,77.57,95,,62.06,percent of total billed charges ,95% of total billed charges,65.32,80,,52.26,percent of total billed charges,78% of total billed charges,63.69,78,,50.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.83,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,73.49,90,,58.79,percent of total billed charges,90% of total billed charges,65.32,80,,52.26,percent of total billed charges,80% of total billed charges,0.83,100,,,fee schedule,100% of GA fee schedule,69.4,85,,55.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,64.5,79,,51.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.83,450,
USTEKINDUMAB 130MG/26ML VIAL,250019925,CDM,636,RC,J3358,HCPCS,outpatient,,,4494.41,3146.09,,3550.58,79,,2840.46,percent of total billed charges,79% of total billed charges,4044.97,90,,3235.98,percent of total billed charges,90% of total billed charges,12.97,100,,,Fee Schedule,100% of CMS OPPS rate,20.75,160,,,Fee Schedule,160% of CMS OPPS rate,16.86,130,,,Fee Schedule,130% of CMS OPPS rate,12.97,100,,,fee schedule,100% of GA fee schedule,3470.58,77.22,,2776.46,percent of total billed charges,77.22% of total billed charges,13.62,105,,,fee schedule,105% of GA fee schedule,3730.36,83,,2984.29,percent of total billed charges,83% of total,4269.69,95,,3415.75,percent of total billed charges ,95% of total billed charges,3595.53,80,,2876.42,percent of total billed charges,78% of total billed charges,3505.64,78,,2804.512,percent of total billed charges,78% of total billed charges,12.97,100,,,Fee Schedule,100% of CMS OPPS rate,12.97,100,,,fee schedule,100% of GA fee schedule,12.97,100,,,Fee Schedule,100% of CMS OPPS rate,4044.97,90,,3235.98,percent of total billed charges,90% of total billed charges,3595.53,80,,2876.42,percent of total billed charges,80% of total billed charges,12.97,100,,,fee schedule,100% of GA fee schedule,3820.25,85,,3056.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,12.06,93,,,fee schedule,93% of CMS OPPS rate,3550.58,79,,2840.46,percent of total billed charges,79% of total billed charges,12.97,100,,,Fee Schedule,100% of CMS OPPS rate,12.97,100,,,Fee Schedule,100% of CMS OPPS rate,12.06,4269.69,
"ANDEXXA FACTOR XA, INACT-ZHZO",250019926,CDM,636,RC,J7169,HCPCS,outpatient,,,5550,3885,,4384.5,79,,3507.6,percent of total billed charges,79% of total billed charges,4995,90,,3996,percent of total billed charges,90% of total billed charges,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,211.18,160,,,Fee Schedule,160% of CMS OPPS rate,171.58,130,,,Fee Schedule,130% of CMS OPPS rate,3496.5,63,,2797.2,percent of total billed charges,63% of total billed charges,4285.71,77.22,,3428.57,percent of total billed charges,77.22% of total billed charges,3668.55,66.1,,2934.84,percent of total billed charges,66.1% of total billed charges,4606.5,83,,3685.2,percent of total billed charges,83% of total,5272.5,95,,4218,percent of total billed charges ,95% of total billed charges,4440,80,,3552,percent of total billed charges,78% of total billed charges,4329,78,,3463.2,percent of total billed charges,78% of total billed charges,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,3496.5,63,,2797.2,percent of total billed charges,63% of total billed charges,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,4995,90,,3996,percent of total billed charges,90% of total billed charges,4440,80,,3552,percent of total billed charges,80% of total billed charges,3496.5,63,,2797.2,percent of total billed charges,63% of total billed charges,4717.5,85,,3774,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.75,93,,,fee schedule,93% of CMS OPPS rate,4384.5,79,,3507.6,percent of total billed charges,79% of total billed charges,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,122.75,5272.5,
ANDEXXA-WASTE-INACT-ZHZO,250019928,CDM,636,RC,J7169,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,211.18,160,,,Fee Schedule,160% of CMS OPPS rate,171.58,130,,,Fee Schedule,130% of CMS OPPS 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,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,122.75,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,131.99,100,,,Fee Schedule,100% of CMS OPPS rate,122.75,450,
PARAGARD INTRAUTERINE CON LARC,2500199LC,CDM,636,RC,J7300,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1085,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1139.25,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,1085,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1085,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1139.25,
PNEUMOCOCCAL VACC 23 CP,250020001,CDM,636,RC,90732,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,140.14,105,,,fee schedule,105% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.47,100,,,fee schedule,100% of GA fee schedule,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133.47,450,
PNEUMOCCAL 13-VAL CONJ-DIP,250020002,CDM,636,RC,90670,HCPCS,outpatient,,,368,257.6,,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,331.2,90,,264.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.99,100,,,fee schedule,100% of GA fee schedule,284.17,77.22,,227.34,percent of total billed charges,77.22% of total billed charges,270.89,105,,,fee schedule,105% of GA fee schedule,305.44,83,,244.35,percent of total billed charges,83% of total,349.6,95,,279.68,percent of total billed charges ,95% of total billed charges,294.4,80,,235.52,percent of total billed charges,78% of total billed charges,287.04,78,,229.632,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,257.99,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,257.99,100,,,fee schedule,100% of GA fee schedule,312.8,85,,250.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,290.72,79,,232.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257.99,450,
SURGIGRAFT PER SQ CM,250228817,CDM,636,RC,Q4183,HCPCS,outpatient,,,296,207.2,,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,266.4,90,,213.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,228.57,77.22,,182.86,percent of total billed charges,77.22% of total billed charges,195.66,66.1,,156.53,percent of total billed charges,66.1% of total billed charges,245.68,83,,196.54,percent of total billed charges,83% of total,281.2,95,,224.96,percent of total billed charges ,95% of total billed charges,236.8,80,,189.44,percent of total billed charges,78% of total billed charges,230.88,78,,184.704,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,186.48,63,,149.18,percent of total billed charges,63% of total billed charges,251.6,85,,201.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,233.84,79,,187.07,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,186.48,450,
ALBUMIN 25% INJ 50ML VIAL,258017035,CDM,636,RC,P9047,HCPCS,outpatient,,,340,238,,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,306,90,,244.8,percent of total billed charges,90% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,84.92,160,,,Fee Schedule,160% of CMS OPPS rate,69,130,,,Fee Schedule,130% of CMS OPPS rate,53.08,100,,,fee schedule,100% of GA fee schedule,262.55,77.22,,210.04,percent of total billed charges,77.22% of total billed charges,55.73,105,,,fee schedule,105% of GA fee schedule,282.2,83,,225.76,percent of total billed charges,83% of total,323,95,,258.4,percent of total billed charges ,95% of total billed charges,272,80,,217.6,percent of total billed charges,78% of total billed charges,265.2,78,,212.16,percent of total billed charges,78% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,53.08,100,,,fee schedule,100% of GA fee schedule,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,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,53.08,100,,,fee schedule,100% of GA fee schedule,289,85,,231.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,49.36,93,,,fee schedule,93% of CMS OPPS rate,268.6,79,,214.88,percent of total billed charges,79% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,49.36,450,
CEFTAROLINE FOSAMIL ACET 600MG,258019759,CDM,636,RC,J0712,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,6.3,160,,,Fee Schedule,160% of CMS OPPS rate,5.12,130,,,Fee Schedule,130% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,235.32,66.1,,188.26,percent of total billed charges,66.1% of total billed charges,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,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,224.28,63,,179.42,percent of total billed charges,63% of total billed charges,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3.66,93,,,fee schedule,93% of CMS OPPS rate,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,3.94,100,,,Fee Schedule,100% of CMS OPPS rate,3.66,450,
CP IV INF BAMLANIV ETESEVIMAB,258019840,CDM,636,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CASIRIVIMAB/IMDEVIMA 600/600MG,258019855,CDM,636,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
SODIUM CHLORIDE IRRIG SO 500ML,258019923,CDM,636,RC,J7040,HCPCS,outpatient,,,17,11.9,,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,15.3,90,,12.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.28,100,,,fee schedule,100% of GA fee schedule,13.13,77.22,,10.5,percent of total billed charges,77.22% of total billed charges,1.34,105,,,fee schedule,105% of GA fee schedule,14.11,83,,11.29,percent of total billed charges,83% of total,16.15,95,,12.92,percent of total billed charges ,95% of total billed charges,13.6,80,,10.88,percent of total billed charges,78% of total billed charges,13.26,78,,10.608,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.28,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,1.28,100,,,fee schedule,100% of GA fee schedule,14.45,85,,11.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,13.43,79,,10.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.28,450,
NUSHIELD PER SQ CM  VN 1160C,324227635,CDM,636,RC,Q4160,HCPCS,outpatient,,,1382,967.4,,1091.78,79,,873.42,percent of total billed charges,79% of total billed charges,1243.8,90,,995.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,870.66,63,,696.53,percent of total billed charges,63% of total billed charges,1067.18,77.22,,853.74,percent of total billed charges,77.22% of total billed charges,913.5,66.1,,730.8,percent of total billed charges,66.1% of total billed charges,1147.06,83,,917.65,percent of total billed charges,83% of total,1312.9,95,,1050.32,percent of total billed charges ,95% of total billed charges,1105.6,80,,884.48,percent of total billed charges,78% of total billed charges,1077.96,78,,862.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,870.66,63,,696.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,870.66,63,,696.53,percent of total billed charges,63% of total billed charges,1174.7,85,,939.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1091.78,79,,873.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1312.9,
EPIFIX SK SU GS-5180 PER SQ CM,324227690,CDM,636,RC,Q4186,HCPCS,outpatient,,,2397,1677.9,,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,1850.96,77.22,,1480.77,percent of total billed charges,77.22% of total billed charges,1584.42,66.1,,1267.54,percent of total billed charges,66.1% of total billed charges,1989.51,83,,1591.61,percent of total billed charges,83% of total,2277.15,95,,1821.72,percent of total billed charges ,95% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,78% of total billed charges,1869.66,78,,1495.728,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2157.3,90,,1725.84,percent of total billed charges,90% of total billed charges,1917.6,80,,1534.08,percent of total billed charges,80% of total billed charges,1510.11,63,,1208.09,percent of total billed charges,63% of total billed charges,2037.45,85,,1629.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1893.63,79,,1514.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2277.15,
PURAPLY AM PER SQ CM,324227741,CDM,636,RC,Q4196,HCPCS,outpatient,,,394,275.8,,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,304.25,77.22,,243.4,percent of total billed charges,77.22% of total billed charges,260.43,66.1,,208.34,percent of total billed charges,66.1% of total billed charges,327.02,83,,261.62,percent of total billed charges,83% of total,374.3,95,,299.44,percent of total billed charges ,95% of total billed charges,315.2,80,,252.16,percent of total billed charges,78% of total billed charges,307.32,78,,245.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,248.22,450,
THERASKIN 100TSXS 2.5x2.5 cm,324228562,CDM,636,RC,Q4121,HCPCS,outpatient,,,1425,997.5,,1125.75,79,,900.6,percent of total billed charges,79% of total billed charges,1282.5,90,,1026,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,1100.39,77.22,,880.31,percent of total billed charges,77.22% of total billed charges,43.95,105,,,fee schedule,105% of GA fee schedule,1182.75,83,,946.2,percent of total billed charges,83% of total,1353.75,95,,1083,percent of total billed charges ,95% of total billed charges,1140,80,,912,percent of total billed charges,78% of total billed charges,1111.5,78,,889.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1282.5,90,,1026,percent of total billed charges,90% of total billed charges,1140,80,,912,percent of total billed charges,80% of total billed charges,41.86,100,,,fee schedule,100% of GA fee schedule,1211.25,85,,969,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1125.75,79,,900.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.86,1353.75,
THERASKIN 101TSS 2.5x5.1cm,324228563,CDM,636,RC,Q4121,HCPCS,outpatient,,,1620,1134,,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,1250.96,77.22,,1000.77,percent of total billed charges,77.22% of total billed charges,43.95,105,,,fee schedule,105% of GA fee schedule,1344.6,83,,1075.68,percent of total billed charges,83% of total,1539,95,,1231.2,percent of total billed charges ,95% of total billed charges,1296,80,,1036.8,percent of total billed charges,78% of total billed charges,1263.6,78,,1010.88,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1458,90,,1166.4,percent of total billed charges,90% of total billed charges,1296,80,,1036.8,percent of total billed charges,80% of total billed charges,41.86,100,,,fee schedule,100% of GA fee schedule,1377,85,,1101.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1279.8,79,,1023.84,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.86,1539,
THERASKIN 102TSL 5.1x7.6 cm,324228564,CDM,636,RC,Q4121,HCPCS,outpatient,,,1942,1359.4,,1534.18,79,,1227.34,percent of total billed charges,79% of total billed charges,1747.8,90,,1398.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,1499.61,77.22,,1199.69,percent of total billed charges,77.22% of total billed charges,43.95,105,,,fee schedule,105% of GA fee schedule,1611.86,83,,1289.49,percent of total billed charges,83% of total,1844.9,95,,1475.92,percent of total billed charges ,95% of total billed charges,1553.6,80,,1242.88,percent of total billed charges,78% of total billed charges,1514.76,78,,1211.808,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,1747.8,90,,1398.24,percent of total billed charges,90% of total billed charges,1553.6,80,,1242.88,percent of total billed charges,80% of total billed charges,41.86,100,,,fee schedule,100% of GA fee schedule,1650.7,85,,1320.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1534.18,79,,1227.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.86,1844.9,
THERASKIN 103TSXL 7.6 x 15.2cm,324228565,CDM,636,RC,Q4121,HCPCS,outpatient,,,5242,3669.4,,4141.18,79,,3312.94,percent of total billed charges,79% of total billed charges,4717.8,90,,3774.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,4047.87,77.22,,3238.3,percent of total billed charges,77.22% of total billed charges,43.95,105,,,fee schedule,105% of GA fee schedule,4350.86,83,,3480.69,percent of total billed charges,83% of total,4979.9,95,,3983.92,percent of total billed charges ,95% of total billed charges,4193.6,80,,3354.88,percent of total billed charges,78% of total billed charges,4088.76,78,,3271.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,41.86,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,4717.8,90,,3774.24,percent of total billed charges,90% of total billed charges,4193.6,80,,3354.88,percent of total billed charges,80% of total billed charges,41.86,100,,,fee schedule,100% of GA fee schedule,4455.7,85,,3564.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4141.18,79,,3312.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41.86,4979.9,
APLIGRAF SKIN SUB PER SQ CM,324228761,CDM,636,RC,Q4101,HCPCS,outpatient,,,90,63,,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,81,90,,64.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,69.5,77.22,,55.6,percent of total billed charges,77.22% of total billed charges,59.49,66.1,,47.59,percent of total billed charges,66.1% of total billed charges,74.7,83,,59.76,percent of total billed charges,83% of total,85.5,95,,68.4,percent of total billed charges ,95% of total billed charges,72,80,,57.6,percent of total billed charges,78% of total billed charges,70.2,78,,56.16,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,56.7,63,,45.36,percent of total billed charges,63% of total billed charges,76.5,85,,61.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.1,79,,56.88,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56.7,450,
SURGIGRAFT DRY GRFT DISC 1.8CM,324228955,CDM,636,RC,Q4183,HCPCS,outpatient,,,630,441,,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,567,90,,453.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,486.49,77.22,,389.19,percent of total billed charges,77.22% of total billed charges,416.43,66.1,,333.14,percent of total billed charges,66.1% of total billed charges,522.9,83,,418.32,percent of total billed charges,83% of total,598.5,95,,478.8,percent of total billed charges ,95% of total billed charges,504,80,,403.2,percent of total billed charges,78% of total billed charges,491.4,78,,393.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,396.9,63,,317.52,percent of total billed charges,63% of total billed charges,535.5,85,,428.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,497.7,79,,398.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,396.9,598.5,
EPICORD SK SU EC-5230 SQ CM,324229013,CDM,636,RC,Q4187,HCPCS,outpatient,,,728.5,509.95,,575.52,79,,460.42,percent of total billed charges,79% of total billed charges,655.65,90,,524.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,458.96,63,,367.17,percent of total billed charges,63% of total billed charges,562.55,77.22,,450.04,percent of total billed charges,77.22% of total billed charges,481.54,66.1,,385.23,percent of total billed charges,66.1% of total billed charges,604.66,83,,483.73,percent of total billed charges,83% of total,692.08,95,,553.66,percent of total billed charges ,95% of total billed charges,582.8,80,,466.24,percent of total billed charges,78% of total billed charges,568.23,78,,454.584,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,458.96,63,,367.17,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,655.65,90,,524.52,percent of total billed charges,90% of total billed charges,582.8,80,,466.24,percent of total billed charges,80% of total billed charges,458.96,63,,367.17,percent of total billed charges,63% of total billed charges,619.23,85,,495.384,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,575.52,79,,460.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,692.08,
SURGIGRAFT DRY SGD-203/SQ CM,324229030,CDM,636,RC,Q4183,HCPCS,outpatient,,,248.5,173.95,,196.32,79,,157.06,percent of total billed charges,79% of total billed charges,223.65,90,,178.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.56,63,,125.25,percent of total billed charges,63% of total billed charges,191.89,77.22,,153.51,percent of total billed charges,77.22% of total billed charges,164.26,66.1,,131.41,percent of total billed charges,66.1% of total billed charges,206.26,83,,165.01,percent of total billed charges,83% of total,236.08,95,,188.86,percent of total billed charges ,95% of total billed charges,198.8,80,,159.04,percent of total billed charges,78% of total billed charges,193.83,78,,155.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,156.56,63,,125.25,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,223.65,90,,178.92,percent of total billed charges,90% of total billed charges,198.8,80,,159.04,percent of total billed charges,80% of total billed charges,156.56,63,,125.25,percent of total billed charges,63% of total billed charges,211.23,85,,168.984,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,196.32,79,,157.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,156.56,450,
ALBUMIN 25% 50 ML.,390000502,CDM,636,RC,P9047,HCPCS,outpatient,,,135,94.5,,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,121.5,90,,97.2,percent of total billed charges,90% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,84.92,160,,,Fee Schedule,160% of CMS OPPS rate,69,130,,,Fee Schedule,130% of CMS OPPS rate,53.08,100,,,fee schedule,100% of GA fee schedule,104.25,77.22,,83.4,percent of total billed charges,77.22% of total billed charges,55.73,105,,,fee schedule,105% of GA fee schedule,112.05,83,,89.64,percent of total billed charges,83% of total,128.25,95,,102.6,percent of total billed charges ,95% of total billed charges,108,80,,86.4,percent of total billed charges,78% of total billed charges,105.3,78,,84.24,percent of total billed charges,78% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,53.08,100,,,fee schedule,100% of GA fee schedule,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,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,53.08,100,,,fee schedule,100% of GA fee schedule,114.75,85,,91.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,49.36,93,,,fee schedule,93% of CMS OPPS rate,106.65,79,,85.32,percent of total billed charges,79% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,49.36,450,
ALBUMIN 25% 100 ML.,390000503,CDM,636,RC,P9047,HCPCS,outpatient,,,166,116.2,,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,149.4,90,,119.52,percent of total billed charges,90% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,84.92,160,,,Fee Schedule,160% of CMS OPPS rate,69,130,,,Fee Schedule,130% of CMS OPPS rate,53.08,100,,,fee schedule,100% of GA fee schedule,128.19,77.22,,102.55,percent of total billed charges,77.22% of total billed charges,55.73,105,,,fee schedule,105% of GA fee schedule,137.78,83,,110.22,percent of total billed charges,83% of total,157.7,95,,126.16,percent of total billed charges ,95% of total billed charges,132.8,80,,106.24,percent of total billed charges,78% of total billed charges,129.48,78,,103.584,percent of total billed charges,78% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,53.08,100,,,fee schedule,100% of GA fee schedule,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,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,53.08,100,,,fee schedule,100% of GA fee schedule,141.1,85,,112.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,49.36,93,,,fee schedule,93% of CMS OPPS rate,131.14,79,,104.91,percent of total billed charges,79% of total billed charges,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,53.08,100,,,Fee Schedule,100% of CMS OPPS rate,49.36,450,
PNEUMONIA VACCINE V03.82,493090732,CDM,636,RC,90732,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.47,100,,,fee schedule,100% of GA fee schedule,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,140.14,105,,,fee schedule,105% of GA fee schedule,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,133.47,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,133.47,100,,,fee schedule,100% of GA fee schedule,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.8,450,
DEPO-MEDROL 20 MG INJ,4930J1010,CDM,636,RC,J1010,HCPCS,outpatient,,,7.5,5.25,,5.93,79,,4.74,percent of total billed charges,79% of total billed charges,6.75,90,,5.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.12,100,,,fee schedule,100% of GA fee schedule,5.79,77.22,,4.63,percent of total billed charges,77.22% of total billed charges,0.13,105,,,fee schedule,105% of GA fee schedule,6.23,83,,4.98,percent of total billed charges,83% of total,7.13,95,,5.7,percent of total billed charges ,95% of total billed charges,6,80,,4.8,percent of total billed charges,78% of total billed charges,5.85,78,,4.68,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.12,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,6.75,90,,5.4,percent of total billed charges,90% of total billed charges,6,80,,4.8,percent of total billed charges,80% of total billed charges,0.12,100,,,fee schedule,100% of GA fee schedule,6.38,85,,5.104,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5.93,79,,4.74,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.12,450,
DEPO-MEDROL 40 MG INJ,4930J10102,CDM,636,RC,J1010,HCPCS,outpatient,,,15,10.5,,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,13.5,90,,10.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.12,100,,,fee schedule,100% of GA fee schedule,11.58,77.22,,9.26,percent of total billed charges,77.22% of total billed charges,0.13,105,,,fee schedule,105% of GA fee schedule,12.45,83,,9.96,percent of total billed charges,83% of total,14.25,95,,11.4,percent of total billed charges ,95% of total billed charges,12,80,,9.6,percent of total billed charges,78% of total billed charges,11.7,78,,9.36,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.12,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.12,100,,,fee schedule,100% of GA fee schedule,12.75,85,,10.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,11.85,79,,9.48,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.12,450,
DEPO-MEDROL 80 MG INJ,4930J10103,CDM,636,RC,J1010,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.12,100,,,fee schedule,100% of GA fee schedule,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,0.13,105,,,fee schedule,105% of GA fee schedule,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.12,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.12,100,,,fee schedule,100% of GA fee schedule,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.12,450,
KENALOG INJECTION 40MG,4930J3301,CDM,636,RC,J3301,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,0.95,105,,,fee schedule,105% of GA fee schedule,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,0.9,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,0.9,100,,,fee schedule,100% of GA fee schedule,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,0.9,450,
PREVNAR  13,90670,CDM,636,RC,90670,HCPCS,outpatient,,,225,157.5,,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,202.5,90,,162,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.99,100,,,fee schedule,100% of GA fee schedule,173.75,77.22,,139,percent of total billed charges,77.22% of total billed charges,270.89,105,,,fee schedule,105% of GA fee schedule,186.75,83,,149.4,percent of total billed charges,83% of total,213.75,95,,171,percent of total billed charges ,95% of total billed charges,180,80,,144,percent of total billed charges,78% of total billed charges,175.5,78,,140.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,257.99,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,257.99,100,,,fee schedule,100% of GA fee schedule,191.25,85,,153,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,177.75,79,,142.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.75,450,
PCV20 VACCINE INTRAMUSC USE,90677,CDM,636,RC,90677,HCPCS,outpatient,,,356,249.2,,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,320.4,90,,256.32,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,298.04,100,,,fee schedule,100% of GA fee schedule,274.9,77.22,,219.92,percent of total billed charges,77.22% of total billed charges,312.94,105,,,fee schedule,105% of GA fee schedule,295.48,83,,236.38,percent of total billed charges,83% of total,338.2,95,,270.56,percent of total billed charges ,95% of total billed charges,284.8,80,,227.84,percent of total billed charges,78% of total billed charges,277.68,78,,222.144,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,298.04,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,298.04,100,,,fee schedule,100% of GA fee schedule,302.6,85,,242.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,281.24,79,,224.99,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,274.9,450,
INFLUENZA VACCINE,90686,CDM,636,RC,90686,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.79,450,
TDAP BOOSTRIX 10-18 YRS,90715,CDM,636,RC,90715,HCPCS,outpatient,,,85,59.5,,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,76.5,90,,61.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.52,100,,,fee schedule,100% of GA fee schedule,65.64,77.22,,52.51,percent of total billed charges,77.22% of total billed charges,40.45,105,,,fee schedule,105% of GA fee schedule,70.55,83,,56.44,percent of total billed charges,83% of total,80.75,95,,64.6,percent of total billed charges ,95% of total billed charges,68,80,,54.4,percent of total billed charges,78% of total billed charges,66.3,78,,53.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,38.52,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,38.52,100,,,fee schedule,100% of GA fee schedule,72.25,85,,57.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,67.15,79,,53.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.52,450,
HEP B 20 YRS AND OVER  V05.3,90746,CDM,636,RC,90746,HCPCS,outpatient,,,134,93.8,,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,120.6,90,,96.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.38,100,,,fee schedule,100% of GA fee schedule,103.47,77.22,,82.78,percent of total billed charges,77.22% of total billed charges,73.9,105,,,fee schedule,105% of GA fee schedule,111.22,83,,88.98,percent of total billed charges,83% of total,127.3,95,,101.84,percent of total billed charges ,95% of total billed charges,107.2,80,,85.76,percent of total billed charges,78% of total billed charges,104.52,78,,83.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,70.38,100,,,fee schedule,100% of GA fee schedule,,,,,other ,not seperately reimbursable,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,70.38,100,,,fee schedule,100% of GA fee schedule,113.9,85,,91.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,105.86,79,,84.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.38,450,
DEPO-MEDROL 20 MG INJ,J1010,CDM,636,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DEPO-MEDROL 40 MG INJ,J10102,CDM,636,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DEPO-MEDROL 80 MG INJ,J10103,CDM,636,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INFLUENZA VACCINE MEDICARE,Q2038,CDM,636,RC,Q2038,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
INSULIN NPH HUMAN 100U/ML,250019702,CDM,637,RC,A9270,HCPCS,outpatient,,,12,8.4,,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,10.8,90,,8.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,9.27,77.22,,7.42,percent of total billed charges,77.22% of total billed charges,7.93,66.1,,6.34,percent of total billed charges,66.1% of total billed charges,9.96,83,,7.97,percent of total billed charges,83% of total,11.4,95,,9.12,percent of total billed charges ,95% of total billed charges,9.6,80,,7.68,percent of total billed charges,78% of total billed charges,9.36,78,,7.488,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,7.56,63,,6.05,percent of total billed charges,63% of total billed charges,10.2,85,,8.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,9.48,79,,7.58,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.56,450,
LAMOTRIGINE 25 MG TABLET,250019813,CDM,637,RC,A9270,HCPCS,outpatient,,,3,2.1,,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,2.7,90,,2.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.32,77.22,,1.86,percent of total billed charges,77.22% of total billed charges,1.98,66.1,,1.58,percent of total billed charges,66.1% of total billed charges,2.49,83,,1.99,percent of total billed charges,83% of total,2.85,95,,2.28,percent of total billed charges ,95% of total billed charges,2.4,80,,1.92,percent of total billed charges,78% of total billed charges,2.34,78,,1.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1.89,63,,1.51,percent of total billed charges,63% of total billed charges,2.55,85,,2.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2.37,79,,1.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.89,450,
ERYTHROMYCIN BASE 1 APP E OINT,250019891,CDM,637,RC,,,outpatient,,,30.9,21.63,,24.41,79,,19.53,percent of total billed charges,79% of total billed charges,27.81,90,,22.25,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.47,63,,15.58,percent of total billed charges,63% of total billed charges,23.86,77.22,,19.09,percent of total billed charges,77.22% of total billed charges,20.42,66.1,,16.34,percent of total billed charges,66.1% of total billed charges,25.65,83,,20.52,percent of total billed charges,83% of total,29.36,95,,23.49,percent of total billed charges ,95% of total billed charges,24.72,80,,19.78,percent of total billed charges,78% of total billed charges,24.1,78,,19.28,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,19.47,63,,15.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,27.81,90,,22.25,percent of total billed charges,90% of total billed charges,24.72,80,,19.78,percent of total billed charges,80% of total billed charges,19.47,63,,15.58,percent of total billed charges,63% of total billed charges,26.27,85,,21.016,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,24.41,79,,19.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19.47,450,
ALBUTEROL SULFATE,J7610,CDM,637,RC,J7610,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
IPRATROPIUM BROMIDE ATROVENT,J7645,CDM,637,RC,J7645,HCPCS,outpatient,,,16,11.2,,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,14.4,90,,11.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,12.36,77.22,,9.89,percent of total billed charges,77.22% of total billed charges,10.58,66.1,,8.46,percent of total billed charges,66.1% of total billed charges,13.28,83,,10.62,percent of total billed charges,83% of total,15.2,95,,12.16,percent of total billed charges ,95% of total billed charges,12.8,80,,10.24,percent of total billed charges,78% of total billed charges,12.48,78,,9.984,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,10.08,63,,8.06,percent of total billed charges,63% of total billed charges,13.6,85,,10.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,12.64,79,,10.11,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,10.08,450,
OBS APPLY LONG ARM SPLINT,762029105,CDM,700,RC,29105,HCPCS,outpatient,,,318,222.6,,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,286.2,90,,228.96,percent of total billed charges,90% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,210.79,160,,,Fee Schedule,160% of CMS OPPS rate,171.27,130,,,Fee Schedule,130% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,245.56,77.22,,196.45,percent of total billed charges,77.22% of total billed charges,210.2,66.1,,168.16,percent of total billed charges,66.1% of total billed charges,263.94,83,,211.15,percent of total billed charges,83% of total,302.1,95,,241.68,percent of total billed charges ,95% of total billed charges,254.4,80,,203.52,percent of total billed charges,78% of total billed charges,248.04,78,,198.432,percent of total billed charges,78% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,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,200.34,63,,160.27,percent of total billed charges,63% of total billed charges,270.3,85,,216.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,122.53,93,,,fee schedule,93% of CMS OPPS rate,251.22,79,,200.98,percent of total billed charges,79% of total billed charges,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,131.75,100,,,Fee Schedule,100% of CMS OPPS rate,122.53,450,
OBS APPLY FOREARM SPLINT,762029125,CDM,700,RC,29125,HCPCS,outpatient,,,308,215.6,,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,277.2,90,,221.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,237.84,77.22,,190.27,percent of total billed charges,77.22% of total billed charges,203.59,66.1,,162.87,percent of total billed charges,66.1% of total billed charges,255.64,83,,204.51,percent of total billed charges,83% of total,292.6,95,,234.08,percent of total billed charges ,95% of total billed charges,246.4,80,,197.12,percent of total billed charges,78% of total billed charges,240.24,78,,192.192,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,194.04,63,,155.23,percent of total billed charges,63% of total billed charges,261.8,85,,209.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,243.32,79,,194.66,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
MA PACU 0-30 MINS,710001000,CDM,710,RC,,,outpatient,,,3592,2514.4,,2837.68,79,,2270.14,percent of total billed charges,79% of total billed charges,3232.8,90,,2586.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2262.96,63,,1810.37,percent of total billed charges,63% of total billed charges,2773.74,77.22,,2218.99,percent of total billed charges,77.22% of total billed charges,2374.31,66.1,,1899.45,percent of total billed charges,66.1% of total billed charges,2981.36,83,,2385.09,percent of total billed charges,83% of total,3412.4,95,,2729.92,percent of total billed charges ,95% of total billed charges,2873.6,80,,2298.88,percent of total billed charges,78% of total billed charges,2801.76,78,,2241.408,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2262.96,63,,1810.37,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3232.8,90,,2586.24,percent of total billed charges,90% of total billed charges,2873.6,80,,2298.88,percent of total billed charges,80% of total billed charges,2262.96,63,,1810.37,percent of total billed charges,63% of total billed charges,3053.2,85,,2442.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2837.68,79,,2270.14,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3412.4,
PACU - EA ADDTIONAL 15 MIN,710001001,CDM,710,RC,,,outpatient,,,835,584.5,,659.65,79,,527.72,percent of total billed charges,79% of total billed charges,751.5,90,,601.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,526.05,63,,420.84,percent of total billed charges,63% of total billed charges,644.79,77.22,,515.83,percent of total billed charges,77.22% of total billed charges,551.94,66.1,,441.55,percent of total billed charges,66.1% of total billed charges,693.05,83,,554.44,percent of total billed charges,83% of total,793.25,95,,634.6,percent of total billed charges ,95% of total billed charges,668,80,,534.4,percent of total billed charges,78% of total billed charges,651.3,78,,521.04,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,526.05,63,,420.84,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,526.05,63,,420.84,percent of total billed charges,63% of total billed charges,709.75,85,,567.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,659.65,79,,527.72,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,793.25,
MA PACU > 3 PM & WKENDS 0-30 M,710001002,CDM,710,RC,,,outpatient,,,1654,1157.8,,1306.66,79,,1045.33,percent of total billed charges,79% of total billed charges,1488.6,90,,1190.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,1277.22,77.22,,1021.78,percent of total billed charges,77.22% of total billed charges,1093.29,66.1,,874.63,percent of total billed charges,66.1% of total billed charges,1372.82,83,,1098.26,percent of total billed charges,83% of total,1571.3,95,,1257.04,percent of total billed charges ,95% of total billed charges,1323.2,80,,1058.56,percent of total billed charges,78% of total billed charges,1290.12,78,,1032.096,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1488.6,90,,1190.88,percent of total billed charges,90% of total billed charges,1323.2,80,,1058.56,percent of total billed charges,80% of total billed charges,1042.02,63,,833.62,percent of total billed charges,63% of total billed charges,1405.9,85,,1124.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1306.66,79,,1045.33,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1571.3,
MA PACU >3PM/WKND EA ADD 15 MN,710001003,CDM,710,RC,,,outpatient,,,457,319.9,,361.03,79,,288.82,percent of total billed charges,79% of total billed charges,411.3,90,,329.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,352.9,77.22,,282.32,percent of total billed charges,77.22% of total billed charges,302.08,66.1,,241.66,percent of total billed charges,66.1% of total billed charges,379.31,83,,303.45,percent of total billed charges,83% of total,434.15,95,,347.32,percent of total billed charges ,95% of total billed charges,365.6,80,,292.48,percent of total billed charges,78% of total billed charges,356.46,78,,285.168,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,411.3,90,,329.04,percent of total billed charges,90% of total billed charges,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,287.91,63,,230.33,percent of total billed charges,63% of total billed charges,388.45,85,,310.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,361.03,79,,288.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,287.91,450,
MI PACU 0-30 MINS,710001004,CDM,710,RC,,,outpatient,,,2846,1992.2,,2248.34,79,,1798.67,percent of total billed charges,79% of total billed charges,2561.4,90,,2049.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1792.98,63,,1434.38,percent of total billed charges,63% of total billed charges,2197.68,77.22,,1758.14,percent of total billed charges,77.22% of total billed charges,1881.21,66.1,,1504.97,percent of total billed charges,66.1% of total billed charges,2362.18,83,,1889.74,percent of total billed charges,83% of total,2703.7,95,,2162.96,percent of total billed charges ,95% of total billed charges,2276.8,80,,1821.44,percent of total billed charges,78% of total billed charges,2219.88,78,,1775.904,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1792.98,63,,1434.38,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2561.4,90,,2049.12,percent of total billed charges,90% of total billed charges,2276.8,80,,1821.44,percent of total billed charges,80% of total billed charges,1792.98,63,,1434.38,percent of total billed charges,63% of total billed charges,2419.1,85,,1935.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2248.34,79,,1798.67,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2703.7,
MI PACU > 3 PM & WKENDS 0-30 M,710001005,CDM,710,RC,,,outpatient,,,1338,936.6,,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1033.2,77.22,,826.56,percent of total billed charges,77.22% of total billed charges,884.42,66.1,,707.54,percent of total billed charges,66.1% of total billed charges,1110.54,83,,888.43,percent of total billed charges,83% of total,1271.1,95,,1016.88,percent of total billed charges ,95% of total billed charges,1070.4,80,,856.32,percent of total billed charges,78% of total billed charges,1043.64,78,,834.912,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1204.2,90,,963.36,percent of total billed charges,90% of total billed charges,1070.4,80,,856.32,percent of total billed charges,80% of total billed charges,842.94,63,,674.35,percent of total billed charges,63% of total billed charges,1137.3,85,,909.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1057.02,79,,845.62,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1271.1,
MI PACU >3PM/WKND EA ADD 15 MN,710001006,CDM,710,RC,,,outpatient,,,428,299.6,,338.12,79,,270.5,percent of total billed charges,79% of total billed charges,385.2,90,,308.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,330.5,77.22,,264.4,percent of total billed charges,77.22% of total billed charges,282.91,66.1,,226.33,percent of total billed charges,66.1% of total billed charges,355.24,83,,284.19,percent of total billed charges,83% of total,406.6,95,,325.28,percent of total billed charges ,95% of total billed charges,342.4,80,,273.92,percent of total billed charges,78% of total billed charges,333.84,78,,267.072,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,269.64,63,,215.71,percent of total billed charges,63% of total billed charges,363.8,85,,291.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,338.12,79,,270.5,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,269.64,450,
SDC RECOVERY 0-30 MINS,710001007,CDM,710,RC,,,outpatient,,,650,455,,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,585,90,,468,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,501.93,77.22,,401.54,percent of total billed charges,77.22% of total billed charges,429.65,66.1,,343.72,percent of total billed charges,66.1% of total billed charges,539.5,83,,431.6,percent of total billed charges,83% of total,617.5,95,,494,percent of total billed charges ,95% of total billed charges,520,80,,416,percent of total billed charges,78% of total billed charges,507,78,,405.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,409.5,63,,327.6,percent of total billed charges,63% of total billed charges,552.5,85,,442,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,513.5,79,,410.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,409.5,617.5,
SDC RECOVERY - EA ADDL 15 MIN,710001008,CDM,710,RC,,,outpatient,,,214,149.8,,169.06,79,,135.25,percent of total billed charges,79% of total billed charges,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.82,63,,107.86,percent of total billed charges,63% of total billed charges,165.25,77.22,,132.2,percent of total billed charges,77.22% of total billed charges,141.45,66.1,,113.16,percent of total billed charges,66.1% of total billed charges,177.62,83,,142.1,percent of total billed charges,83% of total,203.3,95,,162.64,percent of total billed charges ,95% of total billed charges,171.2,80,,136.96,percent of total billed charges,78% of total billed charges,166.92,78,,133.536,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,134.82,63,,107.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,192.6,90,,154.08,percent of total billed charges,90% of total billed charges,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,134.82,63,,107.86,percent of total billed charges,63% of total billed charges,181.9,85,,145.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,169.06,79,,135.25,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,134.82,450,
FETAL NON-STRESS TEST,480025088,CDM,720,RC,59025,HCPCS,outpatient,,,617,431.9,,487.43,79,,389.94,percent of total billed charges,79% of total billed charges,555.3,90,,444.24,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,476.45,77.22,,381.16,percent of total billed charges,77.22% of total billed charges,407.84,66.1,,326.27,percent of total billed charges,66.1% of total billed charges,512.11,83,,409.69,percent of total billed charges,83% of total,586.15,95,,468.92,percent of total billed charges ,95% of total billed charges,493.6,80,,394.88,percent of total billed charges,78% of total billed charges,481.26,78,,385.008,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,388.71,63,,310.97,percent of total billed charges,63% of total billed charges,524.45,85,,419.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,487.43,79,,389.94,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,586.15,
VAGINAL DELIVERY W/O COMPLICAT,720001201,CDM,720,RC,,,outpatient,,,7253,5077.1,,5729.87,79,,4583.9,percent of total billed charges,79% of total billed charges,6527.7,90,,5222.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4569.39,63,,3655.51,percent of total billed charges,63% of total billed charges,5600.77,77.22,,4480.62,percent of total billed charges,77.22% of total billed charges,4794.23,66.1,,3835.38,percent of total billed charges,66.1% of total billed charges,6019.99,83,,4815.99,percent of total billed charges,83% of total,6890.35,95,,5512.28,percent of total billed charges ,95% of total billed charges,5802.4,80,,4641.92,percent of total billed charges,78% of total billed charges,5657.34,78,,4525.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4569.39,63,,3655.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,6527.7,90,,5222.16,percent of total billed charges,90% of total billed charges,5802.4,80,,4641.92,percent of total billed charges,80% of total billed charges,4569.39,63,,3655.51,percent of total billed charges,63% of total billed charges,6165.05,85,,4932.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5729.87,79,,4583.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,6890.35,
VAGINAL DELIVERY WITH STERILIZ,720001202,CDM,720,RC,,,outpatient,,,9408,6585.6,,7432.32,79,,5945.86,percent of total billed charges,79% of total billed charges,8467.2,90,,6773.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5927.04,63,,4741.63,percent of total billed charges,63% of total billed charges,7264.86,77.22,,5811.89,percent of total billed charges,77.22% of total billed charges,6218.69,66.1,,4974.95,percent of total billed charges,66.1% of total billed charges,7808.64,83,,6246.91,percent of total billed charges,83% of total,8937.6,95,,7150.08,percent of total billed charges ,95% of total billed charges,7526.4,80,,6021.12,percent of total billed charges,78% of total billed charges,7338.24,78,,5870.592,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5927.04,63,,4741.63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,8467.2,90,,6773.76,percent of total billed charges,90% of total billed charges,7526.4,80,,6021.12,percent of total billed charges,80% of total billed charges,5927.04,63,,4741.63,percent of total billed charges,63% of total billed charges,7996.8,85,,6397.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,7432.32,79,,5945.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,8937.6,
VAGINAL DELIVERY W COMPLICATIO,720001204,CDM,720,RC,,,outpatient,,,21757,15229.9,,17188.03,79,,13750.42,percent of total billed charges,79% of total billed charges,19581.3,90,,15665.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13706.91,63,,10965.53,percent of total billed charges,63% of total billed charges,16800.76,77.22,,13440.61,percent of total billed charges,77.22% of total billed charges,14381.38,66.1,,11505.1,percent of total billed charges,66.1% of total billed charges,18058.31,83,,14446.65,percent of total billed charges,83% of total,20669.15,95,,16535.32,percent of total billed charges ,95% of total billed charges,17405.6,80,,13924.48,percent of total billed charges,78% of total billed charges,16970.46,78,,13576.368,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13706.91,63,,10965.53,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,19581.3,90,,15665.04,percent of total billed charges,90% of total billed charges,17405.6,80,,13924.48,percent of total billed charges,80% of total billed charges,13706.91,63,,10965.53,percent of total billed charges,63% of total billed charges,18493.45,85,,14794.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17188.03,79,,13750.42,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,20669.15,
LABOR 1ST HOUR,720001205,CDM,720,RC,,,outpatient,,,313,219.1,,247.27,79,,197.82,percent of total billed charges,79% of total billed charges,281.7,90,,225.36,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,197.19,63,,157.75,percent of total billed charges,63% of total billed charges,241.7,77.22,,193.36,percent of total billed charges,77.22% of total billed charges,206.89,66.1,,165.51,percent of total billed charges,66.1% of total billed charges,259.79,83,,207.83,percent of total billed charges,83% of total,297.35,95,,237.88,percent of total billed charges ,95% of total billed charges,250.4,80,,200.32,percent of total billed charges,78% of total billed charges,244.14,78,,195.312,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,197.19,63,,157.75,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,197.19,63,,157.75,percent of total billed charges,63% of total billed charges,266.05,85,,212.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,247.27,79,,197.82,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,197.19,450,
LABOR ADDITIONAL HOURS,720001206,CDM,720,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
NON-BILLABLE CHARGE OBSTERTICS,720005555,CDM,720,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OB INSERT TEM IND BLDR CATH SI,720051702,CDM,720,RC,51702,HCPCS,outpatient,,,283,198.1,,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,218.53,77.22,,174.82,percent of total billed charges,77.22% of total billed charges,187.06,66.1,,149.65,percent of total billed charges,66.1% of total billed charges,234.89,83,,187.91,percent of total billed charges,83% of total,268.85,95,,215.08,percent of total billed charges ,95% of total billed charges,226.4,80,,181.12,percent of total billed charges,78% of total billed charges,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
TRANSABDOMINAL AMNIOINFUSION,720059070,CDM,720,RC,59070,HCPCS,outpatient,,,648,453.6,,511.92,79,,409.54,percent of total billed charges,79% of total billed charges,583.2,90,,466.56,percent of total billed charges,90% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,429.19,160,,,Fee Schedule,160% of CMS OPPS rate,348.71,130,,,Fee Schedule,130% of CMS OPPS rate,408.24,63,,326.59,percent of total billed charges,63% of total billed charges,500.39,77.22,,400.31,percent of total billed charges,77.22% of total billed charges,428.33,66.1,,342.66,percent of total billed charges,66.1% of total billed charges,537.84,83,,430.27,percent of total billed charges,83% of total,615.6,95,,492.48,percent of total billed charges ,95% of total billed charges,518.4,80,,414.72,percent of total billed charges,78% of total billed charges,505.44,78,,404.352,percent of total billed charges,78% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,408.24,63,,326.59,percent of total billed charges,63% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,583.2,90,,466.56,percent of total billed charges,90% of total billed charges,518.4,80,,414.72,percent of total billed charges,80% of total billed charges,408.24,63,,326.59,percent of total billed charges,63% of total billed charges,550.8,85,,440.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,249.46,93,,,fee schedule,93% of CMS OPPS rate,511.92,79,,409.54,percent of total billed charges,79% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,249.46,615.6,
OB INTRAUT PRESSURE MONITORING,760059050,CDM,720,RC,59050,HCPCS,outpatient,,,353,247.1,,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,317.7,90,,254.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,272.59,77.22,,218.07,percent of total billed charges,77.22% of total billed charges,233.33,66.1,,186.66,percent of total billed charges,66.1% of total billed charges,292.99,83,,234.39,percent of total billed charges,83% of total,335.35,95,,268.28,percent of total billed charges ,95% of total billed charges,282.4,80,,225.92,percent of total billed charges,78% of total billed charges,275.34,78,,220.272,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,222.39,63,,177.91,percent of total billed charges,63% of total billed charges,300.05,85,,240.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,278.87,79,,223.1,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,222.39,450,
FETAL SCALP ELECTRODE APPLIC,761059901,CDM,720,RC,59899,HCPCS,outpatient,,,153,107.1,,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,137.7,90,,110.16,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,118.15,77.22,,94.52,percent of total billed charges,77.22% of total billed charges,101.13,66.1,,80.9,percent of total billed charges,66.1% of total billed charges,126.99,83,,101.59,percent of total billed charges,83% of total,145.35,95,,116.28,percent of total billed charges ,95% of total billed charges,122.4,80,,97.92,percent of total billed charges,78% of total billed charges,119.34,78,,95.472,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,96.39,63,,77.11,percent of total billed charges,63% of total billed charges,130.05,85,,104.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,120.87,79,,96.7,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,96.39,450,
INSERT CERVICAL DILATOR,762059200,CDM,720,RC,59200,HCPCS,outpatient,,,823,576.1,,650.17,79,,520.14,percent of total billed charges,79% of total billed charges,740.7,90,,592.56,percent of total billed charges,90% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,429.19,160,,,Fee Schedule,160% of CMS OPPS rate,348.71,130,,,Fee Schedule,130% of CMS OPPS rate,518.49,63,,414.79,percent of total billed charges,63% of total billed charges,635.52,77.22,,508.42,percent of total billed charges,77.22% of total billed charges,544,66.1,,435.2,percent of total billed charges,66.1% of total billed charges,683.09,83,,546.47,percent of total billed charges,83% of total,781.85,95,,625.48,percent of total billed charges ,95% of total billed charges,658.4,80,,526.72,percent of total billed charges,78% of total billed charges,641.94,78,,513.552,percent of total billed charges,78% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,518.49,63,,414.79,percent of total billed charges,63% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,518.49,63,,414.79,percent of total billed charges,63% of total billed charges,699.55,85,,559.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,249.46,93,,,fee schedule,93% of CMS OPPS rate,650.17,79,,520.14,percent of total billed charges,79% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,249.46,781.85,
DELIVER PLACENTA,762059414,CDM,722,RC,59414,HCPCS,outpatient,,,2305,1613.5,,1820.95,79,,1456.76,percent of total billed charges,79% of total billed charges,2074.5,90,,1659.6,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,1452.15,63,,1161.72,percent of total billed charges,63% of total billed charges,1779.92,77.22,,1423.94,percent of total billed charges,77.22% of total billed charges,1523.61,66.1,,1218.89,percent of total billed charges,66.1% of total billed charges,1913.15,83,,1530.52,percent of total billed charges,83% of total,2189.75,95,,1751.8,percent of total billed charges ,95% of total billed charges,1844,80,,1475.2,percent of total billed charges,78% of total billed charges,1797.9,78,,1438.32,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,1452.15,63,,1161.72,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,1452.15,63,,1161.72,percent of total billed charges,63% of total billed charges,1959.25,85,,1567.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,1820.95,79,,1456.76,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,4182.66,
NEWBORN RESUSCITATION,724099465,CDM,724,RC,99465,HCPCS,outpatient,,,224,156.8,,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,201.6,90,,161.28,percent of total billed charges,90% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,870.72,160,,,Fee Schedule,160% of CMS OPPS rate,707.46,130,,,Fee Schedule,130% of CMS OPPS rate,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,172.97,77.22,,138.38,percent of total billed charges,77.22% of total billed charges,148.06,66.1,,118.45,percent of total billed charges,66.1% of total billed charges,185.92,83,,148.74,percent of total billed charges,83% of total,212.8,95,,170.24,percent of total billed charges ,95% of total billed charges,179.2,80,,143.36,percent of total billed charges,78% of total billed charges,174.72,78,,139.776,percent of total billed charges,78% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,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,141.12,63,,112.9,percent of total billed charges,63% of total billed charges,190.4,85,,152.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,506.1,93,,,fee schedule,93% of CMS OPPS rate,176.96,79,,141.57,percent of total billed charges,79% of total billed charges,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,544.19,100,,,Fee Schedule,100% of CMS OPPS rate,141.12,870.72,
"RHYTHM EKG 1-3 LEADS, TRACING",450093041,CDM,730,RC,93041,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
EKG WITH INTERPRETATION,493093000,CDM,730,RC,93000,HCPCS,outpatient,,,91,63.7,,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,81.9,90,,65.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,70.27,77.22,,56.22,percent of total billed charges,77.22% of total billed charges,60.15,66.1,,48.12,percent of total billed charges,66.1% of total billed charges,75.53,83,,60.42,percent of total billed charges,83% of total,86.45,95,,69.16,percent of total billed charges ,95% of total billed charges,72.8,80,,58.24,percent of total billed charges,78% of total billed charges,70.98,78,,56.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,57.33,63,,45.86,percent of total billed charges,63% of total billed charges,77.35,85,,61.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,71.89,79,,57.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.33,450,
EKG,730000690,CDM,730,RC,93005,HCPCS,outpatient,,,283,198.1,,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,218.53,77.22,,174.82,percent of total billed charges,77.22% of total billed charges,187.06,66.1,,149.65,percent of total billed charges,66.1% of total billed charges,234.89,83,,187.91,percent of total billed charges,83% of total,268.85,95,,215.08,percent of total billed charges ,95% of total billed charges,226.4,80,,181.12,percent of total billed charges,78% of total billed charges,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
RHYTHM ECG TRACING W/O INTER,730000697,CDM,730,RC,93041,HCPCS,outpatient,,,285,199.5,,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,256.5,90,,205.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,220.08,77.22,,176.06,percent of total billed charges,77.22% of total billed charges,188.39,66.1,,150.71,percent of total billed charges,66.1% of total billed charges,236.55,83,,189.24,percent of total billed charges,83% of total,270.75,95,,216.6,percent of total billed charges ,95% of total billed charges,228,80,,182.4,percent of total billed charges,78% of total billed charges,222.3,78,,177.84,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,179.55,63,,143.64,percent of total billed charges,63% of total billed charges,242.25,85,,193.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,225.15,79,,180.12,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
EKG COMPONENT CHARGE CP,730060500,CDM,730,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HOLTER MONITORING,731000695,CDM,731,RC,93225,HCPCS,outpatient,,,840,588,,663.6,79,,530.88,percent of total billed charges,79% of total billed charges,756,90,,604.8,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,529.2,63,,423.36,percent of total billed charges,63% of total billed charges,648.65,77.22,,518.92,percent of total billed charges,77.22% of total billed charges,555.24,66.1,,444.19,percent of total billed charges,66.1% of total billed charges,697.2,83,,557.76,percent of total billed charges,83% of total,798,95,,638.4,percent of total billed charges ,95% of total billed charges,672,80,,537.6,percent of total billed charges,78% of total billed charges,655.2,78,,524.16,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,529.2,63,,423.36,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,756,90,,604.8,percent of total billed charges,90% of total billed charges,672,80,,537.6,percent of total billed charges,80% of total billed charges,529.2,63,,423.36,percent of total billed charges,63% of total billed charges,714,85,,571.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,663.6,79,,530.88,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,798,
HOLTER MONITOR SCAN ANALY,731000697,CDM,731,RC,93226,HCPCS,outpatient,,,608,425.6,,480.32,79,,384.26,percent of total billed charges,79% of total billed charges,547.2,90,,437.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,383.04,63,,306.43,percent of total billed charges,63% of total billed charges,469.5,77.22,,375.6,percent of total billed charges,77.22% of total billed charges,401.89,66.1,,321.51,percent of total billed charges,66.1% of total billed charges,504.64,83,,403.71,percent of total billed charges,83% of total,577.6,95,,462.08,percent of total billed charges ,95% of total billed charges,486.4,80,,389.12,percent of total billed charges,78% of total billed charges,474.24,78,,379.392,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,383.04,63,,306.43,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,383.04,63,,306.43,percent of total billed charges,63% of total billed charges,516.8,85,,413.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,480.32,79,,384.26,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,577.6,
HOLTER MONITOR & SCANNING CP,731000698,CDM,731,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HOLTER MONITOR SCAN ANAL PF CP,731000700,CDM,731,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
NON-BILLABLE CHARGE HM,731005555,CDM,731,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
RPLC GASTRO TUBE NO REVJ TRC,230043762,CDM,750,RC,43762,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,447.1,77.22,,357.68,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,550.05,
REPLC GTUBE REVJ GSTRST TRC,230043763,CDM,750,RC,43763,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,447.1,77.22,,357.68,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,550.05,
I&D OF PERIANAL ABSCESS,230046050,CDM,750,RC,46050,HCPCS,outpatient,,,994,695.8,,785.26,79,,628.21,percent of total billed charges,79% of total billed charges,894.6,90,,715.68,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,626.22,63,,500.98,percent of total billed charges,63% of total billed charges,767.57,77.22,,614.06,percent of total billed charges,77.22% of total billed charges,657.03,66.1,,525.62,percent of total billed charges,66.1% of total billed charges,825.02,83,,660.02,percent of total billed charges,83% of total,944.3,95,,755.44,percent of total billed charges ,95% of total billed charges,795.2,80,,636.16,percent of total billed charges,78% of total billed charges,775.32,78,,620.256,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,626.22,63,,500.98,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,894.6,90,,715.68,percent of total billed charges,90% of total billed charges,795.2,80,,636.16,percent of total billed charges,80% of total billed charges,626.22,63,,500.98,percent of total billed charges,63% of total billed charges,844.9,85,,675.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,785.26,79,,628.21,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,1222.75,
OR SIGMOIDOSCOPY FLEX W BIOPSY,360000701,CDM,750,RC,45331,HCPCS,outpatient,,,2431,1701.7,,1920.49,79,,1536.39,percent of total billed charges,79% of total billed charges,2187.9,90,,1750.32,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,1531.53,63,,1225.22,percent of total billed charges,63% of total billed charges,1877.22,77.22,,1501.78,percent of total billed charges,77.22% of total billed charges,1606.89,66.1,,1285.51,percent of total billed charges,66.1% of total billed charges,2017.73,83,,1614.18,percent of total billed charges,83% of total,2309.45,95,,1847.56,percent of total billed charges ,95% of total billed charges,1944.8,80,,1555.84,percent of total billed charges,78% of total billed charges,1896.18,78,,1516.944,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1531.53,63,,1225.22,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,2187.9,90,,1750.32,percent of total billed charges,90% of total billed charges,1944.8,80,,1555.84,percent of total billed charges,80% of total billed charges,1531.53,63,,1225.22,percent of total billed charges,63% of total billed charges,2066.35,85,,1653.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,1920.49,79,,1536.39,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,2309.45,
OR COLONOSCOPY,360000706,CDM,750,RC,,,outpatient,,,8004,5602.8,,6323.16,79,,5058.53,percent of total billed charges,79% of total billed charges,7203.6,90,,5762.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5042.52,63,,4034.02,percent of total billed charges,63% of total billed charges,6180.69,77.22,,4944.55,percent of total billed charges,77.22% of total billed charges,5290.64,66.1,,4232.51,percent of total billed charges,66.1% of total billed charges,6643.32,83,,5314.66,percent of total billed charges,83% of total,7603.8,95,,6083.04,percent of total billed charges ,95% of total billed charges,6403.2,80,,5122.56,percent of total billed charges,78% of total billed charges,6243.12,78,,4994.496,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5042.52,63,,4034.02,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7203.6,90,,5762.88,percent of total billed charges,90% of total billed charges,6403.2,80,,5122.56,percent of total billed charges,80% of total billed charges,5042.52,63,,4034.02,percent of total billed charges,63% of total billed charges,6803.4,85,,5442.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6323.16,79,,5058.53,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7603.8,
OR FLEX SIGMOIDOSCOPY DIAGNOST,360000708,CDM,750,RC,45330,HCPCS,outpatient,,,1862,1303.4,,1470.98,79,,1176.78,percent of total billed charges,79% of total billed charges,1675.8,90,,1340.64,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,1173.06,63,,938.45,percent of total billed charges,63% of total billed charges,1437.84,77.22,,1150.27,percent of total billed charges,77.22% of total billed charges,1230.78,66.1,,984.62,percent of total billed charges,66.1% of total billed charges,1545.46,83,,1236.37,percent of total billed charges,83% of total,1768.9,95,,1415.12,percent of total billed charges ,95% of total billed charges,1489.6,80,,1191.68,percent of total billed charges,78% of total billed charges,1452.36,78,,1161.888,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1173.06,63,,938.45,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1675.8,90,,1340.64,percent of total billed charges,90% of total billed charges,1489.6,80,,1191.68,percent of total billed charges,80% of total billed charges,1173.06,63,,938.45,percent of total billed charges,63% of total billed charges,1582.7,85,,1266.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,1470.98,79,,1176.78,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,1768.9,
OR ESOPHAGOGASTRODUODENOSCOPY,360000942,CDM,750,RC,,,outpatient,,,6549,4584.3,,5173.71,79,,4138.97,percent of total billed charges,79% of total billed charges,5894.1,90,,4715.28,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4125.87,63,,3300.7,percent of total billed charges,63% of total billed charges,5057.14,77.22,,4045.71,percent of total billed charges,77.22% of total billed charges,4328.89,66.1,,3463.11,percent of total billed charges,66.1% of total billed charges,5435.67,83,,4348.54,percent of total billed charges,83% of total,6221.55,95,,4977.24,percent of total billed charges ,95% of total billed charges,5239.2,80,,4191.36,percent of total billed charges,78% of total billed charges,5108.22,78,,4086.576,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,4125.87,63,,3300.7,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5894.1,90,,4715.28,percent of total billed charges,90% of total billed charges,5239.2,80,,4191.36,percent of total billed charges,80% of total billed charges,4125.87,63,,3300.7,percent of total billed charges,63% of total billed charges,5566.65,85,,4453.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,5173.71,79,,4138.97,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,6221.55,
OR BALLOON DILATION,360040060,CDM,750,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR FLEX SIGMOIDOSCOPY SCREEN,360040079,CDM,750,RC,G0104,HCPCS,outpatient,,,1862,1303.4,,1470.98,79,,1176.78,percent of total billed charges,79% of total billed charges,1675.8,90,,1340.64,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,1173.06,63,,938.45,percent of total billed charges,63% of total billed charges,1437.84,77.22,,1150.27,percent of total billed charges,77.22% of total billed charges,1230.78,66.1,,984.62,percent of total billed charges,66.1% of total billed charges,1545.46,83,,1236.37,percent of total billed charges,83% of total,1768.9,95,,1415.12,percent of total billed charges ,95% of total billed charges,1489.6,80,,1191.68,percent of total billed charges,78% of total billed charges,1452.36,78,,1161.888,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1173.06,63,,938.45,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1675.8,90,,1340.64,percent of total billed charges,90% of total billed charges,1489.6,80,,1191.68,percent of total billed charges,80% of total billed charges,1173.06,63,,938.45,percent of total billed charges,63% of total billed charges,1582.7,85,,1266.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,1470.98,79,,1176.78,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,1768.9,
COLONOSCOPY SCREEN-HIGH RISK,360040080,CDM,750,RC,G0105,HCPCS,outpatient,,,3851,2695.7,,3042.29,79,,2433.83,percent of total billed charges,79% of total billed charges,3465.9,90,,2772.72,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,2973.74,77.22,,2378.99,percent of total billed charges,77.22% of total billed charges,2545.51,66.1,,2036.41,percent of total billed charges,66.1% of total billed charges,3196.33,83,,2557.06,percent of total billed charges,83% of total,3658.45,95,,2926.76,percent of total billed charges ,95% of total billed charges,3080.8,80,,2464.64,percent of total billed charges,78% of total billed charges,3003.78,78,,2403.024,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,3465.9,90,,2772.72,percent of total billed charges,90% of total billed charges,3080.8,80,,2464.64,percent of total billed charges,80% of total billed charges,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,3273.35,85,,2618.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,3042.29,79,,2433.83,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,3658.45,
COLONOSCOPY SCREEN-NOT HI RISK,360040081,CDM,750,RC,G0121,HCPCS,outpatient,,,3851,2695.7,,3042.29,79,,2433.83,percent of total billed charges,79% of total billed charges,3465.9,90,,2772.72,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,2973.74,77.22,,2378.99,percent of total billed charges,77.22% of total billed charges,2545.51,66.1,,2036.41,percent of total billed charges,66.1% of total billed charges,3196.33,83,,2557.06,percent of total billed charges,83% of total,3658.45,95,,2926.76,percent of total billed charges ,95% of total billed charges,3080.8,80,,2464.64,percent of total billed charges,78% of total billed charges,3003.78,78,,2403.024,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,3465.9,90,,2772.72,percent of total billed charges,90% of total billed charges,3080.8,80,,2464.64,percent of total billed charges,80% of total billed charges,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,3273.35,85,,2618.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,3042.29,79,,2433.83,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,3658.45,
OR COLONOSCOPY W/ENDO BIOPSY,360040237,CDM,750,RC,,,outpatient,,,8054,5637.8,,6362.66,79,,5090.13,percent of total billed charges,79% of total billed charges,7248.6,90,,5798.88,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5074.02,63,,4059.22,percent of total billed charges,63% of total billed charges,6219.3,77.22,,4975.44,percent of total billed charges,77.22% of total billed charges,5323.69,66.1,,4258.95,percent of total billed charges,66.1% of total billed charges,6684.82,83,,5347.86,percent of total billed charges,83% of total,7651.3,95,,6121.04,percent of total billed charges ,95% of total billed charges,6443.2,80,,5154.56,percent of total billed charges,78% of total billed charges,6282.12,78,,5025.696,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,5074.02,63,,4059.22,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,7248.6,90,,5798.88,percent of total billed charges,90% of total billed charges,6443.2,80,,5154.56,percent of total billed charges,80% of total billed charges,5074.02,63,,4059.22,percent of total billed charges,63% of total billed charges,6845.9,85,,5476.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,6362.66,79,,5090.13,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,7651.3,
OR EGD W/ENDO BIOPSY,360040238,CDM,750,RC,,,outpatient,,,5843,4090.1,,4615.97,79,,3692.78,percent of total billed charges,79% of total billed charges,5258.7,90,,4206.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3681.09,63,,2944.87,percent of total billed charges,63% of total billed charges,4511.96,77.22,,3609.57,percent of total billed charges,77.22% of total billed charges,3862.22,66.1,,3089.78,percent of total billed charges,66.1% of total billed charges,4849.69,83,,3879.75,percent of total billed charges,83% of total,5550.85,95,,4440.68,percent of total billed charges ,95% of total billed charges,4674.4,80,,3739.52,percent of total billed charges,78% of total billed charges,4557.54,78,,3646.032,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3681.09,63,,2944.87,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5258.7,90,,4206.96,percent of total billed charges,90% of total billed charges,4674.4,80,,3739.52,percent of total billed charges,80% of total billed charges,3681.09,63,,2944.87,percent of total billed charges,63% of total billed charges,4966.55,85,,3973.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4615.97,79,,3692.78,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5550.85,
OR ESOPHAGASCOPY W/ENDO BIOPSY,360040239,CDM,750,RC,,,outpatient,,,3902,2731.4,,3082.58,79,,2466.06,percent of total billed charges,79% of total billed charges,3511.8,90,,2809.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2458.26,63,,1966.61,percent of total billed charges,63% of total billed charges,3013.12,77.22,,2410.5,percent of total billed charges,77.22% of total billed charges,2579.22,66.1,,2063.38,percent of total billed charges,66.1% of total billed charges,3238.66,83,,2590.93,percent of total billed charges,83% of total,3706.9,95,,2965.52,percent of total billed charges ,95% of total billed charges,3121.6,80,,2497.28,percent of total billed charges,78% of total billed charges,3043.56,78,,2434.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2458.26,63,,1966.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3511.8,90,,2809.44,percent of total billed charges,90% of total billed charges,3121.6,80,,2497.28,percent of total billed charges,80% of total billed charges,2458.26,63,,1966.61,percent of total billed charges,63% of total billed charges,3316.7,85,,2653.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3082.58,79,,2466.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3706.9,
OR COLONOSCOPY W/SNARE POLYPEC,360040241,CDM,750,RC,,,outpatient,,,6311,4417.7,,4985.69,79,,3988.55,percent of total billed charges,79% of total billed charges,5679.9,90,,4543.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3975.93,63,,3180.74,percent of total billed charges,63% of total billed charges,4873.35,77.22,,3898.68,percent of total billed charges,77.22% of total billed charges,4171.57,66.1,,3337.26,percent of total billed charges,66.1% of total billed charges,5238.13,83,,4190.5,percent of total billed charges,83% of total,5995.45,95,,4796.36,percent of total billed charges ,95% of total billed charges,5048.8,80,,4039.04,percent of total billed charges,78% of total billed charges,4922.58,78,,3938.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3975.93,63,,3180.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,5679.9,90,,4543.92,percent of total billed charges,90% of total billed charges,5048.8,80,,4039.04,percent of total billed charges,80% of total billed charges,3975.93,63,,3180.74,percent of total billed charges,63% of total billed charges,5364.35,85,,4291.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4985.69,79,,3988.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5995.45,
OR SIGMOIDOSCOPY W/ENDO BIOPSY,360040242,CDM,750,RC,,,outpatient,,,716,501.2,,565.64,79,,452.51,percent of total billed charges,79% of total billed charges,644.4,90,,515.52,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,451.08,63,,360.86,percent of total billed charges,63% of total billed charges,552.9,77.22,,442.32,percent of total billed charges,77.22% of total billed charges,473.28,66.1,,378.62,percent of total billed charges,66.1% of total billed charges,594.28,83,,475.42,percent of total billed charges,83% of total,680.2,95,,544.16,percent of total billed charges ,95% of total billed charges,572.8,80,,458.24,percent of total billed charges,78% of total billed charges,558.48,78,,446.784,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,451.08,63,,360.86,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,644.4,90,,515.52,percent of total billed charges,90% of total billed charges,572.8,80,,458.24,percent of total billed charges,80% of total billed charges,451.08,63,,360.86,percent of total billed charges,63% of total billed charges,608.6,85,,486.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,565.64,79,,452.51,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,680.2,
OR EGD W/PLACMNT PER GASTRO TU,360040243,CDM,750,RC,,,outpatient,,,5423,3796.1,,4284.17,79,,3427.34,percent of total billed charges,79% of total billed charges,4880.7,90,,3904.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3416.49,63,,2733.19,percent of total billed charges,63% of total billed charges,4187.64,77.22,,3350.11,percent of total billed charges,77.22% of total billed charges,3584.6,66.1,,2867.68,percent of total billed charges,66.1% of total billed charges,4501.09,83,,3600.87,percent of total billed charges,83% of total,5151.85,95,,4121.48,percent of total billed charges ,95% of total billed charges,4338.4,80,,3470.72,percent of total billed charges,78% of total billed charges,4229.94,78,,3383.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3416.49,63,,2733.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4880.7,90,,3904.56,percent of total billed charges,90% of total billed charges,4338.4,80,,3470.72,percent of total billed charges,80% of total billed charges,3416.49,63,,2733.19,percent of total billed charges,63% of total billed charges,4609.55,85,,3687.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,4284.17,79,,3427.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,5151.85,
OR COLONOSCOPY W/HOT BIOPSY,360040245,CDM,750,RC,,,outpatient,,,4855,3398.5,,3835.45,79,,3068.36,percent of total billed charges,79% of total billed charges,4369.5,90,,3495.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3058.65,63,,2446.92,percent of total billed charges,63% of total billed charges,3749.03,77.22,,2999.22,percent of total billed charges,77.22% of total billed charges,3209.16,66.1,,2567.33,percent of total billed charges,66.1% of total billed charges,4029.65,83,,3223.72,percent of total billed charges,83% of total,4612.25,95,,3689.8,percent of total billed charges ,95% of total billed charges,3884,80,,3107.2,percent of total billed charges,78% of total billed charges,3786.9,78,,3029.52,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,3058.65,63,,2446.92,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4369.5,90,,3495.6,percent of total billed charges,90% of total billed charges,3884,80,,3107.2,percent of total billed charges,80% of total billed charges,3058.65,63,,2446.92,percent of total billed charges,63% of total billed charges,4126.75,85,,3301.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3835.45,79,,3068.36,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4612.25,
OR EGD W/POLYPECTOMY,360040246,CDM,750,RC,,,outpatient,,,3994,2795.8,,3155.26,79,,2524.21,percent of total billed charges,79% of total billed charges,3594.6,90,,2875.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2516.22,63,,2012.98,percent of total billed charges,63% of total billed charges,3084.17,77.22,,2467.34,percent of total billed charges,77.22% of total billed charges,2640.03,66.1,,2112.02,percent of total billed charges,66.1% of total billed charges,3315.02,83,,2652.02,percent of total billed charges,83% of total,3794.3,95,,3035.44,percent of total billed charges ,95% of total billed charges,3195.2,80,,2556.16,percent of total billed charges,78% of total billed charges,3115.32,78,,2492.256,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2516.22,63,,2012.98,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,2516.22,63,,2012.98,percent of total billed charges,63% of total billed charges,3394.9,85,,2715.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3155.26,79,,2524.21,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3794.3,
OR SIGMOIDOSCOPY W/POLYPECTOMY,360040247,CDM,750,RC,,,outpatient,,,4527,3168.9,,3576.33,79,,2861.06,percent of total billed charges,79% of total billed charges,4074.3,90,,3259.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2852.01,63,,2281.61,percent of total billed charges,63% of total billed charges,3495.75,77.22,,2796.6,percent of total billed charges,77.22% of total billed charges,2992.35,66.1,,2393.88,percent of total billed charges,66.1% of total billed charges,3757.41,83,,3005.93,percent of total billed charges,83% of total,4300.65,95,,3440.52,percent of total billed charges ,95% of total billed charges,3621.6,80,,2897.28,percent of total billed charges,78% of total billed charges,3531.06,78,,2824.848,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2852.01,63,,2281.61,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4074.3,90,,3259.44,percent of total billed charges,90% of total billed charges,3621.6,80,,2897.28,percent of total billed charges,80% of total billed charges,2852.01,63,,2281.61,percent of total billed charges,63% of total billed charges,3847.95,85,,3078.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3576.33,79,,2861.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4300.65,
OR EGD W/ESOPH DIL (BALOON),360040252,CDM,750,RC,,,outpatient,,,1378,964.6,,1088.62,79,,870.9,percent of total billed charges,79% of total billed charges,1240.2,90,,992.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,868.14,63,,694.51,percent of total billed charges,63% of total billed charges,1064.09,77.22,,851.27,percent of total billed charges,77.22% of total billed charges,910.86,66.1,,728.69,percent of total billed charges,66.1% of total billed charges,1143.74,83,,914.99,percent of total billed charges,83% of total,1309.1,95,,1047.28,percent of total billed charges ,95% of total billed charges,1102.4,80,,881.92,percent of total billed charges,78% of total billed charges,1074.84,78,,859.872,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,868.14,63,,694.51,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,868.14,63,,694.51,percent of total billed charges,63% of total billed charges,1171.3,85,,937.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1088.62,79,,870.9,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1309.1,
OR COLONOSCOPY DIAGNOSTIC,360045378,CDM,750,RC,,,outpatient,,,3851,2695.7,,3042.29,79,,2433.83,percent of total billed charges,79% of total billed charges,3465.9,90,,2772.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,2973.74,77.22,,2378.99,percent of total billed charges,77.22% of total billed charges,2545.51,66.1,,2036.41,percent of total billed charges,66.1% of total billed charges,3196.33,83,,2557.06,percent of total billed charges,83% of total,3658.45,95,,2926.76,percent of total billed charges ,95% of total billed charges,3080.8,80,,2464.64,percent of total billed charges,78% of total billed charges,3003.78,78,,2403.024,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,3465.9,90,,2772.72,percent of total billed charges,90% of total billed charges,3080.8,80,,2464.64,percent of total billed charges,80% of total billed charges,2426.13,63,,1940.9,percent of total billed charges,63% of total billed charges,3273.35,85,,2618.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3042.29,79,,2433.83,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,3658.45,
ESOPH EGD DILATION <30 MM,402043249,CDM,750,RC,43249,HCPCS,outpatient,,,4079,2855.3,,3222.41,79,,2577.93,percent of total billed charges,79% of total billed charges,3671.1,90,,2936.88,percent of total billed charges,90% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,2545.71,160,,,Fee Schedule,160% of CMS OPPS rate,2068.39,130,,,Fee Schedule,130% of CMS OPPS rate,2569.77,63,,2055.82,percent of total billed charges,63% of total billed charges,3149.8,77.22,,2519.84,percent of total billed charges,77.22% of total billed charges,2696.22,66.1,,2156.98,percent of total billed charges,66.1% of total billed charges,3385.57,83,,2708.46,percent of total billed charges,83% of total,3875.05,95,,3100.04,percent of total billed charges ,95% of total billed charges,3263.2,80,,2610.56,percent of total billed charges,78% of total billed charges,3181.62,78,,2545.296,percent of total billed charges,78% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,2569.77,63,,2055.82,percent of total billed charges,63% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,3671.1,90,,2936.88,percent of total billed charges,90% of total billed charges,3263.2,80,,2610.56,percent of total billed charges,80% of total billed charges,2569.77,63,,2055.82,percent of total billed charges,63% of total billed charges,3467.15,85,,2773.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1479.7,93,,,fee schedule,93% of CMS OPPS rate,3222.41,79,,2577.93,percent of total billed charges,79% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,450,3875.05,
EGD W/FB REMOVAL,450043247,CDM,750,RC,43247,HCPCS,outpatient,,,1409,986.3,,1113.11,79,,890.49,percent of total billed charges,79% of total billed charges,1268.1,90,,1014.48,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,887.67,63,,710.14,percent of total billed charges,63% of total billed charges,1088.03,77.22,,870.42,percent of total billed charges,77.22% of total billed charges,931.35,66.1,,745.08,percent of total billed charges,66.1% of total billed charges,1169.47,83,,935.58,percent of total billed charges,83% of total,1338.55,95,,1070.84,percent of total billed charges ,95% of total billed charges,1127.2,80,,901.76,percent of total billed charges,78% of total billed charges,1099.02,78,,879.216,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,887.67,63,,710.14,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1268.1,90,,1014.48,percent of total billed charges,90% of total billed charges,1127.2,80,,901.76,percent of total billed charges,80% of total billed charges,887.67,63,,710.14,percent of total billed charges,63% of total billed charges,1197.65,85,,958.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1113.11,79,,890.49,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1338.55,
NASO/ORO-GASTRIC TUBE BY MD,450043752,CDM,750,RC,43752,HCPCS,outpatient,,,649,454.3,,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,501.16,77.22,,400.93,percent of total billed charges,77.22% of total billed charges,428.99,66.1,,343.19,percent of total billed charges,66.1% of total billed charges,538.67,83,,430.94,percent of total billed charges,83% of total,616.55,95,,493.24,percent of total billed charges ,95% of total billed charges,519.2,80,,415.36,percent of total billed charges,78% of total billed charges,506.22,78,,404.976,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,309.84,616.55,
GASTRIC INTUBATION/ASPIRATION,450043753,CDM,750,RC,43753,HCPCS,outpatient,,,745,521.5,,588.55,79,,470.84,percent of total billed charges,79% of total billed charges,670.5,90,,536.4,percent of total billed charges,90% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.19,130,,,Fee Schedule,130% of CMS OPPS rate,469.35,63,,375.48,percent of total billed charges,63% of total billed charges,575.29,77.22,,460.23,percent of total billed charges,77.22% of total billed charges,492.45,66.1,,393.96,percent of total billed charges,66.1% of total billed charges,618.35,83,,494.68,percent of total billed charges,83% of total,707.75,95,,566.2,percent of total billed charges ,95% of total billed charges,596,80,,476.8,percent of total billed charges,78% of total billed charges,581.1,78,,464.88,percent of total billed charges,78% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,469.35,63,,375.48,percent of total billed charges,63% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,670.5,90,,536.4,percent of total billed charges,90% of total billed charges,596,80,,476.8,percent of total billed charges,80% of total billed charges,469.35,63,,375.48,percent of total billed charges,63% of total billed charges,633.25,85,,506.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.08,93,,,fee schedule,93% of CMS OPPS rate,588.55,79,,470.84,percent of total billed charges,79% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.08,707.75,
REPO NASO/ORO TUBE DUODENUM,450043761,CDM,750,RC,43761,HCPCS,outpatient,,,1409,986.3,,1113.11,79,,890.49,percent of total billed charges,79% of total billed charges,1268.1,90,,1014.48,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,887.67,63,,710.14,percent of total billed charges,63% of total billed charges,1088.03,77.22,,870.42,percent of total billed charges,77.22% of total billed charges,931.35,66.1,,745.08,percent of total billed charges,66.1% of total billed charges,1169.47,83,,935.58,percent of total billed charges,83% of total,1338.55,95,,1070.84,percent of total billed charges ,95% of total billed charges,1127.2,80,,901.76,percent of total billed charges,78% of total billed charges,1099.02,78,,879.216,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,887.67,63,,710.14,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,1268.1,90,,1014.48,percent of total billed charges,90% of total billed charges,1127.2,80,,901.76,percent of total billed charges,80% of total billed charges,887.67,63,,710.14,percent of total billed charges,63% of total billed charges,1197.65,85,,958.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,1113.11,79,,890.49,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,1338.55,
PROCTOSCOPE W/FB REMOVAL,450045307,CDM,750,RC,45307,HCPCS,outpatient,,,3480,2436,,2749.2,79,,2199.36,percent of total billed charges,79% of total billed charges,3132,90,,2505.6,percent of total billed charges,90% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,3756.46,160,,,Fee Schedule,160% of CMS OPPS rate,3052.12,130,,,Fee Schedule,130% of CMS OPPS rate,2192.4,63,,1753.92,percent of total billed charges,63% of total billed charges,2687.26,77.22,,2149.81,percent of total billed charges,77.22% of total billed charges,2300.28,66.1,,1840.22,percent of total billed charges,66.1% of total billed charges,2888.4,83,,2310.72,percent of total billed charges,83% of total,3306,95,,2644.8,percent of total billed charges ,95% of total billed charges,2784,80,,2227.2,percent of total billed charges,78% of total billed charges,2714.4,78,,2171.52,percent of total billed charges,78% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,2192.4,63,,1753.92,percent of total billed charges,63% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,3132,90,,2505.6,percent of total billed charges,90% of total billed charges,2784,80,,2227.2,percent of total billed charges,80% of total billed charges,2192.4,63,,1753.92,percent of total billed charges,63% of total billed charges,2958,85,,2366.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2183.44,93,,,fee schedule,93% of CMS OPPS rate,2749.2,79,,2199.36,percent of total billed charges,79% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,450,3756.46,
PROCTOSIGMOIDOSCOPY W/CTRL BLE,450045317,CDM,750,RC,45317,HCPCS,outpatient,,,1637,1145.9,,1293.23,79,,1034.58,percent of total billed charges,79% of total billed charges,1473.3,90,,1178.64,percent of total billed charges,90% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1578.77,160,,,Fee Schedule,160% of CMS OPPS rate,1282.75,130,,,Fee Schedule,130% of CMS OPPS rate,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,1264.09,77.22,,1011.27,percent of total billed charges,77.22% of total billed charges,1082.06,66.1,,865.65,percent of total billed charges,66.1% of total billed charges,1358.71,83,,1086.97,percent of total billed charges,83% of total,1555.15,95,,1244.12,percent of total billed charges ,95% of total billed charges,1309.6,80,,1047.68,percent of total billed charges,78% of total billed charges,1276.86,78,,1021.488,percent of total billed charges,78% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1473.3,90,,1178.64,percent of total billed charges,90% of total billed charges,1309.6,80,,1047.68,percent of total billed charges,80% of total billed charges,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,1391.45,85,,1113.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,917.66,93,,,fee schedule,93% of CMS OPPS rate,1293.23,79,,1034.58,percent of total billed charges,79% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,450,1578.77,
ER RED OF RECT PROLAP W/ ANEST,450045900,CDM,750,RC,45900,HCPCS,outpatient,,,698,488.6,,551.42,79,,441.14,percent of total billed charges,79% of total billed charges,628.2,90,,502.56,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,539,77.22,,431.2,percent of total billed charges,77.22% of total billed charges,461.38,66.1,,369.1,percent of total billed charges,66.1% of total billed charges,579.34,83,,463.47,percent of total billed charges,83% of total,663.1,95,,530.48,percent of total billed charges ,95% of total billed charges,558.4,80,,446.72,percent of total billed charges,78% of total billed charges,544.44,78,,435.552,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,628.2,90,,502.56,percent of total billed charges,90% of total billed charges,558.4,80,,446.72,percent of total billed charges,80% of total billed charges,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,551.42,79,,441.14,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,439.74,1222.75,
ABSCESS PERIANAL I&D SUPERFIC,450046050,CDM,750,RC,46050,HCPCS,outpatient,,,994,695.8,,785.26,79,,628.21,percent of total billed charges,79% of total billed charges,894.6,90,,715.68,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,626.22,63,,500.98,percent of total billed charges,63% of total billed charges,767.57,77.22,,614.06,percent of total billed charges,77.22% of total billed charges,657.03,66.1,,525.62,percent of total billed charges,66.1% of total billed charges,825.02,83,,660.02,percent of total billed charges,83% of total,944.3,95,,755.44,percent of total billed charges ,95% of total billed charges,795.2,80,,636.16,percent of total billed charges,78% of total billed charges,775.32,78,,620.256,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,626.22,63,,500.98,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,894.6,90,,715.68,percent of total billed charges,90% of total billed charges,795.2,80,,636.16,percent of total billed charges,80% of total billed charges,626.22,63,,500.98,percent of total billed charges,63% of total billed charges,844.9,85,,675.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,785.26,79,,628.21,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,1222.75,
INCISE EXT THROMB HEMORRHOID,450046083,CDM,750,RC,46083,HCPCS,outpatient,,,954,667.8,,753.66,79,,602.93,percent of total billed charges,79% of total billed charges,858.6,90,,686.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,601.02,63,,480.82,percent of total billed charges,63% of total billed charges,736.68,77.22,,589.34,percent of total billed charges,77.22% of total billed charges,630.59,66.1,,504.47,percent of total billed charges,66.1% of total billed charges,791.82,83,,633.46,percent of total billed charges,83% of total,906.3,95,,725.04,percent of total billed charges ,95% of total billed charges,763.2,80,,610.56,percent of total billed charges,78% of total billed charges,744.12,78,,595.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,601.02,63,,480.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,858.6,90,,686.88,percent of total billed charges,90% of total billed charges,763.2,80,,610.56,percent of total billed charges,80% of total billed charges,601.02,63,,480.82,percent of total billed charges,63% of total billed charges,810.9,85,,648.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,753.66,79,,602.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,906.3,
EXC HEMORRHOID EXT THROMB,450046320,CDM,750,RC,46320,HCPCS,outpatient,,,2982,2087.4,,2355.78,79,,1884.62,percent of total billed charges,79% of total billed charges,2683.8,90,,2147.04,percent of total billed charges,90% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1578.77,160,,,Fee Schedule,160% of CMS OPPS rate,1282.75,130,,,Fee Schedule,130% of CMS OPPS rate,1878.66,63,,1502.93,percent of total billed charges,63% of total billed charges,2302.7,77.22,,1842.16,percent of total billed charges,77.22% of total billed charges,1971.1,66.1,,1576.88,percent of total billed charges,66.1% of total billed charges,2475.06,83,,1980.05,percent of total billed charges,83% of total,2832.9,95,,2266.32,percent of total billed charges ,95% of total billed charges,2385.6,80,,1908.48,percent of total billed charges,78% of total billed charges,2325.96,78,,1860.768,percent of total billed charges,78% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1878.66,63,,1502.93,percent of total billed charges,63% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,2683.8,90,,2147.04,percent of total billed charges,90% of total billed charges,2385.6,80,,1908.48,percent of total billed charges,80% of total billed charges,1878.66,63,,1502.93,percent of total billed charges,63% of total billed charges,2534.7,85,,2027.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,917.66,93,,,fee schedule,93% of CMS OPPS rate,2355.78,79,,1884.62,percent of total billed charges,79% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,450,2832.9,
ANOSCOPY DX,450046600,CDM,750,RC,46600,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,159.85,77.22,,127.88,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
ANOSCOPY W/FB REMOVAL,450046608,CDM,750,RC,46608,HCPCS,outpatient,,,1637,1145.9,,1293.23,79,,1034.58,percent of total billed charges,79% of total billed charges,1473.3,90,,1178.64,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,1264.09,77.22,,1011.27,percent of total billed charges,77.22% of total billed charges,1082.06,66.1,,865.65,percent of total billed charges,66.1% of total billed charges,1358.71,83,,1086.97,percent of total billed charges,83% of total,1555.15,95,,1244.12,percent of total billed charges ,95% of total billed charges,1309.6,80,,1047.68,percent of total billed charges,78% of total billed charges,1276.86,78,,1021.488,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1473.3,90,,1178.64,percent of total billed charges,90% of total billed charges,1309.6,80,,1047.68,percent of total billed charges,80% of total billed charges,1031.31,63,,825.05,percent of total billed charges,63% of total billed charges,1391.45,85,,1113.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,1293.23,79,,1034.58,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,1555.15,
CHG PERC BILIARY DRAIN CATH,450047525,CDM,750,RC,47536,HCPCS,outpatient,,,2743,1920.1,,2166.97,79,,1733.58,percent of total billed charges,79% of total billed charges,2468.7,90,,1974.96,percent of total billed charges,90% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,4628.58,160,,,Fee Schedule,160% of CMS OPPS rate,3760.72,130,,,Fee Schedule,130% of CMS OPPS rate,1728.09,63,,1382.47,percent of total billed charges,63% of total billed charges,2118.14,77.22,,1694.51,percent of total billed charges,77.22% of total billed charges,1813.12,66.1,,1450.5,percent of total billed charges,66.1% of total billed charges,2276.69,83,,1821.35,percent of total billed charges,83% of total,2605.85,95,,2084.68,percent of total billed charges ,95% of total billed charges,2194.4,80,,1755.52,percent of total billed charges,78% of total billed charges,2139.54,78,,1711.632,percent of total billed charges,78% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,1728.09,63,,1382.47,percent of total billed charges,63% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,2468.7,90,,1974.96,percent of total billed charges,90% of total billed charges,2194.4,80,,1755.52,percent of total billed charges,80% of total billed charges,1728.09,63,,1382.47,percent of total billed charges,63% of total billed charges,2331.55,85,,1865.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2690.36,93,,,fee schedule,93% of CMS OPPS rate,2166.97,79,,1733.58,percent of total billed charges,79% of total billed charges,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,2892.86,100,,,Fee Schedule,100% of CMS OPPS rate,450,4628.58,
"ER PUNCTURE,PERITONEAL CAVITY",450049080,CDM,750,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
"ER PUNCTURE,PERI CAVITY SUBSEQ",450049081,CDM,750,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
PARACENTESIS NO GUIDANCE,450049082,CDM,750,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
OR GI SECONDARY PROCEDURE FEE,750000111,CDM,750,RC,,,outpatient,,,2410,1687,,1903.9,79,,1523.12,percent of total billed charges,79% of total billed charges,2169,90,,1735.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1518.3,63,,1214.64,percent of total billed charges,63% of total billed charges,1861,77.22,,1488.8,percent of total billed charges,77.22% of total billed charges,1593.01,66.1,,1274.41,percent of total billed charges,66.1% of total billed charges,2000.3,83,,1600.24,percent of total billed charges,83% of total,2289.5,95,,1831.6,percent of total billed charges ,95% of total billed charges,1928,80,,1542.4,percent of total billed charges,78% of total billed charges,1879.8,78,,1503.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1518.3,63,,1214.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2169,90,,1735.2,percent of total billed charges,90% of total billed charges,1928,80,,1542.4,percent of total billed charges,80% of total billed charges,1518.3,63,,1214.64,percent of total billed charges,63% of total billed charges,2048.5,85,,1638.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1903.9,79,,1523.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2289.5,
OR EGD CAUTERY TMR POLY HOT BI,750043250,CDM,750,RC,43250,HCPCS,outpatient,,,3708,2595.6,,2929.32,79,,2343.46,percent of total billed charges,79% of total billed charges,3337.2,90,,2669.76,percent of total billed charges,90% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,2545.71,160,,,Fee Schedule,160% of CMS OPPS rate,2068.39,130,,,Fee Schedule,130% of CMS OPPS rate,2336.04,63,,1868.83,percent of total billed charges,63% of total billed charges,2863.32,77.22,,2290.66,percent of total billed charges,77.22% of total billed charges,2450.99,66.1,,1960.79,percent of total billed charges,66.1% of total billed charges,3077.64,83,,2462.11,percent of total billed charges,83% of total,3522.6,95,,2818.08,percent of total billed charges ,95% of total billed charges,2966.4,80,,2373.12,percent of total billed charges,78% of total billed charges,2892.24,78,,2313.792,percent of total billed charges,78% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,2336.04,63,,1868.83,percent of total billed charges,63% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,3337.2,90,,2669.76,percent of total billed charges,90% of total billed charges,2966.4,80,,2373.12,percent of total billed charges,80% of total billed charges,2336.04,63,,1868.83,percent of total billed charges,63% of total billed charges,3151.8,85,,2521.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1479.7,93,,,fee schedule,93% of CMS OPPS rate,2929.32,79,,2343.46,percent of total billed charges,79% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,450,3522.6,
OR EGD FLEX TRANS REM BY SNARE,750043251,CDM,750,RC,43251,HCPCS,outpatient,,,3708,2595.6,,2929.32,79,,2343.46,percent of total billed charges,79% of total billed charges,3337.2,90,,2669.76,percent of total billed charges,90% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,2545.71,160,,,Fee Schedule,160% of CMS OPPS rate,2068.39,130,,,Fee Schedule,130% of CMS OPPS rate,2336.04,63,,1868.83,percent of total billed charges,63% of total billed charges,2863.32,77.22,,2290.66,percent of total billed charges,77.22% of total billed charges,2450.99,66.1,,1960.79,percent of total billed charges,66.1% of total billed charges,3077.64,83,,2462.11,percent of total billed charges,83% of total,3522.6,95,,2818.08,percent of total billed charges ,95% of total billed charges,2966.4,80,,2373.12,percent of total billed charges,78% of total billed charges,2892.24,78,,2313.792,percent of total billed charges,78% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,2336.04,63,,1868.83,percent of total billed charges,63% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,3337.2,90,,2669.76,percent of total billed charges,90% of total billed charges,2966.4,80,,2373.12,percent of total billed charges,80% of total billed charges,2336.04,63,,1868.83,percent of total billed charges,63% of total billed charges,3151.8,85,,2521.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1479.7,93,,,fee schedule,93% of CMS OPPS rate,2929.32,79,,2343.46,percent of total billed charges,79% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,450,3522.6,
OR SIGMDSC FLX W BAND LIGATION,750045350,CDM,750,RC,45350,HCPCS,outpatient,,,2074,1451.8,,1638.46,79,,1310.77,percent of total billed charges,79% of total billed charges,1866.6,90,,1493.28,percent of total billed charges,90% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1578.77,160,,,Fee Schedule,160% of CMS OPPS rate,1282.75,130,,,Fee Schedule,130% of CMS OPPS rate,1306.62,63,,1045.3,percent of total billed charges,63% of total billed charges,1601.54,77.22,,1281.23,percent of total billed charges,77.22% of total billed charges,1370.91,66.1,,1096.73,percent of total billed charges,66.1% of total billed charges,1721.42,83,,1377.14,percent of total billed charges,83% of total,1970.3,95,,1576.24,percent of total billed charges ,95% of total billed charges,1659.2,80,,1327.36,percent of total billed charges,78% of total billed charges,1617.72,78,,1294.176,percent of total billed charges,78% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1306.62,63,,1045.3,percent of total billed charges,63% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,1306.62,63,,1045.3,percent of total billed charges,63% of total billed charges,1762.9,85,,1410.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,917.66,93,,,fee schedule,93% of CMS OPPS rate,1638.46,79,,1310.77,percent of total billed charges,79% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,450,1970.3,
OR COLONOSCOPY FLEX W/BIOPSY,750045380,CDM,750,RC,45380,HCPCS,outpatient,,,8054,5637.8,,6362.66,79,,5090.13,percent of total billed charges,79% of total billed charges,7248.6,90,,5798.88,percent of total billed charges,90% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1578.77,160,,,Fee Schedule,160% of CMS OPPS rate,1282.75,130,,,Fee Schedule,130% of CMS OPPS rate,5074.02,63,,4059.22,percent of total billed charges,63% of total billed charges,6219.3,77.22,,4975.44,percent of total billed charges,77.22% of total billed charges,5323.69,66.1,,4258.95,percent of total billed charges,66.1% of total billed charges,6684.82,83,,5347.86,percent of total billed charges,83% of total,7651.3,95,,6121.04,percent of total billed charges ,95% of total billed charges,6443.2,80,,5154.56,percent of total billed charges,78% of total billed charges,6282.12,78,,5025.696,percent of total billed charges,78% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,5074.02,63,,4059.22,percent of total billed charges,63% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,7248.6,90,,5798.88,percent of total billed charges,90% of total billed charges,6443.2,80,,5154.56,percent of total billed charges,80% of total billed charges,5074.02,63,,4059.22,percent of total billed charges,63% of total billed charges,6845.9,85,,5476.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,917.66,93,,,fee schedule,93% of CMS OPPS rate,6362.66,79,,5090.13,percent of total billed charges,79% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,450,7651.3,
COLONOSCOPY FLEX W BAND LIGAT,750045398,CDM,750,RC,45398,HCPCS,outpatient,,,7876,5513.2,,6222.04,79,,4977.63,percent of total billed charges,79% of total billed charges,7088.4,90,,5670.72,percent of total billed charges,90% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1578.77,160,,,Fee Schedule,160% of CMS OPPS rate,1282.75,130,,,Fee Schedule,130% of CMS OPPS rate,4961.88,63,,3969.5,percent of total billed charges,63% of total billed charges,6081.85,77.22,,4865.48,percent of total billed charges,77.22% of total billed charges,5206.04,66.1,,4164.83,percent of total billed charges,66.1% of total billed charges,6537.08,83,,5229.66,percent of total billed charges,83% of total,7482.2,95,,5985.76,percent of total billed charges ,95% of total billed charges,6300.8,80,,5040.64,percent of total billed charges,78% of total billed charges,6143.28,78,,4914.624,percent of total billed charges,78% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,4961.88,63,,3969.5,percent of total billed charges,63% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,7088.4,90,,5670.72,percent of total billed charges,90% of total billed charges,6300.8,80,,5040.64,percent of total billed charges,80% of total billed charges,4961.88,63,,3969.5,percent of total billed charges,63% of total billed charges,6694.6,85,,5355.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,917.66,93,,,fee schedule,93% of CMS OPPS rate,6222.04,79,,4977.63,percent of total billed charges,79% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,450,7482.2,
HEMORRHOID LIG INT RUBBER BAND,750046221,CDM,750,RC,46221,HCPCS,outpatient,,,1719,1203.3,,1358.01,79,,1086.41,percent of total billed charges,79% of total billed charges,1547.1,90,,1237.68,percent of total billed charges,90% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1222.75,160,,,Fee Schedule,160% of CMS OPPS rate,993.48,130,,,Fee Schedule,130% of CMS OPPS rate,1082.97,63,,866.38,percent of total billed charges,63% of total billed charges,1327.41,77.22,,1061.93,percent of total billed charges,77.22% of total billed charges,1136.26,66.1,,909.01,percent of total billed charges,66.1% of total billed charges,1426.77,83,,1141.42,percent of total billed charges,83% of total,1633.05,95,,1306.44,percent of total billed charges ,95% of total billed charges,1375.2,80,,1100.16,percent of total billed charges,78% of total billed charges,1340.82,78,,1072.656,percent of total billed charges,78% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1082.97,63,,866.38,percent of total billed charges,63% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,1547.1,90,,1237.68,percent of total billed charges,90% of total billed charges,1375.2,80,,1100.16,percent of total billed charges,80% of total billed charges,1082.97,63,,866.38,percent of total billed charges,63% of total billed charges,1461.15,85,,1168.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,710.72,93,,,fee schedule,93% of CMS OPPS rate,1358.01,79,,1086.41,percent of total billed charges,79% of total billed charges,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,764.22,100,,,Fee Schedule,100% of CMS OPPS rate,450,1633.05,
HEMORRHOID LIG INT WO IMAGING,750046945,CDM,750,RC,46945,HCPCS,outpatient,,,5274,3691.8,,4166.46,79,,3333.17,percent of total billed charges,79% of total billed charges,4746.6,90,,3797.28,percent of total billed charges,90% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,3756.46,160,,,Fee Schedule,160% of CMS OPPS rate,3052.12,130,,,Fee Schedule,130% of CMS OPPS rate,3322.62,63,,2658.1,percent of total billed charges,63% of total billed charges,4072.58,77.22,,3258.06,percent of total billed charges,77.22% of total billed charges,3486.11,66.1,,2788.89,percent of total billed charges,66.1% of total billed charges,4377.42,83,,3501.94,percent of total billed charges,83% of total,5010.3,95,,4008.24,percent of total billed charges ,95% of total billed charges,4219.2,80,,3375.36,percent of total billed charges,78% of total billed charges,4113.72,78,,3290.976,percent of total billed charges,78% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,3322.62,63,,2658.1,percent of total billed charges,63% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,4746.6,90,,3797.28,percent of total billed charges,90% of total billed charges,4219.2,80,,3375.36,percent of total billed charges,80% of total billed charges,3322.62,63,,2658.1,percent of total billed charges,63% of total billed charges,4482.9,85,,3586.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2183.44,93,,,fee schedule,93% of CMS OPPS rate,4166.46,79,,3333.17,percent of total billed charges,79% of total billed charges,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,2347.79,100,,,Fee Schedule,100% of CMS OPPS rate,450,5010.3,
OBS UPPER GASTROINTEST ENDO,762043239,CDM,750,RC,43239,HCPCS,outpatient,,,665,465.5,,525.35,79,,420.28,percent of total billed charges,79% of total billed charges,598.5,90,,478.8,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,418.95,63,,335.16,percent of total billed charges,63% of total billed charges,513.51,77.22,,410.81,percent of total billed charges,77.22% of total billed charges,439.57,66.1,,351.66,percent of total billed charges,66.1% of total billed charges,551.95,83,,441.56,percent of total billed charges,83% of total,631.75,95,,505.4,percent of total billed charges ,95% of total billed charges,532,80,,425.6,percent of total billed charges,78% of total billed charges,518.7,78,,414.96,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,418.95,63,,335.16,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,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,418.95,63,,335.16,percent of total billed charges,63% of total billed charges,565.25,85,,452.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,525.35,79,,420.28,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,418.95,1212.75,
OBS G TUBE PLACEMENT,762043246,CDM,750,RC,43246,HCPCS,outpatient,,,1399,979.3,,1105.21,79,,884.17,percent of total billed charges,79% of total billed charges,1259.1,90,,1007.28,percent of total billed charges,90% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,2545.71,160,,,Fee Schedule,160% of CMS OPPS rate,2068.39,130,,,Fee Schedule,130% of CMS OPPS rate,881.37,63,,705.1,percent of total billed charges,63% of total billed charges,1080.31,77.22,,864.25,percent of total billed charges,77.22% of total billed charges,924.74,66.1,,739.79,percent of total billed charges,66.1% of total billed charges,1161.17,83,,928.94,percent of total billed charges,83% of total,1329.05,95,,1063.24,percent of total billed charges ,95% of total billed charges,1119.2,80,,895.36,percent of total billed charges,78% of total billed charges,1091.22,78,,872.976,percent of total billed charges,78% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,881.37,63,,705.1,percent of total billed charges,63% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,1259.1,90,,1007.28,percent of total billed charges,90% of total billed charges,1119.2,80,,895.36,percent of total billed charges,80% of total billed charges,881.37,63,,705.1,percent of total billed charges,63% of total billed charges,1189.15,85,,951.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1479.7,93,,,fee schedule,93% of CMS OPPS rate,1105.21,79,,884.17,percent of total billed charges,79% of total billed charges,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,1591.08,100,,,Fee Schedule,100% of CMS OPPS rate,450,2545.71,
OBS DILATION OF ESOPHAGUS,762043450,CDM,750,RC,43450,HCPCS,outpatient,,,454,317.8,,358.66,79,,286.93,percent of total billed charges,79% of total billed charges,408.6,90,,326.88,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,286.02,63,,228.82,percent of total billed charges,63% of total billed charges,350.58,77.22,,280.46,percent of total billed charges,77.22% of total billed charges,300.09,66.1,,240.07,percent of total billed charges,66.1% of total billed charges,376.82,83,,301.46,percent of total billed charges,83% of total,431.3,95,,345.04,percent of total billed charges ,95% of total billed charges,363.2,80,,290.56,percent of total billed charges,78% of total billed charges,354.12,78,,283.296,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,286.02,63,,228.82,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,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,286.02,63,,228.82,percent of total billed charges,63% of total billed charges,385.9,85,,308.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,358.66,79,,286.93,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,286.02,1212.75,
NASAL/OROGASTRIC W/STINT,762043752,CDM,750,RC,43752,HCPCS,outpatient,,,649,454.3,,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,584.1,90,,467.28,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,501.16,77.22,,400.93,percent of total billed charges,77.22% of total billed charges,428.99,66.1,,343.19,percent of total billed charges,66.1% of total billed charges,538.67,83,,430.94,percent of total billed charges,83% of total,616.55,95,,493.24,percent of total billed charges ,95% of total billed charges,519.2,80,,415.36,percent of total billed charges,78% of total billed charges,506.22,78,,404.976,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,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,408.87,63,,327.1,percent of total billed charges,63% of total billed charges,551.65,85,,441.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,512.71,79,,410.17,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,309.84,616.55,
OBS GASTRIC INTUBATION TX,762091105,CDM,750,RC,43753,HCPCS,outpatient,,,745,521.5,,588.55,79,,470.84,percent of total billed charges,79% of total billed charges,670.5,90,,536.4,percent of total billed charges,90% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,419.92,160,,,Fee Schedule,160% of CMS OPPS rate,341.19,130,,,Fee Schedule,130% of CMS OPPS rate,469.35,63,,375.48,percent of total billed charges,63% of total billed charges,575.29,77.22,,460.23,percent of total billed charges,77.22% of total billed charges,492.45,66.1,,393.96,percent of total billed charges,66.1% of total billed charges,618.35,83,,494.68,percent of total billed charges,83% of total,707.75,95,,566.2,percent of total billed charges ,95% of total billed charges,596,80,,476.8,percent of total billed charges,78% of total billed charges,581.1,78,,464.88,percent of total billed charges,78% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,469.35,63,,375.48,percent of total billed charges,63% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,670.5,90,,536.4,percent of total billed charges,90% of total billed charges,596,80,,476.8,percent of total billed charges,80% of total billed charges,469.35,63,,375.48,percent of total billed charges,63% of total billed charges,633.25,85,,506.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,244.08,93,,,fee schedule,93% of CMS OPPS rate,588.55,79,,470.84,percent of total billed charges,79% of total billed charges,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,262.45,100,,,Fee Schedule,100% of CMS OPPS rate,244.08,707.75,
I&D SINGLE OR SIMPLE,10060P,CDM,761,RC,10060,HCPCS,outpatient,,,126,88.2,,,,,,other ,not seperately reimbursable,113.4,90,,90.72,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,97.3,77.22,,77.84,percent of total billed charges,77.22% of total billed charges,83.29,66.1,,66.63,percent of total billed charges,66.1% of total billed charges,104.58,83,,83.66,percent of total billed charges,83% of total,119.7,95,,95.76,percent of total billed charges ,95% of total billed charges,100.8,80,,80.64,percent of total billed charges,78% of total billed charges,98.28,78,,78.624,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,79.38,63,,63.5,percent of total billed charges,63% of total billed charges,107.1,85,,85.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,99.54,79,,79.63,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,79.38,450,
I&D SINGLE OR SIMPLE,10060T,CDM,761,RC,10060,HCPCS,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,145.95,77.22,,116.76,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,119.07,450,
INCISION & DRAINAGE MULTIPLE,10061P,CDM,761,RC,10061,HCPCS,outpatient,,,221,154.7,,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,198.9,90,,159.12,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,170.66,77.22,,136.53,percent of total billed charges,77.22% of total billed charges,146.08,66.1,,116.86,percent of total billed charges,66.1% of total billed charges,183.43,83,,146.74,percent of total billed charges,83% of total,209.95,95,,167.96,percent of total billed charges ,95% of total billed charges,176.8,80,,141.44,percent of total billed charges,78% of total billed charges,172.38,78,,137.904,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,139.23,63,,111.38,percent of total billed charges,63% of total billed charges,187.85,85,,150.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,174.59,79,,139.67,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,139.23,533.46,
INCISION & DRAINAGE MULTIPLE,10061T,CDM,761,RC,10061,HCPCS,outpatient,,,332,232.4,,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,256.37,77.22,,205.1,percent of total billed charges,77.22% of total billed charges,219.45,66.1,,175.56,percent of total billed charges,66.1% of total billed charges,275.56,83,,220.45,percent of total billed charges,83% of total,315.4,95,,252.32,percent of total billed charges ,95% of total billed charges,265.6,80,,212.48,percent of total billed charges,78% of total billed charges,258.96,78,,207.168,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,209.16,533.46,
FB REMOVAL SQ W/INC SMPL,10120P,CDM,761,RC,10120,HCPCS,outpatient,,,160,112,,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,144,90,,115.2,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,123.55,77.22,,98.84,percent of total billed charges,77.22% of total billed charges,105.76,66.1,,84.61,percent of total billed charges,66.1% of total billed charges,132.8,83,,106.24,percent of total billed charges,83% of total,152,95,,121.6,percent of total billed charges ,95% of total billed charges,128,80,,102.4,percent of total billed charges,78% of total billed charges,124.8,78,,99.84,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,100.8,63,,80.64,percent of total billed charges,63% of total billed charges,136,85,,108.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,126.4,79,,101.12,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,100.8,533.46,
FB REMOVAL SQ W/INC SMPL,10120T,CDM,761,RC,10120,HCPCS,outpatient,,,240,168,,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,216,90,,172.8,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,185.33,77.22,,148.26,percent of total billed charges,77.22% of total billed charges,158.64,66.1,,126.91,percent of total billed charges,66.1% of total billed charges,199.2,83,,159.36,percent of total billed charges,83% of total,228,95,,182.4,percent of total billed charges ,95% of total billed charges,192,80,,153.6,percent of total billed charges,78% of total billed charges,187.2,78,,149.76,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,151.2,63,,120.96,percent of total billed charges,63% of total billed charges,204,85,,163.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,189.6,79,,151.68,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,151.2,533.46,
I&D HEMATOMA SEROMA OR FLUID,10140P,CDM,761,RC,10140,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,2169.07,
I&D HEMATOMA SEROMA OR FLUID,10140T,CDM,761,RC,10140,HCPCS,outpatient,,,242,169.4,,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,186.87,77.22,,149.5,percent of total billed charges,77.22% of total billed charges,159.96,66.1,,127.97,percent of total billed charges,66.1% of total billed charges,200.86,83,,160.69,percent of total billed charges,83% of total,229.9,95,,183.92,percent of total billed charges ,95% of total billed charges,193.6,80,,154.88,percent of total billed charges,78% of total billed charges,188.76,78,,151.008,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,152.46,2169.07,
DEB SKIN SUBCUTANEOUS TISSUE,11042P,CDM,761,RC,11042,HCPCS,outpatient,,,140,98,,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,126,90,,100.8,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,108.11,77.22,,86.49,percent of total billed charges,77.22% of total billed charges,92.54,66.1,,74.03,percent of total billed charges,66.1% of total billed charges,116.2,83,,92.96,percent of total billed charges,83% of total,133,95,,106.4,percent of total billed charges ,95% of total billed charges,112,80,,89.6,percent of total billed charges,78% of total billed charges,109.2,78,,87.36,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,88.2,63,,70.56,percent of total billed charges,63% of total billed charges,119,85,,95.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,110.6,79,,88.48,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,88.2,533.46,
DEB SKIN SUBCUTANEOUS TISSUE,11042T,CDM,761,RC,11042,HCPCS,outpatient,,,210,147,,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,162.16,77.22,,129.73,percent of total billed charges,77.22% of total billed charges,138.81,66.1,,111.05,percent of total billed charges,66.1% of total billed charges,174.3,83,,139.44,percent of total billed charges,83% of total,199.5,95,,159.6,percent of total billed charges ,95% of total billed charges,168,80,,134.4,percent of total billed charges,78% of total billed charges,163.8,78,,131.04,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,533.46,
DEB SKIN SUBCUTAN TISSUE MUS,11043P,CDM,761,RC,11043,HCPCS,outpatient,,,264,184.8,,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,203.86,77.22,,163.09,percent of total billed charges,77.22% of total billed charges,174.5,66.1,,139.6,percent of total billed charges,66.1% of total billed charges,219.12,83,,175.3,percent of total billed charges,83% of total,250.8,95,,200.64,percent of total billed charges ,95% of total billed charges,211.2,80,,168.96,percent of total billed charges,78% of total billed charges,205.92,78,,164.736,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,166.32,840.25,
DEB SKIN SUBCUTAN TISSUE MUS,11043T,CDM,761,RC,11043,HCPCS,outpatient,,,397,277.9,,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,357.3,90,,285.84,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,306.56,77.22,,245.25,percent of total billed charges,77.22% of total billed charges,262.42,66.1,,209.94,percent of total billed charges,66.1% of total billed charges,329.51,83,,263.61,percent of total billed charges,83% of total,377.15,95,,301.72,percent of total billed charges ,95% of total billed charges,317.6,80,,254.08,percent of total billed charges,78% of total billed charges,309.66,78,,247.728,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,250.11,63,,200.09,percent of total billed charges,63% of total billed charges,337.45,85,,269.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,313.63,79,,250.9,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,250.11,840.25,
TRIM SKIN LESION,11055P,CDM,761,RC,11055,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,18.9,450,
TRIM SKIN LESION,11055T,CDM,761,RC,11055,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,28.35,450,
TANGENTIAL BIOP SKIN SGL LESIO,11102P,CDM,761,RC,11102,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,64.89,450,
TANGENTIAL BIOP SKIN SGL LESIO,11102T,CDM,761,RC,11102,HCPCS,outpatient,,,155,108.5,,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,139.5,90,,111.6,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,119.69,77.22,,95.75,percent of total billed charges,77.22% of total billed charges,102.46,66.1,,81.97,percent of total billed charges,66.1% of total billed charges,128.65,83,,102.92,percent of total billed charges,83% of total,147.25,95,,117.8,percent of total billed charges ,95% of total billed charges,124,80,,99.2,percent of total billed charges,78% of total billed charges,120.9,78,,96.72,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,97.65,63,,78.12,percent of total billed charges,63% of total billed charges,131.75,85,,105.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,122.45,79,,97.96,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,97.65,450,
SHAVING EPIDERMAN DERMAL LESN,11300P,CDM,761,RC,11300,HCPCS,outpatient,,,63,44.1,,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,56.7,90,,45.36,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,48.65,77.22,,38.92,percent of total billed charges,77.22% of total billed charges,41.64,66.1,,33.31,percent of total billed charges,66.1% of total billed charges,52.29,83,,41.83,percent of total billed charges,83% of total,59.85,95,,47.88,percent of total billed charges ,95% of total billed charges,50.4,80,,40.32,percent of total billed charges,78% of total billed charges,49.14,78,,39.312,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,39.69,63,,31.75,percent of total billed charges,63% of total billed charges,53.55,85,,42.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,49.77,79,,39.82,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,39.69,533.46,
SHAVING EPIDERMAN DERMAL LESN,11300T,CDM,761,RC,11300,HCPCS,outpatient,,,94,65.8,,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,84.6,90,,67.68,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,72.59,77.22,,58.07,percent of total billed charges,77.22% of total billed charges,62.13,66.1,,49.7,percent of total billed charges,66.1% of total billed charges,78.02,83,,62.42,percent of total billed charges,83% of total,89.3,95,,71.44,percent of total billed charges ,95% of total billed charges,75.2,80,,60.16,percent of total billed charges,78% of total billed charges,73.32,78,,58.656,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,59.22,63,,47.38,percent of total billed charges,63% of total billed charges,79.9,85,,63.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,74.26,79,,59.41,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,59.22,533.46,
ELECTRO CAUTERIZATION OF WART,11301P,CDM,761,RC,11301,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,64.89,450,
ELECTRO CAUTERIZATION OF WART,11301T,CDM,761,RC,11301,HCPCS,outpatient,,,154,107.8,,121.66,79,,97.33,percent of total billed charges,79% of total billed charges,138.6,90,,110.88,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,97.02,63,,77.62,percent of total billed charges,63% of total billed charges,118.92,77.22,,95.14,percent of total billed charges,77.22% of total billed charges,101.79,66.1,,81.43,percent of total billed charges,66.1% of total billed charges,127.82,83,,102.26,percent of total billed charges,83% of total,146.3,95,,117.04,percent of total billed charges ,95% of total billed charges,123.2,80,,98.56,percent of total billed charges,78% of total billed charges,120.12,78,,96.096,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,97.02,63,,77.62,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,97.02,63,,77.62,percent of total billed charges,63% of total billed charges,130.9,85,,104.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,121.66,79,,97.33,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,97.02,450,
SHAVE SKIN LESION 0.5 CM <,11305P,CDM,761,RC,11305,HCPCS,outpatient,,,107,74.9,,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,96.3,90,,77.04,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,82.63,77.22,,66.1,percent of total billed charges,77.22% of total billed charges,70.73,66.1,,56.58,percent of total billed charges,66.1% of total billed charges,88.81,83,,71.05,percent of total billed charges,83% of total,101.65,95,,81.32,percent of total billed charges ,95% of total billed charges,85.6,80,,68.48,percent of total billed charges,78% of total billed charges,83.46,78,,66.768,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,67.41,63,,53.93,percent of total billed charges,63% of total billed charges,90.95,85,,72.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,84.53,79,,67.62,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,67.41,450,
SHAVE SKIN LESION 0.5 CM <,11305T,CDM,761,RC,11305,HCPCS,outpatient,,,161,112.7,,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,144.9,90,,115.92,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,124.32,77.22,,99.46,percent of total billed charges,77.22% of total billed charges,106.42,66.1,,85.14,percent of total billed charges,66.1% of total billed charges,133.63,83,,106.9,percent of total billed charges,83% of total,152.95,95,,122.36,percent of total billed charges ,95% of total billed charges,128.8,80,,103.04,percent of total billed charges,78% of total billed charges,125.58,78,,100.464,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,101.43,63,,81.14,percent of total billed charges,63% of total billed charges,136.85,85,,109.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,127.19,79,,101.75,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,101.43,450,
SHAVE SKIN LESION 0.6-1.0 CM,11306P,CDM,761,RC,11306,HCPCS,outpatient,,,128,89.6,,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,115.2,90,,92.16,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,98.84,77.22,,79.07,percent of total billed charges,77.22% of total billed charges,84.61,66.1,,67.69,percent of total billed charges,66.1% of total billed charges,106.24,83,,84.99,percent of total billed charges,83% of total,121.6,95,,97.28,percent of total billed charges ,95% of total billed charges,102.4,80,,81.92,percent of total billed charges,78% of total billed charges,99.84,78,,79.872,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,80.64,63,,64.51,percent of total billed charges,63% of total billed charges,108.8,85,,87.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,101.12,79,,80.9,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,80.64,450,
SHAVE SKIN LESION 0.6-1.0 CM,11306T,CDM,761,RC,11306,HCPCS,outpatient,,,191,133.7,,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,171.9,90,,137.52,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,147.49,77.22,,117.99,percent of total billed charges,77.22% of total billed charges,126.25,66.1,,101,percent of total billed charges,66.1% of total billed charges,158.53,83,,126.82,percent of total billed charges,83% of total,181.45,95,,145.16,percent of total billed charges ,95% of total billed charges,152.8,80,,122.24,percent of total billed charges,78% of total billed charges,148.98,78,,119.184,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,120.33,63,,96.26,percent of total billed charges,63% of total billed charges,162.35,85,,129.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,150.89,79,,120.71,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,120.33,450,
EXC BENIGN LESION,11401P,CDM,761,RC,11401,HCPCS,outpatient,,,145,101.5,,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,130.5,90,,104.4,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,91.35,63,,73.08,percent of total billed charges,63% of total billed charges,111.97,77.22,,89.58,percent of total billed charges,77.22% of total billed charges,95.85,66.1,,76.68,percent of total billed charges,66.1% of total billed charges,120.35,83,,96.28,percent of total billed charges,83% of total,137.75,95,,110.2,percent of total billed charges ,95% of total billed charges,116,80,,92.8,percent of total billed charges,78% of total billed charges,113.1,78,,90.48,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,91.35,63,,73.08,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,91.35,63,,73.08,percent of total billed charges,63% of total billed charges,123.25,85,,98.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,114.55,79,,91.64,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,91.35,533.46,
EXC BENIGN LESION,11401T,CDM,761,RC,11401,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,168.34,77.22,,134.67,percent of total billed charges,77.22% of total billed charges,144.1,66.1,,115.28,percent of total billed charges,66.1% of total billed charges,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,533.46,
EXC BENIGN LESION 1.1 - 2.0 CM,11402P,CDM,761,RC,11402,HCPCS,outpatient,,,162,113.4,,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,145.8,90,,116.64,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,125.1,77.22,,100.08,percent of total billed charges,77.22% of total billed charges,107.08,66.1,,85.66,percent of total billed charges,66.1% of total billed charges,134.46,83,,107.57,percent of total billed charges,83% of total,153.9,95,,123.12,percent of total billed charges ,95% of total billed charges,129.6,80,,103.68,percent of total billed charges,78% of total billed charges,126.36,78,,101.088,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,102.06,63,,81.65,percent of total billed charges,63% of total billed charges,137.7,85,,110.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,127.98,79,,102.38,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,102.06,941.28,
EXC BENIGN LESION 1.1 - 2.0 CM,11402T,CDM,761,RC,11402,HCPCS,outpatient,,,242,169.4,,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,217.8,90,,174.24,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,186.87,77.22,,149.5,percent of total billed charges,77.22% of total billed charges,159.96,66.1,,127.97,percent of total billed charges,66.1% of total billed charges,200.86,83,,160.69,percent of total billed charges,83% of total,229.9,95,,183.92,percent of total billed charges ,95% of total billed charges,193.6,80,,154.88,percent of total billed charges,78% of total billed charges,188.76,78,,151.008,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,152.46,63,,121.97,percent of total billed charges,63% of total billed charges,205.7,85,,164.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,191.18,79,,152.94,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,152.46,941.28,
EXC BENIGN LESION 2.1-3.0 CM,11403P,CDM,761,RC,11403,HCPCS,outpatient,,,199,139.3,,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,179.1,90,,143.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,125.37,63,,100.3,percent of total billed charges,63% of total billed charges,153.67,77.22,,122.94,percent of total billed charges,77.22% of total billed charges,131.54,66.1,,105.23,percent of total billed charges,66.1% of total billed charges,165.17,83,,132.14,percent of total billed charges,83% of total,189.05,95,,151.24,percent of total billed charges ,95% of total billed charges,159.2,80,,127.36,percent of total billed charges,78% of total billed charges,155.22,78,,124.176,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,125.37,63,,100.3,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,125.37,63,,100.3,percent of total billed charges,63% of total billed charges,169.15,85,,135.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,157.21,79,,125.77,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,125.37,941.28,
EXC BENIGN LESION 2.1-3.0 CM,11403T,CDM,761,RC,11403,HCPCS,outpatient,,,299,209.3,,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,269.1,90,,215.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,230.89,77.22,,184.71,percent of total billed charges,77.22% of total billed charges,197.64,66.1,,158.11,percent of total billed charges,66.1% of total billed charges,248.17,83,,198.54,percent of total billed charges,83% of total,284.05,95,,227.24,percent of total billed charges ,95% of total billed charges,239.2,80,,191.36,percent of total billed charges,78% of total billed charges,233.22,78,,186.576,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,188.37,63,,150.7,percent of total billed charges,63% of total billed charges,254.15,85,,203.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,236.21,79,,188.97,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,188.37,941.28,
EXC BENIGN LESION 0.6-1.0 CM,11421P,CDM,761,RC,11421,HCPCS,outpatient,,,152,106.4,,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,136.8,90,,109.44,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,117.37,77.22,,93.9,percent of total billed charges,77.22% of total billed charges,100.47,66.1,,80.38,percent of total billed charges,66.1% of total billed charges,126.16,83,,100.93,percent of total billed charges,83% of total,144.4,95,,115.52,percent of total billed charges ,95% of total billed charges,121.6,80,,97.28,percent of total billed charges,78% of total billed charges,118.56,78,,94.848,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,95.76,63,,76.61,percent of total billed charges,63% of total billed charges,129.2,85,,103.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,120.08,79,,96.06,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,95.76,941.28,
EXC BENIGN LESION 0.6-1.0 CM,11421T,CDM,761,RC,11421,HCPCS,outpatient,,,228,159.6,,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,205.2,90,,164.16,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,176.06,77.22,,140.85,percent of total billed charges,77.22% of total billed charges,150.71,66.1,,120.57,percent of total billed charges,66.1% of total billed charges,189.24,83,,151.39,percent of total billed charges,83% of total,216.6,95,,173.28,percent of total billed charges ,95% of total billed charges,182.4,80,,145.92,percent of total billed charges,78% of total billed charges,177.84,78,,142.272,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,143.64,63,,114.91,percent of total billed charges,63% of total billed charges,193.8,85,,155.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,180.12,79,,144.1,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,143.64,941.28,
EX BEN LES FAC EAR EYLID 1.1-2,11442P,CDM,761,RC,11442,HCPCS,outpatient,,,210,147,,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,189,90,,151.2,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,162.16,77.22,,129.73,percent of total billed charges,77.22% of total billed charges,138.81,66.1,,111.05,percent of total billed charges,66.1% of total billed charges,174.3,83,,139.44,percent of total billed charges,83% of total,199.5,95,,159.6,percent of total billed charges ,95% of total billed charges,168,80,,134.4,percent of total billed charges,78% of total billed charges,163.8,78,,131.04,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,132.3,63,,105.84,percent of total billed charges,63% of total billed charges,178.5,85,,142.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,165.9,79,,132.72,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,132.3,941.28,
EX BEN LES FAC EAR EYLID 1.1-2,11442T,CDM,761,RC,11442,HCPCS,outpatient,,,315,220.5,,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,283.5,90,,226.8,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,243.24,77.22,,194.59,percent of total billed charges,77.22% of total billed charges,208.22,66.1,,166.58,percent of total billed charges,66.1% of total billed charges,261.45,83,,209.16,percent of total billed charges,83% of total,299.25,95,,239.4,percent of total billed charges ,95% of total billed charges,252,80,,201.6,percent of total billed charges,78% of total billed charges,245.7,78,,196.56,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,198.45,63,,158.76,percent of total billed charges,63% of total billed charges,267.75,85,,214.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,248.85,79,,199.08,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,198.45,941.28,
EXC MAL LES TRUNK ARM LEG 0.5C,11600P,CDM,761,RC,11600,HCPCS,outpatient,,,187,130.9,,147.73,79,,118.18,percent of total billed charges,79% of total billed charges,168.3,90,,134.64,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,117.81,63,,94.25,percent of total billed charges,63% of total billed charges,144.4,77.22,,115.52,percent of total billed charges,77.22% of total billed charges,123.61,66.1,,98.89,percent of total billed charges,66.1% of total billed charges,155.21,83,,124.17,percent of total billed charges,83% of total,177.65,95,,142.12,percent of total billed charges ,95% of total billed charges,149.6,80,,119.68,percent of total billed charges,78% of total billed charges,145.86,78,,116.688,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,117.81,63,,94.25,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,117.81,63,,94.25,percent of total billed charges,63% of total billed charges,158.95,85,,127.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,147.73,79,,118.18,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,117.81,941.28,
EXC MAL LES TRUNK ARM LEG 0.5C,11600T,CDM,761,RC,11600,HCPCS,outpatient,,,280,196,,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,252,90,,201.6,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,216.22,77.22,,172.98,percent of total billed charges,77.22% of total billed charges,185.08,66.1,,148.06,percent of total billed charges,66.1% of total billed charges,232.4,83,,185.92,percent of total billed charges,83% of total,266,95,,212.8,percent of total billed charges ,95% of total billed charges,224,80,,179.2,percent of total billed charges,78% of total billed charges,218.4,78,,174.72,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,176.4,63,,141.12,percent of total billed charges,63% of total billed charges,238,85,,190.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,221.2,79,,176.96,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,176.4,941.28,
EXC MAL LES TRK ARM LEG >4.0CM,11606P,CDM,761,RC,11606,HCPCS,outpatient,,,468,327.6,,369.72,79,,295.78,percent of total billed charges,79% of total billed charges,421.2,90,,336.96,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,294.84,63,,235.87,percent of total billed charges,63% of total billed charges,361.39,77.22,,289.11,percent of total billed charges,77.22% of total billed charges,309.35,66.1,,247.48,percent of total billed charges,66.1% of total billed charges,388.44,83,,310.75,percent of total billed charges,83% of total,444.6,95,,355.68,percent of total billed charges ,95% of total billed charges,374.4,80,,299.52,percent of total billed charges,78% of total billed charges,365.04,78,,292.032,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,294.84,63,,235.87,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,421.2,90,,336.96,percent of total billed charges,90% of total billed charges,374.4,80,,299.52,percent of total billed charges,80% of total billed charges,294.84,63,,235.87,percent of total billed charges,63% of total billed charges,397.8,85,,318.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,369.72,79,,295.78,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,294.84,2169.07,
EXC MAL LES TRK ARM LEG >4.0CM,11606T,CDM,761,RC,11606,HCPCS,outpatient,,,703,492.1,,555.37,79,,444.3,percent of total billed charges,79% of total billed charges,632.7,90,,506.16,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,442.89,63,,354.31,percent of total billed charges,63% of total billed charges,542.86,77.22,,434.29,percent of total billed charges,77.22% of total billed charges,464.68,66.1,,371.74,percent of total billed charges,66.1% of total billed charges,583.49,83,,466.79,percent of total billed charges,83% of total,667.85,95,,534.28,percent of total billed charges ,95% of total billed charges,562.4,80,,449.92,percent of total billed charges,78% of total billed charges,548.34,78,,438.672,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,442.89,63,,354.31,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,442.89,63,,354.31,percent of total billed charges,63% of total billed charges,597.55,85,,478.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,555.37,79,,444.3,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,442.89,2169.07,
TRIMMING TOENAILS ANY NUMBER,11719P,CDM,761,RC,11719,HCPCS,outpatient,,,20,14,,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,18,90,,14.4,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,15.44,77.22,,12.35,percent of total billed charges,77.22% of total billed charges,13.22,66.1,,10.58,percent of total billed charges,66.1% of total billed charges,16.6,83,,13.28,percent of total billed charges,83% of total,19,95,,15.2,percent of total billed charges ,95% of total billed charges,16,80,,12.8,percent of total billed charges,78% of total billed charges,15.6,78,,12.48,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,12.6,63,,10.08,percent of total billed charges,63% of total billed charges,17,85,,13.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,15.8,79,,12.64,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,12.6,450,
TRIMMING TOENAILS ANY NUMBER,11719T,CDM,761,RC,11719,HCPCS,outpatient,,,29,20.3,,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,26.1,90,,20.88,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,22.39,77.22,,17.91,percent of total billed charges,77.22% of total billed charges,19.17,66.1,,15.34,percent of total billed charges,66.1% of total billed charges,24.07,83,,19.26,percent of total billed charges,83% of total,27.55,95,,22.04,percent of total billed charges ,95% of total billed charges,23.2,80,,18.56,percent of total billed charges,78% of total billed charges,22.62,78,,18.096,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,18.27,63,,14.62,percent of total billed charges,63% of total billed charges,24.65,85,,19.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,22.91,79,,18.33,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,18.27,450,
EXCISION/REMOVAL OF NAIL,11750P,CDM,761,RC,11750,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,122.85,533.46,
EXCISION/REMOVAL OF NAIL,11750T,CDM,761,RC,11750,HCPCS,outpatient,,,293,205.1,,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,184.59,63,,147.67,percent of total billed charges,63% of total billed charges,226.25,77.22,,181,percent of total billed charges,77.22% of total billed charges,193.67,66.1,,154.94,percent of total billed charges,66.1% of total billed charges,243.19,83,,194.55,percent of total billed charges,83% of total,278.35,95,,222.68,percent of total billed charges ,95% of total billed charges,234.4,80,,187.52,percent of total billed charges,78% of total billed charges,228.54,78,,182.832,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,184.59,63,,147.67,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,263.7,90,,210.96,percent of total billed charges,90% of total billed charges,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,184.59,63,,147.67,percent of total billed charges,63% of total billed charges,249.05,85,,199.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,231.47,79,,185.18,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,184.59,533.46,
REPAIR LAC SCALP TRNK 2.6-7.5C,12032P,CDM,761,RC,12032,HCPCS,outpatient,,,263,184.1,,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,236.7,90,,189.36,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,203.09,77.22,,162.47,percent of total billed charges,77.22% of total billed charges,173.84,66.1,,139.07,percent of total billed charges,66.1% of total billed charges,218.29,83,,174.63,percent of total billed charges,83% of total,249.85,95,,199.88,percent of total billed charges ,95% of total billed charges,210.4,80,,168.32,percent of total billed charges,78% of total billed charges,205.14,78,,164.112,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,165.69,63,,132.55,percent of total billed charges,63% of total billed charges,223.55,85,,178.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,207.77,79,,166.22,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,165.69,533.46,
REPAIR LAC SCALP TRNK 2.6-7.5C,12032T,CDM,761,RC,12032,HCPCS,outpatient,,,394,275.8,,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,354.6,90,,283.68,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,304.25,77.22,,243.4,percent of total billed charges,77.22% of total billed charges,260.43,66.1,,208.34,percent of total billed charges,66.1% of total billed charges,327.02,83,,261.62,percent of total billed charges,83% of total,374.3,95,,299.44,percent of total billed charges ,95% of total billed charges,315.2,80,,252.16,percent of total billed charges,78% of total billed charges,307.32,78,,245.856,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,248.22,63,,198.58,percent of total billed charges,63% of total billed charges,334.9,85,,267.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,311.26,79,,249.01,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,248.22,533.46,
DESTRUCTION 1 LES BENIGN CRYFR,17000P,CDM,761,RC,17000,HCPCS,outpatient,,,69,48.3,,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,53.28,77.22,,42.62,percent of total billed charges,77.22% of total billed charges,45.61,66.1,,36.49,percent of total billed charges,66.1% of total billed charges,57.27,83,,45.82,percent of total billed charges,83% of total,65.55,95,,52.44,percent of total billed charges ,95% of total billed charges,55.2,80,,44.16,percent of total billed charges,78% of total billed charges,53.82,78,,43.056,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,62.1,90,,49.68,percent of total billed charges,90% of total billed charges,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,43.47,63,,34.78,percent of total billed charges,63% of total billed charges,58.65,85,,46.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,54.51,79,,43.61,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,43.47,450,
DESTRUCTION 1 LES BENIGN CRYFR,17000T,CDM,761,RC,17000,HCPCS,outpatient,,,103,72.1,,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,92.7,90,,74.16,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,79.54,77.22,,63.63,percent of total billed charges,77.22% of total billed charges,68.08,66.1,,54.46,percent of total billed charges,66.1% of total billed charges,85.49,83,,68.39,percent of total billed charges,83% of total,97.85,95,,78.28,percent of total billed charges ,95% of total billed charges,82.4,80,,65.92,percent of total billed charges,78% of total billed charges,80.34,78,,64.272,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,64.89,63,,51.91,percent of total billed charges,63% of total billed charges,87.55,85,,70.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,81.37,79,,65.1,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,64.89,450,
CRYOFREEZE 2 THRU 14 LESIONS,17003P,CDM,761,RC,17003,HCPCS,outpatient,,,18,12.6,,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,16.2,90,,12.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,13.9,77.22,,11.12,percent of total billed charges,77.22% of total billed charges,11.9,66.1,,9.52,percent of total billed charges,66.1% of total billed charges,14.94,83,,11.95,percent of total billed charges,83% of total,17.1,95,,13.68,percent of total billed charges ,95% of total billed charges,14.4,80,,11.52,percent of total billed charges,78% of total billed charges,14.04,78,,11.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,11.34,63,,9.07,percent of total billed charges,63% of total billed charges,15.3,85,,12.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,14.22,79,,11.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.34,450,
CRYOFREEZE 2 THRU 14 LESIONS,17003T,CDM,761,RC,17003,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.38,450,
DESTRUCTION BENIGN LES TO 14,17110P,CDM,761,RC,17110,HCPCS,outpatient,,,115,80.5,,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,103.5,90,,82.8,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,88.8,77.22,,71.04,percent of total billed charges,77.22% of total billed charges,76.02,66.1,,60.82,percent of total billed charges,66.1% of total billed charges,95.45,83,,76.36,percent of total billed charges,83% of total,109.25,95,,87.4,percent of total billed charges ,95% of total billed charges,92,80,,73.6,percent of total billed charges,78% of total billed charges,89.7,78,,71.76,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,72.45,63,,57.96,percent of total billed charges,63% of total billed charges,97.75,85,,78.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,90.85,79,,72.68,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,72.45,450,
DESTRUCTION BENIGN LES TO 14,17110T,CDM,761,RC,17110,HCPCS,outpatient,,,172,120.4,,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,132.82,77.22,,106.26,percent of total billed charges,77.22% of total billed charges,113.69,66.1,,90.95,percent of total billed charges,66.1% of total billed charges,142.76,83,,114.21,percent of total billed charges,83% of total,163.4,95,,130.72,percent of total billed charges ,95% of total billed charges,137.6,80,,110.08,percent of total billed charges,78% of total billed charges,134.16,78,,107.328,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,154.8,90,,123.84,percent of total billed charges,90% of total billed charges,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,108.36,63,,86.69,percent of total billed charges,63% of total billed charges,146.2,85,,116.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,135.88,79,,108.7,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,108.36,450,
I&D SOFT TIS ABSCESS SUBFASCIA,20005P,CDM,761,RC,,,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,157.5,63,,126,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,197.5,79,,158,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,157.5,450,
I&D SOFT TIS ABSCESS SUBFASCIA,20005T,CDM,761,RC,,,outpatient,,,375,262.5,,296.25,79,,237,percent of total billed charges,79% of total billed charges,337.5,90,,270,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,289.58,77.22,,231.66,percent of total billed charges,77.22% of total billed charges,247.88,66.1,,198.3,percent of total billed charges,66.1% of total billed charges,311.25,83,,249,percent of total billed charges,83% of total,356.25,95,,285,percent of total billed charges ,95% of total billed charges,300,80,,240,percent of total billed charges,78% of total billed charges,292.5,78,,234,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,236.25,63,,189,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,236.25,63,,189,percent of total billed charges,63% of total billed charges,318.75,85,,255,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,296.25,79,,237,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,236.25,450,
"INJECTION, TENDON, LIGAMENT",20550,CDM,761,RC,20550,HCPCS,outpatient,,,195,136.5,,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,175.5,90,,140.4,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,150.58,77.22,,120.46,percent of total billed charges,77.22% of total billed charges,128.9,66.1,,103.12,percent of total billed charges,66.1% of total billed charges,161.85,83,,129.48,percent of total billed charges,83% of total,185.25,95,,148.2,percent of total billed charges ,95% of total billed charges,156,80,,124.8,percent of total billed charges,78% of total billed charges,152.1,78,,121.68,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,122.85,63,,98.28,percent of total billed charges,63% of total billed charges,165.75,85,,132.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,154.05,79,,123.24,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,122.85,450,
TWO TRIGGER POINT INJECTIONS,20552,CDM,761,RC,20552,HCPCS,outpatient,,,148,103.6,,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,133.2,90,,106.56,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,114.29,77.22,,91.43,percent of total billed charges,77.22% of total billed charges,97.83,66.1,,78.26,percent of total billed charges,66.1% of total billed charges,122.84,83,,98.27,percent of total billed charges,83% of total,140.6,95,,112.48,percent of total billed charges ,95% of total billed charges,118.4,80,,94.72,percent of total billed charges,78% of total billed charges,115.44,78,,92.352,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,93.24,63,,74.59,percent of total billed charges,63% of total billed charges,125.8,85,,100.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,116.92,79,,93.54,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,93.24,450,
DRAIN INJ JOINT BURSA WO US,20600P,CDM,761,RC,20600,HCPCS,outpatient,,,57,39.9,,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,51.3,90,,41.04,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,44.02,77.22,,35.22,percent of total billed charges,77.22% of total billed charges,37.68,66.1,,30.14,percent of total billed charges,66.1% of total billed charges,47.31,83,,37.85,percent of total billed charges,83% of total,54.15,95,,43.32,percent of total billed charges ,95% of total billed charges,45.6,80,,36.48,percent of total billed charges,78% of total billed charges,44.46,78,,35.568,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,35.91,63,,28.73,percent of total billed charges,63% of total billed charges,48.45,85,,38.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,45.03,79,,36.02,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,35.91,450,
DRAIN INJ JOINT BURSA WO US,20600T,CDM,761,RC,20600,HCPCS,outpatient,,,86,60.2,,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,77.4,90,,61.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,66.41,77.22,,53.13,percent of total billed charges,77.22% of total billed charges,56.85,66.1,,45.48,percent of total billed charges,66.1% of total billed charges,71.38,83,,57.1,percent of total billed charges,83% of total,81.7,95,,65.36,percent of total billed charges ,95% of total billed charges,68.8,80,,55.04,percent of total billed charges,78% of total billed charges,67.08,78,,53.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,54.18,63,,43.34,percent of total billed charges,63% of total billed charges,73.1,85,,58.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,67.94,79,,54.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,54.18,450,
ASPIRATION JOINT/BURSA,20605P,CDM,761,RC,20605,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,49.14,450,
ASPIRATION JOINT/BURSA,20605T,CDM,761,RC,20605,HCPCS,outpatient,,,118,82.6,,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,106.2,90,,84.96,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,91.12,77.22,,72.9,percent of total billed charges,77.22% of total billed charges,78,66.1,,62.4,percent of total billed charges,66.1% of total billed charges,97.94,83,,78.35,percent of total billed charges,83% of total,112.1,95,,89.68,percent of total billed charges ,95% of total billed charges,94.4,80,,75.52,percent of total billed charges,78% of total billed charges,92.04,78,,73.632,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,74.34,63,,59.47,percent of total billed charges,63% of total billed charges,100.3,85,,80.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,93.22,79,,74.58,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,74.34,450,
"INJEC,JNT/BURSA/KNEE,HIP,SHLDR",20610,CDM,761,RC,20610,HCPCS,outpatient,,,250,175,,197.5,79,,158,percent of total billed charges,79% of total billed charges,225,90,,180,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,193.05,77.22,,154.44,percent of total billed charges,77.22% of total billed charges,165.25,66.1,,132.2,percent of total billed charges,66.1% of total billed charges,207.5,83,,166,percent of total billed charges,83% of total,237.5,95,,190,percent of total billed charges ,95% of total billed charges,200,80,,160,percent of total billed charges,78% of total billed charges,195,78,,156,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,157.5,63,,126,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,157.5,63,,126,percent of total billed charges,63% of total billed charges,212.5,85,,170,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,197.5,79,,158,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,157.5,450,
SIMPLE INCISION & DRAINAGE,230010060,CDM,761,RC,10060,HCPCS,outpatient,,,377.14,264,,297.94,79,,238.35,percent of total billed charges,79% of total billed charges,339.43,90,,271.54,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,237.6,63,,190.08,percent of total billed charges,63% of total billed charges,291.23,77.22,,232.98,percent of total billed charges,77.22% of total billed charges,249.29,66.1,,199.43,percent of total billed charges,66.1% of total billed charges,313.03,83,,250.42,percent of total billed charges,83% of total,358.28,95,,286.62,percent of total billed charges ,95% of total billed charges,301.71,80,,241.37,percent of total billed charges,78% of total billed charges,294.17,78,,235.336,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,237.6,63,,190.08,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,339.43,90,,271.54,percent of total billed charges,90% of total billed charges,301.71,80,,241.37,percent of total billed charges,80% of total billed charges,237.6,63,,190.08,percent of total billed charges,63% of total billed charges,320.57,85,,256.456,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,297.94,79,,238.35,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,450,
"DEBRIDE SQ,1ST 20 SQCM OR<BEDS",230011042,CDM,761,RC,11042,HCPCS,outpatient,,,798,558.6,,630.42,79,,504.34,percent of total billed charges,79% of total billed charges,718.2,90,,574.56,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,616.22,77.22,,492.98,percent of total billed charges,77.22% of total billed charges,527.48,66.1,,421.98,percent of total billed charges,66.1% of total billed charges,662.34,83,,529.87,percent of total billed charges,83% of total,758.1,95,,606.48,percent of total billed charges ,95% of total billed charges,638.4,80,,510.72,percent of total billed charges,78% of total billed charges,622.44,78,,497.952,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,502.74,63,,402.19,percent of total billed charges,63% of total billed charges,678.3,85,,542.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,630.42,79,,504.34,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,758.1,
DEBRIDE MUSC 1ST 20CM< BEDSIDE,230011043,CDM,761,RC,11043,HCPCS,outpatient,,,1226,858.2,,968.54,79,,774.83,percent of total billed charges,79% of total billed charges,1103.4,90,,882.72,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,772.38,63,,617.9,percent of total billed charges,63% of total billed charges,946.72,77.22,,757.38,percent of total billed charges,77.22% of total billed charges,810.39,66.1,,648.31,percent of total billed charges,66.1% of total billed charges,1017.58,83,,814.06,percent of total billed charges,83% of total,1164.7,95,,931.76,percent of total billed charges ,95% of total billed charges,980.8,80,,784.64,percent of total billed charges,78% of total billed charges,956.28,78,,765.024,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,772.38,63,,617.9,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,1103.4,90,,882.72,percent of total billed charges,90% of total billed charges,980.8,80,,784.64,percent of total billed charges,80% of total billed charges,772.38,63,,617.9,percent of total billed charges,63% of total billed charges,1042.1,85,,833.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,968.54,79,,774.83,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1164.7,
DEBRIDE BONE 1ST 20 SQCM < BED,230011044,CDM,761,RC,11044,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3117.37,77.22,,2493.9,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
DEBRIDE BONE EA ADDL 20 SQ CM,230011047,CDM,761,RC,11047,HCPCS,outpatient,,,2018,1412.6,,1594.22,79,,1275.38,percent of total billed charges,79% of total billed charges,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1271.34,63,,1017.07,percent of total billed charges,63% of total billed charges,1558.3,77.22,,1246.64,percent of total billed charges,77.22% of total billed charges,1333.9,66.1,,1067.12,percent of total billed charges,66.1% of total billed charges,1674.94,83,,1339.95,percent of total billed charges,83% of total,1917.1,95,,1533.68,percent of total billed charges ,95% of total billed charges,1614.4,80,,1291.52,percent of total billed charges,78% of total billed charges,1574.04,78,,1259.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1271.34,63,,1017.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1271.34,63,,1017.07,percent of total billed charges,63% of total billed charges,1715.3,85,,1372.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1594.22,79,,1275.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1917.1,
TRIM SKIN LESION,230011055,CDM,761,RC,,,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
BEDSIDE SKIN BX SINGLE LESION,230011100,CDM,761,RC,11106,HCPCS,outpatient,,,310,217,,244.9,79,,195.92,percent of total billed charges,79% of total billed charges,279,90,,223.2,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,239.38,77.22,,191.5,percent of total billed charges,77.22% of total billed charges,204.91,66.1,,163.93,percent of total billed charges,66.1% of total billed charges,257.3,83,,205.84,percent of total billed charges,83% of total,294.5,95,,235.6,percent of total billed charges ,95% of total billed charges,248,80,,198.4,percent of total billed charges,78% of total billed charges,241.8,78,,193.44,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,279,90,,223.2,percent of total billed charges,90% of total billed charges,248,80,,198.4,percent of total billed charges,80% of total billed charges,195.3,63,,156.24,percent of total billed charges,63% of total billed charges,263.5,85,,210.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,244.9,79,,195.92,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,195.3,840.25,
PUNCH BX SKIN SINGLE LESION,230011104,CDM,761,RC,11104,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,533.46,
EXC SKIN SCLP/HND/FT .5CM OR <,230011420,CDM,761,RC,,,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1040.15,77.22,,832.12,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1279.65,
EXC SKIN SCLP/HND/FT 2.1-3.0CM,230011423,CDM,761,RC,,,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1040.15,77.22,,832.12,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1279.65,
EX LESIO TRK ARM LEG 3.1-4.0CM,230011604,CDM,761,RC,11604,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1040.15,77.22,,832.12,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
MAL LESI EYE NSE LPS 1.1-2.0CM,230011642,CDM,761,RC,11642,HCPCS,outpatient,,,896,627.2,,707.84,79,,566.27,percent of total billed charges,79% of total billed charges,806.4,90,,645.12,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,691.89,77.22,,553.51,percent of total billed charges,77.22% of total billed charges,592.26,66.1,,473.81,percent of total billed charges,66.1% of total billed charges,743.68,83,,594.94,percent of total billed charges,83% of total,851.2,95,,680.96,percent of total billed charges ,95% of total billed charges,716.8,80,,573.44,percent of total billed charges,78% of total billed charges,698.88,78,,559.104,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,806.4,90,,645.12,percent of total billed charges,90% of total billed charges,716.8,80,,573.44,percent of total billed charges,80% of total billed charges,564.48,63,,451.58,percent of total billed charges,63% of total billed charges,761.6,85,,609.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,707.84,79,,566.27,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,941.28,
EX CA FACE EYE NSE LPS >4.0CM,230011646,CDM,761,RC,11646,HCPCS,outpatient,,,4779,3345.3,,3775.41,79,,3020.33,percent of total billed charges,79% of total billed charges,4301.1,90,,3440.88,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,3010.77,63,,2408.62,percent of total billed charges,63% of total billed charges,3690.34,77.22,,2952.27,percent of total billed charges,77.22% of total billed charges,3158.92,66.1,,2527.14,percent of total billed charges,66.1% of total billed charges,3966.57,83,,3173.26,percent of total billed charges,83% of total,4540.05,95,,3632.04,percent of total billed charges ,95% of total billed charges,3823.2,80,,3058.56,percent of total billed charges,78% of total billed charges,3727.62,78,,2982.096,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3010.77,63,,2408.62,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,4301.1,90,,3440.88,percent of total billed charges,90% of total billed charges,3823.2,80,,3058.56,percent of total billed charges,80% of total billed charges,3010.77,63,,2408.62,percent of total billed charges,63% of total billed charges,4062.15,85,,3249.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,3775.41,79,,3020.33,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,4540.05,
LAC SP SCP/TRK/EX 2.6-7.5CM BS,230012002,CDM,761,RC,12002,HCPCS,outpatient,,,776,543.2,,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,599.23,77.22,,479.38,percent of total billed charges,77.22% of total billed charges,512.94,66.1,,410.35,percent of total billed charges,66.1% of total billed charges,644.08,83,,515.26,percent of total billed charges,83% of total,737.2,95,,589.76,percent of total billed charges ,95% of total billed charges,620.8,80,,496.64,percent of total billed charges,78% of total billed charges,605.28,78,,484.224,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,737.2,
LACF/ER/EYE/NSE/LP2.6-5.0CM BD,230012013,CDM,761,RC,12013,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,461,77.22,,368.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,567.15,
ASPIRATE/INJ JOINT/BEDSIDE,230020605,CDM,761,RC,20605,HCPCS,outpatient,,,523,366.1,,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,403.86,77.22,,323.09,percent of total billed charges,77.22% of total billed charges,345.7,66.1,,276.56,percent of total billed charges,66.1% of total billed charges,434.09,83,,347.27,percent of total billed charges,83% of total,496.85,95,,397.48,percent of total billed charges ,95% of total billed charges,418.4,80,,334.72,percent of total billed charges,78% of total billed charges,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,496.85,
ARTHROCENTES ASP/INJ JNT WO GU,230020610,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
THORACOSTOMY OPEN BEDSIDE,230032551,CDM,761,RC,32551,HCPCS,outpatient,,,3262,2283.4,,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,2518.92,77.22,,2015.14,percent of total billed charges,77.22% of total billed charges,2156.18,66.1,,1724.94,percent of total billed charges,66.1% of total billed charges,2707.46,83,,2165.97,percent of total billed charges,83% of total,3098.9,95,,2479.12,percent of total billed charges ,95% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,78% of total billed charges,2544.36,78,,2035.488,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,80% of total billed charges,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,2772.7,85,,2218.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3098.9,
THORACENTESIS NO GUIDE BEDSIDE,230032554,CDM,761,RC,32554,HCPCS,outpatient,,,1261,882.7,,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,1134.9,90,,907.92,percent of total billed charges,90% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,840.46,160,,,Fee Schedule,160% of CMS OPPS rate,682.87,130,,,Fee Schedule,130% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,973.74,77.22,,778.99,percent of total billed charges,77.22% of total billed charges,833.52,66.1,,666.82,percent of total billed charges,66.1% of total billed charges,1046.63,83,,837.3,percent of total billed charges,83% of total,1197.95,95,,958.36,percent of total billed charges ,95% of total billed charges,1008.8,80,,807.04,percent of total billed charges,78% of total billed charges,983.58,78,,786.864,percent of total billed charges,78% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,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,794.43,63,,635.54,percent of total billed charges,63% of total billed charges,1071.85,85,,857.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.51,93,,,fee schedule,93% of CMS OPPS rate,996.19,79,,796.95,percent of total billed charges,79% of total billed charges,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,525.27,100,,,Fee Schedule,100% of CMS OPPS rate,450,1197.95,
INS PICCATH/NO PORT/PMP BED>5Y,230036569,CDM,761,RC,36569,HCPCS,outpatient,,,3348,2343.6,,2644.92,79,,2115.94,percent of total billed charges,79% of total billed charges,3013.2,90,,2410.56,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,2585.33,77.22,,2068.26,percent of total billed charges,77.22% of total billed charges,2213.03,66.1,,1770.42,percent of total billed charges,66.1% of total billed charges,2778.84,83,,2223.07,percent of total billed charges,83% of total,3180.6,95,,2544.48,percent of total billed charges ,95% of total billed charges,2678.4,80,,2142.72,percent of total billed charges,78% of total billed charges,2611.44,78,,2089.152,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,3013.2,90,,2410.56,percent of total billed charges,90% of total billed charges,2678.4,80,,2142.72,percent of total billed charges,80% of total billed charges,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,2845.8,85,,2276.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2644.92,79,,2115.94,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3180.6,
ABSCESS I&D PERITONSILLAR BEDS,230042700,CDM,761,RC,42700,HCPCS,outpatient,,,549,384.3,,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,494.1,90,,395.28,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,423.94,77.22,,339.15,percent of total billed charges,77.22% of total billed charges,362.89,66.1,,290.31,percent of total billed charges,66.1% of total billed charges,455.67,83,,364.54,percent of total billed charges,83% of total,521.55,95,,417.24,percent of total billed charges ,95% of total billed charges,439.2,80,,351.36,percent of total billed charges,78% of total billed charges,428.22,78,,342.576,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,345.87,63,,276.7,percent of total billed charges,63% of total billed charges,466.65,85,,373.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,433.71,79,,346.97,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,521.55,
ABD PARACENTESIS NO GUIDANCE,230049082,CDM,761,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,100,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
BS DX LUMBAR SPINAL PUNCTURE,230062270,CDM,761,RC,62270,HCPCS,outpatient,,,1978,1384.6,,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,100,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1527.41,77.22,,1221.93,percent of total billed charges,77.22% of total billed charges,1307.46,66.1,,1045.97,percent of total billed charges,66.1% of total billed charges,1641.74,83,,1313.39,percent of total billed charges,83% of total,1879.1,95,,1503.28,percent of total billed charges ,95% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,78% of total billed charges,1542.84,78,,1234.272,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,80% of total billed charges,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1681.3,85,,1345.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1879.1,
EPIDURAL BLOOD PATCH,230062273,CDM,761,RC,,,outpatient,,,159,111.3,,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,143.1,90,,114.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,122.78,77.22,,98.22,percent of total billed charges,77.22% of total billed charges,105.1,66.1,,84.08,percent of total billed charges,66.1% of total billed charges,131.97,83,,105.58,percent of total billed charges,83% of total,151.05,95,,120.84,percent of total billed charges ,95% of total billed charges,127.2,80,,101.76,percent of total billed charges,78% of total billed charges,124.02,78,,99.216,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,100.17,63,,80.14,percent of total billed charges,63% of total billed charges,135.15,85,,108.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,125.61,79,,100.49,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100.17,450,
BS NJX AA STRD BRACH PLEXUS,230064415,CDM,761,RC,64415,HCPCS,outpatient,,,2778,1944.6,,2194.62,79,,1755.7,percent of total billed charges,79% of total billed charges,2500.2,90,,2000.16,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,1750.14,63,,1400.11,percent of total billed charges,63% of total billed charges,2145.17,77.22,,1716.14,percent of total billed charges,77.22% of total billed charges,1836.26,66.1,,1469.01,percent of total billed charges,66.1% of total billed charges,2305.74,83,,1844.59,percent of total billed charges,83% of total,2639.1,95,,2111.28,percent of total billed charges ,95% of total billed charges,2222.4,80,,1777.92,percent of total billed charges,78% of total billed charges,2166.84,78,,1733.472,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1750.14,63,,1400.11,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,2500.2,90,,2000.16,percent of total billed charges,90% of total billed charges,2222.4,80,,1777.92,percent of total billed charges,80% of total billed charges,1750.14,63,,1400.11,percent of total billed charges,63% of total billed charges,2361.3,85,,1889.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,2194.62,79,,1755.7,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,2639.1,
BLOOD COLLECT CENT/PERIPH CATH,260036592,CDM,761,RC,36592,HCPCS,outpatient,,,218,152.6,,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,196.2,90,,156.96,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,168.34,77.22,,134.67,percent of total billed charges,77.22% of total billed charges,144.1,66.1,,115.28,percent of total billed charges,66.1% of total billed charges,180.94,83,,144.75,percent of total billed charges,83% of total,207.1,95,,165.68,percent of total billed charges ,95% of total billed charges,174.4,80,,139.52,percent of total billed charges,78% of total billed charges,170.04,78,,136.032,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,137.34,63,,109.87,percent of total billed charges,63% of total billed charges,185.3,85,,148.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,172.22,79,,137.78,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
IRRIGATE DRUG DELIVERY DEVICE,260096523,CDM,761,RC,96523,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
I&D COMPLICATED FINGER ABSCESS,26011P,CDM,761,RC,26011,HCPCS,outpatient,,,344,240.8,,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,265.64,77.22,,212.51,percent of total billed charges,77.22% of total billed charges,227.38,66.1,,181.9,percent of total billed charges,66.1% of total billed charges,285.52,83,,228.42,percent of total billed charges,83% of total,326.8,95,,261.44,percent of total billed charges ,95% of total billed charges,275.2,80,,220.16,percent of total billed charges,78% of total billed charges,268.32,78,,214.656,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,309.6,90,,247.68,percent of total billed charges,90% of total billed charges,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,216.72,63,,173.38,percent of total billed charges,63% of total billed charges,292.4,85,,233.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,271.76,79,,217.41,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,216.72,2169.07,
I&D COMPLICATED FINGER ABSCESS,26011T,CDM,761,RC,26011,HCPCS,outpatient,,,517,361.9,,408.43,79,,326.74,percent of total billed charges,79% of total billed charges,465.3,90,,372.24,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,325.71,63,,260.57,percent of total billed charges,63% of total billed charges,399.23,77.22,,319.38,percent of total billed charges,77.22% of total billed charges,341.74,66.1,,273.39,percent of total billed charges,66.1% of total billed charges,429.11,83,,343.29,percent of total billed charges,83% of total,491.15,95,,392.92,percent of total billed charges ,95% of total billed charges,413.6,80,,330.88,percent of total billed charges,78% of total billed charges,403.26,78,,322.608,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,325.71,63,,260.57,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,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,325.71,63,,260.57,percent of total billed charges,63% of total billed charges,439.45,85,,351.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,408.43,79,,326.74,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,325.71,2169.07,
INJECTION PROCEDURE/CYSTO,320001509,CDM,761,RC,51600,HCPCS,outpatient,,,71,49.7,,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,63.9,90,,51.12,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,54.83,77.22,,43.86,percent of total billed charges,77.22% of total billed charges,46.93,66.1,,37.54,percent of total billed charges,66.1% of total billed charges,58.93,83,,47.14,percent of total billed charges,83% of total,67.45,95,,53.96,percent of total billed charges ,95% of total billed charges,56.8,80,,45.44,percent of total billed charges,78% of total billed charges,55.38,78,,44.304,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,44.73,63,,35.78,percent of total billed charges,63% of total billed charges,60.35,85,,48.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,56.09,79,,44.87,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.73,450,
DX LUMBAR SPINAL PUNCTURE,320001707,CDM,761,RC,62270,HCPCS,outpatient,,,1978,1384.6,,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1527.41,77.22,,1221.93,percent of total billed charges,77.22% of total billed charges,1307.46,66.1,,1045.97,percent of total billed charges,66.1% of total billed charges,1641.74,83,,1313.39,percent of total billed charges,83% of total,1879.1,95,,1503.28,percent of total billed charges ,95% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,78% of total billed charges,1542.84,78,,1234.272,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,80% of total billed charges,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1681.3,85,,1345.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1879.1,
CATH/INTRO SALINE OR CONT MATL,320001731,CDM,761,RC,58340,HCPCS,outpatient,,,742,519.4,,586.18,79,,468.94,percent of total billed charges,79% of total billed charges,667.8,90,,534.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.46,63,,373.97,percent of total billed charges,63% of total billed charges,572.97,77.22,,458.38,percent of total billed charges,77.22% of total billed charges,490.46,66.1,,392.37,percent of total billed charges,66.1% of total billed charges,615.86,83,,492.69,percent of total billed charges,83% of total,704.9,95,,563.92,percent of total billed charges ,95% of total billed charges,593.6,80,,474.88,percent of total billed charges,78% of total billed charges,578.76,78,,463.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,467.46,63,,373.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,467.46,63,,373.97,percent of total billed charges,63% of total billed charges,630.7,85,,504.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,586.18,79,,468.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,704.9,
INJ HIP ARTHOGRAM W/O ANES,320001756,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
ARTHROGRAM HIP W/INJ PAIN MED,320001794,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
LUMBAR PUNCT ASP/PRESS READ CP,320080140,CDM,761,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
LUMBAR PUNCTURE ASP ONLY CP,320080141,CDM,761,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
CT ASPIR/INJECT JOINT BURSA,322001775,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
ARTHRO INJ LTD LSHLDER W/O GUI,322001776,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
ARTHRO INJ LTD RSHOULDER W/O G,322001777,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
ABS INCISION & DRAIN SMPL SGLE,324010060,CDM,761,RC,10060,HCPCS,outpatient,,,642,449.4,,507.18,79,,405.74,percent of total billed charges,79% of total billed charges,577.8,90,,462.24,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,404.46,63,,323.57,percent of total billed charges,63% of total billed charges,495.75,77.22,,396.6,percent of total billed charges,77.22% of total billed charges,424.36,66.1,,339.49,percent of total billed charges,66.1% of total billed charges,532.86,83,,426.29,percent of total billed charges,83% of total,609.9,95,,487.92,percent of total billed charges ,95% of total billed charges,513.6,80,,410.88,percent of total billed charges,78% of total billed charges,500.76,78,,400.608,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,404.46,63,,323.57,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,577.8,90,,462.24,percent of total billed charges,90% of total billed charges,513.6,80,,410.88,percent of total billed charges,80% of total billed charges,404.46,63,,323.57,percent of total billed charges,63% of total billed charges,545.7,85,,436.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,507.18,79,,405.74,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,609.9,
ABS INCISION & DRAIN COMP MULT,324010061,CDM,761,RC,10061,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
INCIS DRAIN PILONIDAL CYST SIM,324010080,CDM,761,RC,10080,HCPCS,outpatient,,,1700,1190,,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,1530,90,,1224,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,1312.74,77.22,,1050.19,percent of total billed charges,77.22% of total billed charges,1123.7,66.1,,898.96,percent of total billed charges,66.1% of total billed charges,1411,83,,1128.8,percent of total billed charges,83% of total,1615,95,,1292,percent of total billed charges ,95% of total billed charges,1360,80,,1088,percent of total billed charges,78% of total billed charges,1326,78,,1060.8,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,1071,63,,856.8,percent of total billed charges,63% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1615,
INCIS DRAIN PILONIDAL CYST COM,324010081,CDM,761,RC,10081,HCPCS,outpatient,,,1700,1190,,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,1530,90,,1224,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,1312.74,77.22,,1050.19,percent of total billed charges,77.22% of total billed charges,1123.7,66.1,,898.96,percent of total billed charges,66.1% of total billed charges,1411,83,,1128.8,percent of total billed charges,83% of total,1615,95,,1292,percent of total billed charges ,95% of total billed charges,1360,80,,1088,percent of total billed charges,78% of total billed charges,1326,78,,1060.8,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1071,63,,856.8,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,1071,63,,856.8,percent of total billed charges,63% of total billed charges,1445,85,,1156,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1343,79,,1074.4,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1615,
INCIS REMV FOREIGN BODY SUB SI,324010120,CDM,761,RC,10120,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
INCIS REMV FOREIGN BODY SUB CO,324010121,CDM,761,RC,10121,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3117.37,77.22,,2493.9,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
INCIS DRNG HEMATOMA SEROMA FL,324010140,CDM,761,RC,10140,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3117.37,77.22,,2493.9,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
PUNCT ASPIR ABS HEMAT BULA CYS,324010160,CDM,761,RC,10160,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
INCIS DRAIN COM POST-OP WND IN,324010180,CDM,761,RC,10180,HCPCS,outpatient,,,6980,4886,,5514.2,79,,4411.36,percent of total billed charges,79% of total billed charges,6282,90,,5025.6,percent of total billed charges,90% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,3801.55,160,,,Fee Schedule,160% of CMS OPPS rate,3088.75,130,,,Fee Schedule,130% of CMS OPPS rate,4397.4,63,,3517.92,percent of total billed charges,63% of total billed charges,5389.96,77.22,,4311.97,percent of total billed charges,77.22% of total billed charges,4613.78,66.1,,3691.02,percent of total billed charges,66.1% of total billed charges,5793.4,83,,4634.72,percent of total billed charges,83% of total,6631,95,,5304.8,percent of total billed charges ,95% of total billed charges,5584,80,,4467.2,percent of total billed charges,78% of total billed charges,5444.4,78,,4355.52,percent of total billed charges,78% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,4397.4,63,,3517.92,percent of total billed charges,63% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,6282,90,,5025.6,percent of total billed charges,90% of total billed charges,5584,80,,4467.2,percent of total billed charges,80% of total billed charges,4397.4,63,,3517.92,percent of total billed charges,63% of total billed charges,5933,85,,4746.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2209.64,93,,,fee schedule,93% of CMS OPPS rate,5514.2,79,,4411.36,percent of total billed charges,79% of total billed charges,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,2375.96,100,,,Fee Schedule,100% of CMS OPPS rate,450,6631,
DEBRIDE SUBQ 1ST 20 SQ CM OR <,324011042,CDM,761,RC,11042,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
DEBRID MUSC/FASCIA 1ST 20 SQCM,324011043,CDM,761,RC,11043,HCPCS,outpatient,,,1417,991.9,,1119.43,79,,895.54,percent of total billed charges,79% of total billed charges,1275.3,90,,1020.24,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,892.71,63,,714.17,percent of total billed charges,63% of total billed charges,1094.21,77.22,,875.37,percent of total billed charges,77.22% of total billed charges,936.64,66.1,,749.31,percent of total billed charges,66.1% of total billed charges,1176.11,83,,940.89,percent of total billed charges,83% of total,1346.15,95,,1076.92,percent of total billed charges ,95% of total billed charges,1133.6,80,,906.88,percent of total billed charges,78% of total billed charges,1105.26,78,,884.208,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,892.71,63,,714.17,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,1275.3,90,,1020.24,percent of total billed charges,90% of total billed charges,1133.6,80,,906.88,percent of total billed charges,80% of total billed charges,892.71,63,,714.17,percent of total billed charges,63% of total billed charges,1204.45,85,,963.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,1119.43,79,,895.54,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1346.15,
DEBRIDE BONE 1ST 20 SQ CM OR <,324011044,CDM,761,RC,11044,HCPCS,outpatient,,,4037,2825.9,,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3117.37,77.22,,2493.9,percent of total billed charges,77.22% of total billed charges,2668.46,66.1,,2134.77,percent of total billed charges,66.1% of total billed charges,3350.71,83,,2680.57,percent of total billed charges,83% of total,3835.15,95,,3068.12,percent of total billed charges ,95% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,78% of total billed charges,3148.86,78,,2519.088,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3633.3,90,,2906.64,percent of total billed charges,90% of total billed charges,3229.6,80,,2583.68,percent of total billed charges,80% of total billed charges,2543.31,63,,2034.65,percent of total billed charges,63% of total billed charges,3431.45,85,,2745.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3189.23,79,,2551.38,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3835.15,
DEBRIDE SUBQ EA ADDL 20 SQ CM,324011045,CDM,761,RC,11045,HCPCS,outpatient,,,461,322.7,,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,414.9,90,,331.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,355.98,77.22,,284.78,percent of total billed charges,77.22% of total billed charges,304.72,66.1,,243.78,percent of total billed charges,66.1% of total billed charges,382.63,83,,306.1,percent of total billed charges,83% of total,437.95,95,,350.36,percent of total billed charges ,95% of total billed charges,368.8,80,,295.04,percent of total billed charges,78% of total billed charges,359.58,78,,287.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,391.85,85,,313.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,290.43,450,
DEBRID MUS/FASC EA ADL 20 SQCM,324011046,CDM,761,RC,11046,HCPCS,outpatient,,,709,496.3,,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,638.1,90,,510.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,547.49,77.22,,437.99,percent of total billed charges,77.22% of total billed charges,468.65,66.1,,374.92,percent of total billed charges,66.1% of total billed charges,588.47,83,,470.78,percent of total billed charges,83% of total,673.55,95,,538.84,percent of total billed charges ,95% of total billed charges,567.2,80,,453.76,percent of total billed charges,78% of total billed charges,553.02,78,,442.416,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,446.67,63,,357.34,percent of total billed charges,63% of total billed charges,602.65,85,,482.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,560.11,79,,448.09,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,446.67,673.55,
DEBRIDE BONE EA ADDL 20 SQ CM,324011047,CDM,761,RC,11047,HCPCS,outpatient,,,2018,1412.6,,1594.22,79,,1275.38,percent of total billed charges,79% of total billed charges,1816.2,90,,1452.96,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1271.34,63,,1017.07,percent of total billed charges,63% of total billed charges,1558.3,77.22,,1246.64,percent of total billed charges,77.22% of total billed charges,1333.9,66.1,,1067.12,percent of total billed charges,66.1% of total billed charges,1674.94,83,,1339.95,percent of total billed charges,83% of total,1917.1,95,,1533.68,percent of total billed charges ,95% of total billed charges,1614.4,80,,1291.52,percent of total billed charges,78% of total billed charges,1574.04,78,,1259.232,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1271.34,63,,1017.07,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,1271.34,63,,1017.07,percent of total billed charges,63% of total billed charges,1715.3,85,,1372.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1594.22,79,,1275.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1917.1,
PARG CUTG BENIGN HYPERKE LES 1,324011055,CDM,761,RC,11055,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,492.1,
PARG CUTG BNIGN HYPERKE LES2-4,324011056,CDM,761,RC,11056,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,492.1,
PARG CUTG BNIGN HYPERKE LES >4,324011057,CDM,761,RC,11057,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
TANGENTIAL SKIN BIOPSY SGL LES,324011102,CDM,761,RC,11102,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
TANGENTIAL SKIN BIOP EA ADL LE,324011103,CDM,761,RC,11103,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
PUNCH SKIN BIOPSY SNGLE LESION,324011104,CDM,761,RC,11104,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,533.46,
PUNCH SKIN BIOPSY EA ADL LES,324011105,CDM,761,RC,11105,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
INCISIONAL SKIN BIOPSY SGL LES,324011106,CDM,761,RC,11106,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,840.25,160,,,Fee Schedule,160% of CMS OPPS rate,682.7,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,488.39,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,525.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,875.9,
INCISNL SKIN BIOPSY EA ADL LES,324011107,CDM,761,RC,11107,HCPCS,outpatient,,,461,322.7,,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,414.9,90,,331.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,355.98,77.22,,284.78,percent of total billed charges,77.22% of total billed charges,304.72,66.1,,243.78,percent of total billed charges,66.1% of total billed charges,382.63,83,,306.1,percent of total billed charges,83% of total,437.95,95,,350.36,percent of total billed charges ,95% of total billed charges,368.8,80,,295.04,percent of total billed charges,78% of total billed charges,359.58,78,,287.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,290.43,63,,232.34,percent of total billed charges,63% of total billed charges,391.85,85,,313.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,364.19,79,,291.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,290.43,450,
WC EXC SKIN TRNK/EXT 0.6-1.0CM,324011401,CDM,761,RC,11401,HCPCS,outpatient,,,1236,865.2,,976.44,79,,781.15,percent of total billed charges,79% of total billed charges,1112.4,90,,889.92,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,778.68,63,,622.94,percent of total billed charges,63% of total billed charges,954.44,77.22,,763.55,percent of total billed charges,77.22% of total billed charges,817,66.1,,653.6,percent of total billed charges,66.1% of total billed charges,1025.88,83,,820.7,percent of total billed charges,83% of total,1174.2,95,,939.36,percent of total billed charges ,95% of total billed charges,988.8,80,,791.04,percent of total billed charges,78% of total billed charges,964.08,78,,771.264,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,778.68,63,,622.94,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,778.68,63,,622.94,percent of total billed charges,63% of total billed charges,1050.6,85,,840.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,976.44,79,,781.15,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,1174.2,
WC EXC BENIGN LESION 1.1-2.0CM,324011402,CDM,761,RC,11402,HCPCS,outpatient,,,2224,1556.8,,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,1717.37,77.22,,1373.9,percent of total billed charges,77.22% of total billed charges,1470.06,66.1,,1176.05,percent of total billed charges,66.1% of total billed charges,1845.92,83,,1476.74,percent of total billed charges,83% of total,2112.8,95,,1690.24,percent of total billed charges ,95% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,78% of total billed charges,1734.72,78,,1387.776,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,80% of total billed charges,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,1890.4,85,,1512.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,2112.8,
WC EXC SKIN TRNK/EXT 2.1-3.0CM,324011403,CDM,761,RC,11403,HCPCS,outpatient,,,2224,1556.8,,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,1717.37,77.22,,1373.9,percent of total billed charges,77.22% of total billed charges,1470.06,66.1,,1176.05,percent of total billed charges,66.1% of total billed charges,1845.92,83,,1476.74,percent of total billed charges,83% of total,2112.8,95,,1690.24,percent of total billed charges ,95% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,78% of total billed charges,1734.72,78,,1387.776,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,2001.6,90,,1601.28,percent of total billed charges,90% of total billed charges,1779.2,80,,1423.36,percent of total billed charges,80% of total billed charges,1401.12,63,,1120.9,percent of total billed charges,63% of total billed charges,1890.4,85,,1512.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1756.96,79,,1405.57,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,2112.8,
WC EXC SKIN TRNK/EXT 3.1-4.0CM,324011404,CDM,761,RC,11404,HCPCS,outpatient,,,5029,3520.3,,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,3883.39,77.22,,3106.71,percent of total billed charges,77.22% of total billed charges,3324.17,66.1,,2659.34,percent of total billed charges,66.1% of total billed charges,4174.07,83,,3339.26,percent of total billed charges,83% of total,4777.55,95,,3822.04,percent of total billed charges ,95% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,78% of total billed charges,3922.62,78,,3138.096,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,80% of total billed charges,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,4274.65,85,,3419.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,4777.55,
WC EXC SKIN TRNK/EXT 0.6-1.0CM,324011406,CDM,761,RC,11406,HCPCS,outpatient,,,5029,3520.3,,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,3883.39,77.22,,3106.71,percent of total billed charges,77.22% of total billed charges,3324.17,66.1,,2659.34,percent of total billed charges,66.1% of total billed charges,4174.07,83,,3339.26,percent of total billed charges,83% of total,4777.55,95,,3822.04,percent of total billed charges ,95% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,78% of total billed charges,3922.62,78,,3138.096,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,80% of total billed charges,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,4274.65,85,,3419.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,4777.55,
TRIM NONDYSTROPHIC NAILS ANYNO,324011719,CDM,761,RC,11719,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
DEBRIDE NAILS ANY METH QTY 1-5,324011720,CDM,761,RC,11720,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
DEBRIDE NAILS ANY METH QTY 6>,324011721,CDM,761,RC,11721,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
AVULSION NAIL PLATE SIMP QTY 1,324011730,CDM,761,RC,11730,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,492.1,
AVULSION NAIL EA ADL NAIL PLAT,324011732,CDM,761,RC,11732,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
EXCISION NAIL/MATRIX PERM REMO,324011750,CDM,761,RC,11750,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
WC WOUND PREP TRK/ARM/LEG,324015002,CDM,761,RC,15002,HCPCS,outpatient,,,5421,3794.7,,4282.59,79,,3426.07,percent of total billed charges,79% of total billed charges,4878.9,90,,3903.12,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,3415.23,63,,2732.18,percent of total billed charges,63% of total billed charges,4186.1,77.22,,3348.88,percent of total billed charges,77.22% of total billed charges,3583.28,66.1,,2866.62,percent of total billed charges,66.1% of total billed charges,4499.43,83,,3599.54,percent of total billed charges,83% of total,5149.95,95,,4119.96,percent of total billed charges ,95% of total billed charges,4336.8,80,,3469.44,percent of total billed charges,78% of total billed charges,4228.38,78,,3382.704,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,3415.23,63,,2732.18,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,4878.9,90,,3903.12,percent of total billed charges,90% of total billed charges,4336.8,80,,3469.44,percent of total billed charges,80% of total billed charges,3415.23,63,,2732.18,percent of total billed charges,63% of total billed charges,4607.85,85,,3686.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,4282.59,79,,3426.07,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,5149.95,
EPID AUTGRAFT TNK ARM LG 100SC,324015110,CDM,761,RC,15110,HCPCS,outpatient,,,4546,3182.2,,3591.34,79,,2873.07,percent of total billed charges,79% of total billed charges,4091.4,90,,3273.12,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,2863.98,63,,2291.18,percent of total billed charges,63% of total billed charges,3510.42,77.22,,2808.34,percent of total billed charges,77.22% of total billed charges,3004.91,66.1,,2403.93,percent of total billed charges,66.1% of total billed charges,3773.18,83,,3018.54,percent of total billed charges,83% of total,4318.7,95,,3454.96,percent of total billed charges ,95% of total billed charges,3636.8,80,,2909.44,percent of total billed charges,78% of total billed charges,3545.88,78,,2836.704,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2863.98,63,,2291.18,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,4091.4,90,,3273.12,percent of total billed charges,90% of total billed charges,3636.8,80,,2909.44,percent of total billed charges,80% of total billed charges,2863.98,63,,2291.18,percent of total billed charges,63% of total billed charges,3864.1,85,,3091.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,3591.34,79,,2873.07,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,4318.7,
EPID AUTGRAFT TNK ARM LG AD100,324015111,CDM,761,RC,15111,HCPCS,outpatient,,,2711,1897.7,,2141.69,79,,1713.35,percent of total billed charges,79% of total billed charges,2439.9,90,,1951.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1707.93,63,,1366.34,percent of total billed charges,63% of total billed charges,2093.43,77.22,,1674.74,percent of total billed charges,77.22% of total billed charges,1791.97,66.1,,1433.58,percent of total billed charges,66.1% of total billed charges,2250.13,83,,1800.1,percent of total billed charges,83% of total,2575.45,95,,2060.36,percent of total billed charges ,95% of total billed charges,2168.8,80,,1735.04,percent of total billed charges,78% of total billed charges,2114.58,78,,1691.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1707.93,63,,1366.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2439.9,90,,1951.92,percent of total billed charges,90% of total billed charges,2168.8,80,,1735.04,percent of total billed charges,80% of total billed charges,1707.93,63,,1366.34,percent of total billed charges,63% of total billed charges,2304.35,85,,1843.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2141.69,79,,1713.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2575.45,
EPID AUTGRPH FE SCLP MUL 100SC,324015115,CDM,761,RC,15115,HCPCS,outpatient,,,4546,3182.2,,3591.34,79,,2873.07,percent of total billed charges,79% of total billed charges,4091.4,90,,3273.12,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,2863.98,63,,2291.18,percent of total billed charges,63% of total billed charges,3510.42,77.22,,2808.34,percent of total billed charges,77.22% of total billed charges,3004.91,66.1,,2403.93,percent of total billed charges,66.1% of total billed charges,3773.18,83,,3018.54,percent of total billed charges,83% of total,4318.7,95,,3454.96,percent of total billed charges ,95% of total billed charges,3636.8,80,,2909.44,percent of total billed charges,78% of total billed charges,3545.88,78,,2836.704,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2863.98,63,,2291.18,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,4091.4,90,,3273.12,percent of total billed charges,90% of total billed charges,3636.8,80,,2909.44,percent of total billed charges,80% of total billed charges,2863.98,63,,2291.18,percent of total billed charges,63% of total billed charges,3864.1,85,,3091.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,3591.34,79,,2873.07,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,4318.7,
EPID AUTGRPH FE SCLP EA A100SC,324015116,CDM,761,RC,15116,HCPCS,outpatient,,,2711,1897.7,,2141.69,79,,1713.35,percent of total billed charges,79% of total billed charges,2439.9,90,,1951.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1707.93,63,,1366.34,percent of total billed charges,63% of total billed charges,2093.43,77.22,,1674.74,percent of total billed charges,77.22% of total billed charges,1791.97,66.1,,1433.58,percent of total billed charges,66.1% of total billed charges,2250.13,83,,1800.1,percent of total billed charges,83% of total,2575.45,95,,2060.36,percent of total billed charges ,95% of total billed charges,2168.8,80,,1735.04,percent of total billed charges,78% of total billed charges,2114.58,78,,1691.664,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1707.93,63,,1366.34,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2439.9,90,,1951.92,percent of total billed charges,90% of total billed charges,2168.8,80,,1735.04,percent of total billed charges,80% of total billed charges,1707.93,63,,1366.34,percent of total billed charges,63% of total billed charges,2304.35,85,,1843.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2141.69,79,,1713.35,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2575.45,
APP SK SUB GRT TR/AM/LG 100 SC,324015271,CDM,761,RC,15271,HCPCS,outpatient,,,2864,2004.8,,2262.56,79,,1810.05,percent of total billed charges,79% of total billed charges,2577.6,90,,2062.08,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,2211.58,77.22,,1769.26,percent of total billed charges,77.22% of total billed charges,1893.1,66.1,,1514.48,percent of total billed charges,66.1% of total billed charges,2377.12,83,,1901.7,percent of total billed charges,83% of total,2720.8,95,,2176.64,percent of total billed charges ,95% of total billed charges,2291.2,80,,1832.96,percent of total billed charges,78% of total billed charges,2233.92,78,,1787.136,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2577.6,90,,2062.08,percent of total billed charges,90% of total billed charges,2291.2,80,,1832.96,percent of total billed charges,80% of total billed charges,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,2434.4,85,,1947.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,2262.56,79,,1810.05,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,2720.8,
APP SK SUB GRT TR/AM/LG A25 SC,324015272,CDM,761,RC,15272,HCPCS,outpatient,,,1432,1002.4,,1131.28,79,,905.02,percent of total billed charges,79% of total billed charges,1288.8,90,,1031.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,1105.79,77.22,,884.63,percent of total billed charges,77.22% of total billed charges,946.55,66.1,,757.24,percent of total billed charges,66.1% of total billed charges,1188.56,83,,950.85,percent of total billed charges,83% of total,1360.4,95,,1088.32,percent of total billed charges ,95% of total billed charges,1145.6,80,,916.48,percent of total billed charges,78% of total billed charges,1116.96,78,,893.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,1217.2,85,,973.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1131.28,79,,905.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1360.4,
AP SK SUB GRT TR/AM/LG >=100SC,324015273,CDM,761,RC,15273,HCPCS,outpatient,,,9038,6326.6,,7140.02,79,,5712.02,percent of total billed charges,79% of total billed charges,8134.2,90,,6507.36,percent of total billed charges,90% of total billed charges,2999.86,100,,,Fee Schedule,100% of CMS OPPS rate,4799.77,160,,,Fee Schedule,160% of CMS OPPS rate,3899.81,130,,,Fee Schedule,130% of CMS OPPS rate,5693.94,63,,4555.15,percent of total billed charges,63% of total billed charges,6979.14,77.22,,5583.31,percent of total billed charges,77.22% of total billed charges,5974.12,66.1,,4779.3,percent of total billed charges,66.1% of total billed charges,7501.54,83,,6001.23,percent of total billed charges,83% of total,8586.1,95,,6868.88,percent of total billed charges ,95% of total billed charges,7230.4,80,,5784.32,percent of total billed charges,78% of total billed charges,7049.64,78,,5639.712,percent of total billed charges,78% of total billed charges,2999.86,100,,,Fee Schedule,100% of CMS OPPS rate,5693.94,63,,4555.15,percent of total billed charges,63% of total billed charges,2999.86,100,,,Fee Schedule,100% of CMS OPPS rate,8134.2,90,,6507.36,percent of total billed charges,90% of total billed charges,7230.4,80,,5784.32,percent of total billed charges,80% of total billed charges,5693.94,63,,4555.15,percent of total billed charges,63% of total billed charges,7682.3,85,,6145.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2789.87,93,,,fee schedule,93% of CMS OPPS rate,7140.02,79,,5712.02,percent of total billed charges,79% of total billed charges,2999.86,100,,,Fee Schedule,100% of CMS OPPS rate,2999.86,100,,,Fee Schedule,100% of CMS OPPS rate,450,8586.1,
AP SK SUB GRT T/A/L>=100SC EAD,324015274,CDM,761,RC,15274,HCPCS,outpatient,,,4519,3163.3,,3570.01,79,,2856.01,percent of total billed charges,79% of total billed charges,4067.1,90,,3253.68,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2846.97,63,,2277.58,percent of total billed charges,63% of total billed charges,3489.57,77.22,,2791.66,percent of total billed charges,77.22% of total billed charges,2987.06,66.1,,2389.65,percent of total billed charges,66.1% of total billed charges,3750.77,83,,3000.62,percent of total billed charges,83% of total,4293.05,95,,3434.44,percent of total billed charges ,95% of total billed charges,3615.2,80,,2892.16,percent of total billed charges,78% of total billed charges,3524.82,78,,2819.856,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,2846.97,63,,2277.58,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,4067.1,90,,3253.68,percent of total billed charges,90% of total billed charges,3615.2,80,,2892.16,percent of total billed charges,80% of total billed charges,2846.97,63,,2277.58,percent of total billed charges,63% of total billed charges,3841.15,85,,3072.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,3570.01,79,,2856.01,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,4293.05,
AP SK SUB GRT 100SC 1ST25CM,324015275,CDM,761,RC,15275,HCPCS,outpatient,,,2864,2004.8,,2262.56,79,,1810.05,percent of total billed charges,79% of total billed charges,2577.6,90,,2062.08,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,2211.58,77.22,,1769.26,percent of total billed charges,77.22% of total billed charges,1893.1,66.1,,1514.48,percent of total billed charges,66.1% of total billed charges,2377.12,83,,1901.7,percent of total billed charges,83% of total,2720.8,95,,2176.64,percent of total billed charges ,95% of total billed charges,2291.2,80,,1832.96,percent of total billed charges,78% of total billed charges,2233.92,78,,1787.136,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2577.6,90,,2062.08,percent of total billed charges,90% of total billed charges,2291.2,80,,1832.96,percent of total billed charges,80% of total billed charges,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,2434.4,85,,1947.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,2262.56,79,,1810.05,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,2720.8,
AP SK SUB GRT 100SC EA AD 25CM,324015276,CDM,761,RC,15276,HCPCS,outpatient,,,1432,1002.4,,1131.28,79,,905.02,percent of total billed charges,79% of total billed charges,1288.8,90,,1031.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,1105.79,77.22,,884.63,percent of total billed charges,77.22% of total billed charges,946.55,66.1,,757.24,percent of total billed charges,66.1% of total billed charges,1188.56,83,,950.85,percent of total billed charges,83% of total,1360.4,95,,1088.32,percent of total billed charges ,95% of total billed charges,1145.6,80,,916.48,percent of total billed charges,78% of total billed charges,1116.96,78,,893.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,1217.2,85,,973.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1131.28,79,,905.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1360.4,
AP SK SUB GRT >=100SC 1ST100SC,324015277,CDM,761,RC,15277,HCPCS,outpatient,,,2864,2004.8,,2262.56,79,,1810.05,percent of total billed charges,79% of total billed charges,2577.6,90,,2062.08,percent of total billed charges,90% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2439.76,160,,,Fee Schedule,160% of CMS OPPS rate,1982.3,130,,,Fee Schedule,130% of CMS OPPS rate,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,2211.58,77.22,,1769.26,percent of total billed charges,77.22% of total billed charges,1893.1,66.1,,1514.48,percent of total billed charges,66.1% of total billed charges,2377.12,83,,1901.7,percent of total billed charges,83% of total,2720.8,95,,2176.64,percent of total billed charges ,95% of total billed charges,2291.2,80,,1832.96,percent of total billed charges,78% of total billed charges,2233.92,78,,1787.136,percent of total billed charges,78% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,2577.6,90,,2062.08,percent of total billed charges,90% of total billed charges,2291.2,80,,1832.96,percent of total billed charges,80% of total billed charges,1804.32,63,,1443.46,percent of total billed charges,63% of total billed charges,2434.4,85,,1947.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1418.11,93,,,fee schedule,93% of CMS OPPS rate,2262.56,79,,1810.05,percent of total billed charges,79% of total billed charges,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,1524.85,100,,,Fee Schedule,100% of CMS OPPS rate,450,2720.8,
AP SK SUB GRT >=100SC EA100SC,324015278,CDM,761,RC,15278,HCPCS,outpatient,,,1432,1002.4,,1131.28,79,,905.02,percent of total billed charges,79% of total billed charges,1288.8,90,,1031.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,1105.79,77.22,,884.63,percent of total billed charges,77.22% of total billed charges,946.55,66.1,,757.24,percent of total billed charges,66.1% of total billed charges,1188.56,83,,950.85,percent of total billed charges,83% of total,1360.4,95,,1088.32,percent of total billed charges ,95% of total billed charges,1145.6,80,,916.48,percent of total billed charges,78% of total billed charges,1116.96,78,,893.568,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,902.16,63,,721.73,percent of total billed charges,63% of total billed charges,1217.2,85,,973.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1131.28,79,,905.02,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1360.4,
CHEM CAUTERZN GRANULATN TISSUE,324017250,CDM,761,RC,17250,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,492.1,
REM IMPACTED CERUMEN W LAV IRR,324069209,CDM,761,RC,69209,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
REM IMPACTED CERUMEN W INSTRUM,324069210,CDM,761,RC,69210,HCPCS,outpatient,,,164,114.8,,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,147.6,90,,118.08,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,126.64,77.22,,101.31,percent of total billed charges,77.22% of total billed charges,108.4,66.1,,86.72,percent of total billed charges,66.1% of total billed charges,136.12,83,,108.9,percent of total billed charges,83% of total,155.8,95,,124.64,percent of total billed charges ,95% of total billed charges,131.2,80,,104.96,percent of total billed charges,78% of total billed charges,127.92,78,,102.336,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,103.32,63,,82.66,percent of total billed charges,63% of total billed charges,139.4,85,,111.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,129.56,79,,103.65,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
DEBRIDE OPEN WND 1ST 20 SQ CM<,324097597,CDM,761,RC,97597,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,492.1,
DEBRID OPEN WND EA ADL 20 SQCM,324097598,CDM,761,RC,97598,HCPCS,outpatient,,,259,181.3,,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,233.1,90,,186.48,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,200,77.22,,160,percent of total billed charges,77.22% of total billed charges,171.2,66.1,,136.96,percent of total billed charges,66.1% of total billed charges,214.97,83,,171.98,percent of total billed charges,83% of total,246.05,95,,196.84,percent of total billed charges ,95% of total billed charges,207.2,80,,165.76,percent of total billed charges,78% of total billed charges,202.02,78,,161.616,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,163.17,63,,130.54,percent of total billed charges,63% of total billed charges,220.15,85,,176.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,204.61,79,,163.69,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.17,450,
REMOV DEVITALIZED TISS FRM WND,324097602,CDM,761,RC,97602,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,492.1,
NEG PRESS WND THERAPY <=50 SC,324097605,CDM,761,RC,97605,HCPCS,outpatient,,,550,385,,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,495,90,,396,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,424.71,77.22,,339.77,percent of total billed charges,77.22% of total billed charges,363.55,66.1,,290.84,percent of total billed charges,66.1% of total billed charges,456.5,83,,365.2,percent of total billed charges,83% of total,522.5,95,,418,percent of total billed charges ,95% of total billed charges,440,80,,352,percent of total billed charges,78% of total billed charges,429,78,,343.2,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,495,90,,396,percent of total billed charges,90% of total billed charges,440,80,,352,percent of total billed charges,80% of total billed charges,346.5,63,,277.2,percent of total billed charges,63% of total billed charges,467.5,85,,374,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,434.5,79,,347.6,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,522.5,
NEG PRESS WND THERAPY >50 SQCM,324097606,CDM,761,RC,97606,HCPCS,outpatient,,,1059,741.3,,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,953.1,90,,762.48,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,817.76,77.22,,654.21,percent of total billed charges,77.22% of total billed charges,700,66.1,,560,percent of total billed charges,66.1% of total billed charges,878.97,83,,703.18,percent of total billed charges,83% of total,1006.05,95,,804.84,percent of total billed charges ,95% of total billed charges,847.2,80,,677.76,percent of total billed charges,78% of total billed charges,826.02,78,,660.816,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,667.17,63,,533.74,percent of total billed charges,63% of total billed charges,900.15,85,,720.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,836.61,79,,669.29,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,1006.05,
NEG PRESSURE WND THER <50 SQCM,324097607,CDM,761,RC,97607,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
NEG PRESSURE WND THER >50 SQCM,324097608,CDM,761,RC,97608,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
CT BIOPSY LIVER,351001766,CDM,761,RC,47000,HCPCS,outpatient,,,3183,2228.1,,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2457.91,77.22,,1966.33,percent of total billed charges,77.22% of total billed charges,2103.96,66.1,,1683.17,percent of total billed charges,66.1% of total billed charges,2641.89,83,,2113.51,percent of total billed charges,83% of total,3023.85,95,,2419.08,percent of total billed charges ,95% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,78% of total billed charges,2482.74,78,,1986.192,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,80% of total billed charges,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2705.55,85,,2164.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3023.85,
CT BIOPSY LUNG,351001767,CDM,761,RC,32408,HCPCS,outpatient,,,2814,1969.8,,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2172.97,77.22,,1738.38,percent of total billed charges,77.22% of total billed charges,1860.05,66.1,,1488.04,percent of total billed charges,66.1% of total billed charges,2335.62,83,,1868.5,percent of total billed charges,83% of total,2673.3,95,,2138.64,percent of total billed charges ,95% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,78% of total billed charges,2194.92,78,,1755.936,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2532.6,90,,2026.08,percent of total billed charges,90% of total billed charges,2251.2,80,,1800.96,percent of total billed charges,80% of total billed charges,1772.82,63,,1418.26,percent of total billed charges,63% of total billed charges,2391.9,85,,1913.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2223.06,79,,1778.45,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2673.3,
BIOPSY RETROPERITONEAL AREA,351001770,CDM,761,RC,49010,HCPCS,outpatient,,,3720,2604,,2938.8,79,,2351.04,percent of total billed charges,79% of total billed charges,3348,90,,2678.4,percent of total billed charges,90% of total billed charges,3720,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,3720,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,3720,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,2343.6,63,,1874.88,percent of total billed charges,63% of total billed charges,2872.58,77.22,,2298.06,percent of total billed charges,77.22% of total billed charges,2458.92,66.1,,1967.14,percent of total billed charges,66.1% of total billed charges,3087.6,83,,2470.08,percent of total billed charges,83% of total,3534,95,,2827.2,percent of total billed charges ,95% of total billed charges,2976,80,,2380.8,percent of total billed charges,78% of total billed charges,2901.6,78,,2321.28,percent of total billed charges,78% of total billed charges,3720,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,2343.6,63,,1874.88,percent of total billed charges,63% of total billed charges,3720,100,,,fee schedule ,100% of CMS fee schedule,3348,90,,2678.4,percent of total billed charges,90% of total billed charges,2976,80,,2380.8,percent of total billed charges,80% of total billed charges,2343.6,63,,1874.88,percent of total billed charges,63% of total billed charges,3162,85,,2529.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,3720,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,2938.8,79,,2351.04,percent of total billed charges,79% of total billed charges,3720,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,3720,100,,,Fee Schedule,pays at line item charges due to status indicator see on CMS APC fee schedule,450,3720,
CT ASPIR/INJECT JNT  W/O US GU,351001775,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
DRAINAGE CHEST TUBE,352001732,CDM,761,RC,32551,HCPCS,outpatient,,,3262,2283.4,,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,2518.92,77.22,,2015.14,percent of total billed charges,77.22% of total billed charges,2156.18,66.1,,1724.94,percent of total billed charges,66.1% of total billed charges,2707.46,83,,2165.97,percent of total billed charges,83% of total,3098.9,95,,2479.12,percent of total billed charges ,95% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,78% of total billed charges,2544.36,78,,2035.488,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2935.8,90,,2348.64,percent of total billed charges,90% of total billed charges,2609.6,80,,2087.68,percent of total billed charges,80% of total billed charges,2055.06,63,,1644.05,percent of total billed charges,63% of total billed charges,2772.7,85,,2218.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2576.98,79,,2061.58,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3098.9,
"OR INJ,EPIDRL /BLOOD/CLOT PTCH",360001197,CDM,761,RC,62273,HCPCS,outpatient,,,1358,950.6,,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1048.65,77.22,,838.92,percent of total billed charges,77.22% of total billed charges,897.64,66.1,,718.11,percent of total billed charges,66.1% of total billed charges,1127.14,83,,901.71,percent of total billed charges,83% of total,1290.1,95,,1032.08,percent of total billed charges ,95% of total billed charges,1086.4,80,,869.12,percent of total billed charges,78% of total billed charges,1059.24,78,,847.392,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,1086.4,80,,869.12,percent of total billed charges,80% of total billed charges,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1154.3,85,,923.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1290.1,
OR INSERT PICVAD CATH >5 YRS,360001277,CDM,761,RC,36571,HCPCS,outpatient,,,5542,3879.4,,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,4279.53,77.22,,3423.62,percent of total billed charges,77.22% of total billed charges,3663.26,66.1,,2930.61,percent of total billed charges,66.1% of total billed charges,4599.86,83,,3679.89,percent of total billed charges,83% of total,5264.9,95,,4211.92,percent of total billed charges ,95% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,78% of total billed charges,4322.76,78,,3458.208,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,80% of total billed charges,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,4710.7,85,,3768.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,5264.9,
"OR TRIGGER POINT INJ, 1 OR 2",360020552,CDM,761,RC,20552,HCPCS,outpatient,,,523,366.1,,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,470.7,90,,376.56,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,403.86,77.22,,323.09,percent of total billed charges,77.22% of total billed charges,345.7,66.1,,276.56,percent of total billed charges,66.1% of total billed charges,434.09,83,,347.27,percent of total billed charges,83% of total,496.85,95,,397.48,percent of total billed charges ,95% of total billed charges,418.4,80,,334.72,percent of total billed charges,78% of total billed charges,407.94,78,,326.352,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,329.49,63,,263.59,percent of total billed charges,63% of total billed charges,444.55,85,,355.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,413.17,79,,330.54,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,496.85,
OR HOT BIOPSY/SNARE POLYPECTOM,360040240,CDM,761,RC,,,outpatient,,,3050,2135,,2409.5,79,,1927.6,percent of total billed charges,79% of total billed charges,2745,90,,2196,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1921.5,63,,1537.2,percent of total billed charges,63% of total billed charges,2355.21,77.22,,1884.17,percent of total billed charges,77.22% of total billed charges,2016.05,66.1,,1612.84,percent of total billed charges,66.1% of total billed charges,2531.5,83,,2025.2,percent of total billed charges,83% of total,2897.5,95,,2318,percent of total billed charges ,95% of total billed charges,2440,80,,1952,percent of total billed charges,78% of total billed charges,2379,78,,1903.2,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1921.5,63,,1537.2,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,2745,90,,2196,percent of total billed charges,90% of total billed charges,2440,80,,1952,percent of total billed charges,80% of total billed charges,1921.5,63,,1537.2,percent of total billed charges,63% of total billed charges,2592.5,85,,2074,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,2409.5,79,,1927.6,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,2897.5,
ASPIRATION/THYROID CYST W IMAG,402001637,CDM,761,RC,10005,HCPCS,outpatient,,,1372,960.4,,1083.88,79,,867.1,percent of total billed charges,79% of total billed charges,1234.8,90,,987.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,1059.46,77.22,,847.57,percent of total billed charges,77.22% of total billed charges,906.89,66.1,,725.51,percent of total billed charges,66.1% of total billed charges,1138.76,83,,911.01,percent of total billed charges,83% of total,1303.4,95,,1042.72,percent of total billed charges ,95% of total billed charges,1097.6,80,,878.08,percent of total billed charges,78% of total billed charges,1070.16,78,,856.128,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1234.8,90,,987.84,percent of total billed charges,90% of total billed charges,1097.6,80,,878.08,percent of total billed charges,80% of total billed charges,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,1166.2,85,,932.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1083.88,79,,867.1,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1303.4,
US BIOPSY/EXC LYMPHNODE NEEDLE,402001733,CDM,761,RC,38505,HCPCS,outpatient,,,3090,2163,,2441.1,79,,1952.88,percent of total billed charges,79% of total billed charges,2781,90,,2224.8,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,1946.7,63,,1557.36,percent of total billed charges,63% of total billed charges,2386.1,77.22,,1908.88,percent of total billed charges,77.22% of total billed charges,2042.49,66.1,,1633.99,percent of total billed charges,66.1% of total billed charges,2564.7,83,,2051.76,percent of total billed charges,83% of total,2935.5,95,,2348.4,percent of total billed charges ,95% of total billed charges,2472,80,,1977.6,percent of total billed charges,78% of total billed charges,2410.2,78,,1928.16,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1946.7,63,,1557.36,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2781,90,,2224.8,percent of total billed charges,90% of total billed charges,2472,80,,1977.6,percent of total billed charges,80% of total billed charges,1946.7,63,,1557.36,percent of total billed charges,63% of total billed charges,2626.5,85,,2101.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2441.1,79,,1952.88,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,2935.5,
PUNCT ASPIRATION ABS CYST HEMA,402001833,CDM,761,RC,10160,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
US LIVER BIOPSY,402001836,CDM,761,RC,47000,HCPCS,outpatient,,,3183,2228.1,,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2457.91,77.22,,1966.33,percent of total billed charges,77.22% of total billed charges,2103.96,66.1,,1683.17,percent of total billed charges,66.1% of total billed charges,2641.89,83,,2113.51,percent of total billed charges,83% of total,3023.85,95,,2419.08,percent of total billed charges ,95% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,78% of total billed charges,2482.74,78,,1986.192,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2864.7,90,,2291.76,percent of total billed charges,90% of total billed charges,2546.4,80,,2037.12,percent of total billed charges,80% of total billed charges,2005.29,63,,1604.23,percent of total billed charges,63% of total billed charges,2705.55,85,,2164.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2514.57,79,,2011.66,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3023.85,
FINE NEEDLE ASPIRATION,402001845,CDM,761,RC,10005,HCPCS,outpatient,,,1372,960.4,,1083.88,79,,867.1,percent of total billed charges,79% of total billed charges,1234.8,90,,987.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,1059.46,77.22,,847.57,percent of total billed charges,77.22% of total billed charges,906.89,66.1,,725.51,percent of total billed charges,66.1% of total billed charges,1138.76,83,,911.01,percent of total billed charges,83% of total,1303.4,95,,1042.72,percent of total billed charges ,95% of total billed charges,1097.6,80,,878.08,percent of total billed charges,78% of total billed charges,1070.16,78,,856.128,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1234.8,90,,987.84,percent of total billed charges,90% of total billed charges,1097.6,80,,878.08,percent of total billed charges,80% of total billed charges,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,1166.2,85,,932.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1083.88,79,,867.1,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1303.4,
US PARACENT W/US GUID ABDOMIN,402001848,CDM,761,RC,49083,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
US BIOPSY MUSCLE PERC NEEDLE,402001857,CDM,761,RC,20206,HCPCS,outpatient,,,3476,2433.2,,2746.04,79,,2196.83,percent of total billed charges,79% of total billed charges,3128.4,90,,2502.72,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,2189.88,63,,1751.9,percent of total billed charges,63% of total billed charges,2684.17,77.22,,2147.34,percent of total billed charges,77.22% of total billed charges,2297.64,66.1,,1838.11,percent of total billed charges,66.1% of total billed charges,2885.08,83,,2308.06,percent of total billed charges,83% of total,3302.2,95,,2641.76,percent of total billed charges ,95% of total billed charges,2780.8,80,,2224.64,percent of total billed charges,78% of total billed charges,2711.28,78,,2169.024,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2189.88,63,,1751.9,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3128.4,90,,2502.72,percent of total billed charges,90% of total billed charges,2780.8,80,,2224.64,percent of total billed charges,80% of total billed charges,2189.88,63,,1751.9,percent of total billed charges,63% of total billed charges,2954.6,85,,2363.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,2746.04,79,,2196.83,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,3302.2,
US BIOPSY MUSCLE W GUID CP,402020206,CDM,761,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INTUBATION,410000635,CDM,761,RC,31500,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,314.29,77.22,,251.43,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,450,
IMPLANT SQ HORMONE PELLET,450011980,CDM,761,RC,11980,HCPCS,outpatient,,,207,144.9,,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,533.06,160,,,Fee Schedule,160% of CMS OPPS rate,433.11,130,,,Fee Schedule,130% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,159.85,77.22,,127.88,percent of total billed charges,77.22% of total billed charges,136.83,66.1,,109.46,percent of total billed charges,66.1% of total billed charges,171.81,83,,137.45,percent of total billed charges,83% of total,196.65,95,,157.32,percent of total billed charges ,95% of total billed charges,165.6,80,,132.48,percent of total billed charges,78% of total billed charges,161.46,78,,129.168,percent of total billed charges,78% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,186.3,90,,149.04,percent of total billed charges,90% of total billed charges,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,130.41,63,,104.33,percent of total billed charges,63% of total billed charges,175.95,85,,140.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,309.84,93,,,fee schedule,93% of CMS OPPS rate,163.53,79,,130.82,percent of total billed charges,79% of total billed charges,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,333.16,100,,,Fee Schedule,100% of CMS OPPS rate,130.41,533.06,
FETAL NON STRESS TEST,450059025,CDM,761,RC,59025,HCPCS,outpatient,,,618,432.6,,488.22,79,,390.58,percent of total billed charges,79% of total billed charges,556.2,90,,444.96,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,389.34,63,,311.47,percent of total billed charges,63% of total billed charges,477.22,77.22,,381.78,percent of total billed charges,77.22% of total billed charges,408.5,66.1,,326.8,percent of total billed charges,66.1% of total billed charges,512.94,83,,410.35,percent of total billed charges,83% of total,587.1,95,,469.68,percent of total billed charges ,95% of total billed charges,494.4,80,,395.52,percent of total billed charges,78% of total billed charges,482.04,78,,385.632,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,389.34,63,,311.47,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,389.34,63,,311.47,percent of total billed charges,63% of total billed charges,525.3,85,,420.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,488.22,79,,390.58,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,587.1,
ED THER SPINAL PUNCT DRG CSF,450062272,CDM,761,RC,62272,HCPCS,outpatient,,,543,380.1,,428.97,79,,343.18,percent of total billed charges,79% of total billed charges,488.7,90,,390.96,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,419.3,77.22,,335.44,percent of total billed charges,77.22% of total billed charges,358.92,66.1,,287.14,percent of total billed charges,66.1% of total billed charges,450.69,83,,360.55,percent of total billed charges,83% of total,515.85,95,,412.68,percent of total billed charges ,95% of total billed charges,434.4,80,,347.52,percent of total billed charges,78% of total billed charges,423.54,78,,338.832,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,488.7,90,,390.96,percent of total billed charges,90% of total billed charges,434.4,80,,347.52,percent of total billed charges,80% of total billed charges,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,461.55,85,,369.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,428.97,79,,343.18,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,342.09,925.2,
EPIDURAL BLOOD PATCH,450062273,CDM,761,RC,62273,HCPCS,outpatient,,,1358,950.6,,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1048.65,77.22,,838.92,percent of total billed charges,77.22% of total billed charges,897.64,66.1,,718.11,percent of total billed charges,66.1% of total billed charges,1127.14,83,,901.71,percent of total billed charges,83% of total,1290.1,95,,1032.08,percent of total billed charges ,95% of total billed charges,1086.4,80,,869.12,percent of total billed charges,78% of total billed charges,1059.24,78,,847.392,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,1086.4,80,,869.12,percent of total billed charges,80% of total billed charges,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1154.3,85,,923.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1290.1,
ED NJX AA TRIGEMINAL NERV EABR,450064400,CDM,761,RC,64400,HCPCS,outpatient,,,425,297.5,,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,382.5,90,,306,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,328.19,77.22,,262.55,percent of total billed charges,77.22% of total billed charges,280.93,66.1,,224.74,percent of total billed charges,66.1% of total billed charges,352.75,83,,282.2,percent of total billed charges,83% of total,403.75,95,,323,percent of total billed charges ,95% of total billed charges,340,80,,272,percent of total billed charges,78% of total billed charges,331.5,78,,265.2,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,267.75,63,,214.2,percent of total billed charges,63% of total billed charges,361.25,85,,289,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,335.75,79,,268.6,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,450,
ED NJX AA STRD OTHER PN/BRANCH,450064450,CDM,761,RC,64450,HCPCS,outpatient,,,744,520.8,,587.76,79,,470.21,percent of total billed charges,79% of total billed charges,669.6,90,,535.68,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,468.72,63,,374.98,percent of total billed charges,63% of total billed charges,574.52,77.22,,459.62,percent of total billed charges,77.22% of total billed charges,491.78,66.1,,393.42,percent of total billed charges,66.1% of total billed charges,617.52,83,,494.02,percent of total billed charges,83% of total,706.8,95,,565.44,percent of total billed charges ,95% of total billed charges,595.2,80,,476.16,percent of total billed charges,78% of total billed charges,580.32,78,,464.256,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,468.72,63,,374.98,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,669.6,90,,535.68,percent of total billed charges,90% of total billed charges,595.2,80,,476.16,percent of total billed charges,80% of total billed charges,468.72,63,,374.98,percent of total billed charges,63% of total billed charges,632.4,85,,505.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,587.76,79,,470.21,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,925.2,
IRRIGATION VASCULAR DEVICE,490096523,CDM,761,RC,96523,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
INSERT INDWELLING BLADDER CATH,51702P,CDM,761,RC,51702,HCPCS,outpatient,,,65,45.5,,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,58.5,90,,46.8,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,50.19,77.22,,40.15,percent of total billed charges,77.22% of total billed charges,42.97,66.1,,34.38,percent of total billed charges,66.1% of total billed charges,53.95,83,,43.16,percent of total billed charges,83% of total,61.75,95,,49.4,percent of total billed charges ,95% of total billed charges,52,80,,41.6,percent of total billed charges,78% of total billed charges,50.7,78,,40.56,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,40.95,63,,32.76,percent of total billed charges,63% of total billed charges,55.25,85,,44.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,51.35,79,,41.08,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,40.95,450,
INSERT INDWELLING BLADDER CATH,51702T,CDM,761,RC,51702,HCPCS,outpatient,,,98,68.6,,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,88.2,90,,70.56,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,75.68,77.22,,60.54,percent of total billed charges,77.22% of total billed charges,64.78,66.1,,51.82,percent of total billed charges,66.1% of total billed charges,81.34,83,,65.07,percent of total billed charges,83% of total,93.1,95,,74.48,percent of total billed charges ,95% of total billed charges,78.4,80,,62.72,percent of total billed charges,78% of total billed charges,76.44,78,,61.152,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.74,63,,49.39,percent of total billed charges,63% of total billed charges,83.3,85,,66.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,77.42,79,,61.94,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,61.74,450,
REM OF IMPACTD CERUMEN LAV IRR,69209P,CDM,761,RC,69209,HCPCS,outpatient,,,51,35.7,,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,45.9,90,,36.72,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,39.38,77.22,,31.5,percent of total billed charges,77.22% of total billed charges,33.71,66.1,,26.97,percent of total billed charges,66.1% of total billed charges,42.33,83,,33.86,percent of total billed charges,83% of total,48.45,95,,38.76,percent of total billed charges ,95% of total billed charges,40.8,80,,32.64,percent of total billed charges,78% of total billed charges,39.78,78,,31.824,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,32.13,63,,25.7,percent of total billed charges,63% of total billed charges,43.35,85,,34.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,40.29,79,,32.23,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,32.13,450,
REM OF IMPACTD CERUMEN LAV IRR,69209T,CDM,761,RC,69209,HCPCS,outpatient,,,76,53.2,,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,68.4,90,,54.72,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,58.69,77.22,,46.95,percent of total billed charges,77.22% of total billed charges,50.24,66.1,,40.19,percent of total billed charges,66.1% of total billed charges,63.08,83,,50.46,percent of total billed charges,83% of total,72.2,95,,57.76,percent of total billed charges ,95% of total billed charges,60.8,80,,48.64,percent of total billed charges,78% of total billed charges,59.28,78,,47.424,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,47.88,63,,38.3,percent of total billed charges,63% of total billed charges,64.6,85,,51.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,60.04,79,,48.03,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
REMOVE IMPACTED CERUMEN INSTRU,69210P,CDM,761,RC,69210,HCPCS,outpatient,,,55,38.5,,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,49.5,90,,39.6,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,42.47,77.22,,33.98,percent of total billed charges,77.22% of total billed charges,36.36,66.1,,29.09,percent of total billed charges,66.1% of total billed charges,45.65,83,,36.52,percent of total billed charges,83% of total,52.25,95,,41.8,percent of total billed charges ,95% of total billed charges,44,80,,35.2,percent of total billed charges,78% of total billed charges,42.9,78,,34.32,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,34.65,63,,27.72,percent of total billed charges,63% of total billed charges,46.75,85,,37.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,43.45,79,,34.76,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,34.65,450,
REMOVE IMPACTED CERUMEN INSTRU,69210T,CDM,761,RC,69210,HCPCS,outpatient,,,83,58.1,,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,74.7,90,,59.76,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,64.09,77.22,,51.27,percent of total billed charges,77.22% of total billed charges,54.86,66.1,,43.89,percent of total billed charges,66.1% of total billed charges,68.89,83,,55.11,percent of total billed charges,83% of total,78.85,95,,63.08,percent of total billed charges ,95% of total billed charges,66.4,80,,53.12,percent of total billed charges,78% of total billed charges,64.74,78,,51.792,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,52.29,63,,41.83,percent of total billed charges,63% of total billed charges,70.55,85,,56.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,65.57,79,,52.46,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
OB INSERT NON-IND BLADDER CATH,720051701,CDM,761,RC,51701,HCPCS,outpatient,,,277,193.9,,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,213.9,77.22,,171.12,percent of total billed charges,77.22% of total billed charges,183.1,66.1,,146.48,percent of total billed charges,66.1% of total billed charges,229.91,83,,183.93,percent of total billed charges,83% of total,263.15,95,,210.52,percent of total billed charges ,95% of total billed charges,221.6,80,,177.28,percent of total billed charges,78% of total billed charges,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
OB INS TEMP IND BLDR CATH COMP,720051703,CDM,761,RC,51703,HCPCS,outpatient,,,444,310.8,,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,399.6,90,,319.68,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.97,160,,,Fee Schedule,160% of CMS OPPS rate,169.78,130,,,Fee Schedule,130% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,342.86,77.22,,274.29,percent of total billed charges,77.22% of total billed charges,293.48,66.1,,234.78,percent of total billed charges,66.1% of total billed charges,368.52,83,,294.82,percent of total billed charges,83% of total,421.8,95,,337.44,percent of total billed charges ,95% of total billed charges,355.2,80,,284.16,percent of total billed charges,78% of total billed charges,346.32,78,,277.056,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,279.72,63,,223.78,percent of total billed charges,63% of total billed charges,377.4,85,,301.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.46,93,,,fee schedule,93% of CMS OPPS rate,350.76,79,,280.61,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.46,450,
NJX AA STRD PUDENDAL NERVE BLK,720064430,CDM,761,RC,64430,HCPCS,outpatient,,,1463,1024.1,,1155.77,79,,924.62,percent of total billed charges,79% of total billed charges,1316.7,90,,1053.36,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,921.69,63,,737.35,percent of total billed charges,63% of total billed charges,1129.73,77.22,,903.78,percent of total billed charges,77.22% of total billed charges,967.04,66.1,,773.63,percent of total billed charges,66.1% of total billed charges,1214.29,83,,971.43,percent of total billed charges,83% of total,1389.85,95,,1111.88,percent of total billed charges ,95% of total billed charges,1170.4,80,,936.32,percent of total billed charges,78% of total billed charges,1141.14,78,,912.912,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,921.69,63,,737.35,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,921.69,63,,737.35,percent of total billed charges,63% of total billed charges,1243.55,85,,994.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,1155.77,79,,924.62,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1389.85,
CATH UMBILICAL VEIN NEWBORN,724036510,CDM,761,RC,36510,HCPCS,outpatient,,,150,105,,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,135,90,,108,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,115.83,77.22,,92.66,percent of total billed charges,77.22% of total billed charges,99.15,66.1,,79.32,percent of total billed charges,66.1% of total billed charges,124.5,83,,99.6,percent of total billed charges,83% of total,142.5,95,,114,percent of total billed charges ,95% of total billed charges,120,80,,96,percent of total billed charges,78% of total billed charges,117,78,,93.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,94.5,63,,75.6,percent of total billed charges,63% of total billed charges,127.5,85,,102,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,118.5,79,,94.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.5,450,
TR IV SEDATION,761001253,CDM,761,RC,,,outpatient,,,108,75.6,,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,83.4,77.22,,66.72,percent of total billed charges,77.22% of total billed charges,71.39,66.1,,57.11,percent of total billed charges,66.1% of total billed charges,89.64,83,,71.71,percent of total billed charges,83% of total,102.6,95,,82.08,percent of total billed charges ,95% of total billed charges,86.4,80,,69.12,percent of total billed charges,78% of total billed charges,84.24,78,,67.392,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,97.2,90,,77.76,percent of total billed charges,90% of total billed charges,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,68.04,63,,54.43,percent of total billed charges,63% of total billed charges,91.8,85,,73.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,85.32,79,,68.26,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.04,450,
FNA BX W/US GDN 1ST LES,761010005,CDM,761,RC,10005,HCPCS,outpatient,,,1372,960.4,,1083.88,79,,867.1,percent of total billed charges,79% of total billed charges,1234.8,90,,987.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,1059.46,77.22,,847.57,percent of total billed charges,77.22% of total billed charges,906.89,66.1,,725.51,percent of total billed charges,66.1% of total billed charges,1138.76,83,,911.01,percent of total billed charges,83% of total,1303.4,95,,1042.72,percent of total billed charges ,95% of total billed charges,1097.6,80,,878.08,percent of total billed charges,78% of total billed charges,1070.16,78,,856.128,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1234.8,90,,987.84,percent of total billed charges,90% of total billed charges,1097.6,80,,878.08,percent of total billed charges,80% of total billed charges,864.36,63,,691.49,percent of total billed charges,63% of total billed charges,1166.2,85,,932.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1083.88,79,,867.1,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1303.4,
FNA BX W/US GDN EA ADDL,761010006,CDM,761,RC,10006,HCPCS,outpatient,,,1758,1230.6,,1388.82,79,,1111.06,percent of total billed charges,79% of total billed charges,1582.2,90,,1265.76,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1107.54,63,,886.03,percent of total billed charges,63% of total billed charges,1357.53,77.22,,1086.02,percent of total billed charges,77.22% of total billed charges,1162.04,66.1,,929.63,percent of total billed charges,66.1% of total billed charges,1459.14,83,,1167.31,percent of total billed charges,83% of total,1670.1,95,,1336.08,percent of total billed charges ,95% of total billed charges,1406.4,80,,1125.12,percent of total billed charges,78% of total billed charges,1371.24,78,,1096.992,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1107.54,63,,886.03,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1582.2,90,,1265.76,percent of total billed charges,90% of total billed charges,1406.4,80,,1125.12,percent of total billed charges,80% of total billed charges,1107.54,63,,886.03,percent of total billed charges,63% of total billed charges,1494.3,85,,1195.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1388.82,79,,1111.06,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1670.1,
TR DRAINAGE OF SKIN ABCESS,761010060,CDM,761,RC,10060,HCPCS,outpatient,,,377,263.9,,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,339.3,90,,271.44,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,291.12,77.22,,232.9,percent of total billed charges,77.22% of total billed charges,249.2,66.1,,199.36,percent of total billed charges,66.1% of total billed charges,312.91,83,,250.33,percent of total billed charges,83% of total,358.15,95,,286.52,percent of total billed charges ,95% of total billed charges,301.6,80,,241.28,percent of total billed charges,78% of total billed charges,294.06,78,,235.248,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,237.51,63,,190.01,percent of total billed charges,63% of total billed charges,320.45,85,,256.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,297.83,79,,238.26,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.66,450,
TR PUNCTURE DRAINAGE OF LESION,761010160,CDM,761,RC,10160,HCPCS,outpatient,,,922,645.4,,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,829.8,90,,663.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,711.97,77.22,,569.58,percent of total billed charges,77.22% of total billed charges,609.44,66.1,,487.55,percent of total billed charges,66.1% of total billed charges,765.26,83,,612.21,percent of total billed charges,83% of total,875.9,95,,700.72,percent of total billed charges ,95% of total billed charges,737.6,80,,590.08,percent of total billed charges,78% of total billed charges,719.16,78,,575.328,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,580.86,63,,464.69,percent of total billed charges,63% of total billed charges,783.7,85,,626.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,728.38,79,,582.7,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,875.9,
REMOVAL OF GROWTH 3.1 TO 4.0CM,761011404,CDM,761,RC,11404,HCPCS,outpatient,,,5029,3520.3,,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,2169.07,160,,,Fee Schedule,160% of CMS OPPS rate,1762.37,130,,,Fee Schedule,130% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,3883.39,77.22,,3106.71,percent of total billed charges,77.22% of total billed charges,3324.17,66.1,,2659.34,percent of total billed charges,66.1% of total billed charges,4174.07,83,,3339.26,percent of total billed charges,83% of total,4777.55,95,,3822.04,percent of total billed charges ,95% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,78% of total billed charges,3922.62,78,,3138.096,percent of total billed charges,78% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,4526.1,90,,3620.88,percent of total billed charges,90% of total billed charges,4023.2,80,,3218.56,percent of total billed charges,80% of total billed charges,3168.27,63,,2534.62,percent of total billed charges,63% of total billed charges,4274.65,85,,3419.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1260.77,93,,,fee schedule,93% of CMS OPPS rate,3972.91,79,,3178.33,percent of total billed charges,79% of total billed charges,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,1355.67,100,,,Fee Schedule,100% of CMS OPPS rate,450,4777.55,
EXC MALIG LESION FACE 0.5CM<,761011640,CDM,761,RC,11640,HCPCS,outpatient,,,1371,959.7,,1083.09,79,,866.47,percent of total billed charges,79% of total billed charges,1233.9,90,,987.12,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,863.73,63,,690.98,percent of total billed charges,63% of total billed charges,1058.69,77.22,,846.95,percent of total billed charges,77.22% of total billed charges,906.23,66.1,,724.98,percent of total billed charges,66.1% of total billed charges,1137.93,83,,910.34,percent of total billed charges,83% of total,1302.45,95,,1041.96,percent of total billed charges ,95% of total billed charges,1096.8,80,,877.44,percent of total billed charges,78% of total billed charges,1069.38,78,,855.504,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,863.73,63,,690.98,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,1233.9,90,,987.12,percent of total billed charges,90% of total billed charges,1096.8,80,,877.44,percent of total billed charges,80% of total billed charges,863.73,63,,690.98,percent of total billed charges,63% of total billed charges,1165.35,85,,932.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1083.09,79,,866.47,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1302.45,
INSERT DRUG DELIVERY IMPLANT,761011981,CDM,761,RC,11981,HCPCS,outpatient,,,345,241.5,,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,310.5,90,,248.4,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,266.41,77.22,,213.13,percent of total billed charges,77.22% of total billed charges,228.05,66.1,,182.44,percent of total billed charges,66.1% of total billed charges,286.35,83,,229.08,percent of total billed charges,83% of total,327.75,95,,262.2,percent of total billed charges ,95% of total billed charges,276,80,,220.8,percent of total billed charges,78% of total billed charges,269.1,78,,215.28,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,217.35,63,,173.88,percent of total billed charges,63% of total billed charges,293.25,85,,234.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,272.55,79,,218.04,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
INSERT DRUG DEL IMPLANT LARC,7610119LC,CDM,761,RC,11981,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS 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,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other ,not seperately reimbursable,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,,,,,other,not seperately reimbursable,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
REPAIR SUPERFICIAL WND 2.6-7.5,761012002,CDM,761,RC,12002,HCPCS,outpatient,,,776,543.2,,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,599.23,77.22,,479.38,percent of total billed charges,77.22% of total billed charges,512.94,66.1,,410.35,percent of total billed charges,66.1% of total billed charges,644.08,83,,515.26,percent of total billed charges,83% of total,737.2,95,,589.76,percent of total billed charges ,95% of total billed charges,620.8,80,,496.64,percent of total billed charges,78% of total billed charges,605.28,78,,484.224,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,737.2,
RPR SUPERFICIAL WOUND12.6-20CM,761012005,CDM,761,RC,12005,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.44,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,461,77.22,,368.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,567.15,
REPAIR INTERM WND FACE 2.5CM<,761012051,CDM,761,RC,12051,HCPCS,outpatient,,,507,354.9,,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,391.51,77.22,,313.21,percent of total billed charges,77.22% of total billed charges,335.13,66.1,,268.1,percent of total billed charges,66.1% of total billed charges,420.81,83,,336.65,percent of total billed charges,83% of total,481.65,95,,385.32,percent of total billed charges ,95% of total billed charges,405.6,80,,324.48,percent of total billed charges,78% of total billed charges,395.46,78,,316.368,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,456.3,90,,365.04,percent of total billed charges,90% of total billed charges,405.6,80,,324.48,percent of total billed charges,80% of total billed charges,319.41,63,,255.53,percent of total billed charges,63% of total billed charges,430.95,85,,344.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,400.53,79,,320.42,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,533.46,
ARTHROCENTESIS ASP/INJ JOINT,761020610,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
CLSD RADIUS ULNA FRAC MANIPULA,761025565,CDM,761,RC,25565,HCPCS,outpatient,,,2710,1897,,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,2439,90,,1951.2,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2092.66,77.22,,1674.13,percent of total billed charges,77.22% of total billed charges,1791.31,66.1,,1433.05,percent of total billed charges,66.1% of total billed charges,2249.3,83,,1799.44,percent of total billed charges,83% of total,2574.5,95,,2059.6,percent of total billed charges ,95% of total billed charges,2168,80,,1734.4,percent of total billed charges,78% of total billed charges,2113.8,78,,1691.04,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2574.5,
CLOSD FX DISTAL RAD FX MANIPUL,761025605,CDM,761,RC,25605,HCPCS,outpatient,,,2710,1897,,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,2439,90,,1951.2,percent of total billed charges,90% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,2150.21,160,,,Fee Schedule,160% of CMS OPPS rate,1747.05,130,,,Fee Schedule,130% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2092.66,77.22,,1674.13,percent of total billed charges,77.22% of total billed charges,1791.31,66.1,,1433.05,percent of total billed charges,66.1% of total billed charges,2249.3,83,,1799.44,percent of total billed charges,83% of total,2574.5,95,,2059.6,percent of total billed charges ,95% of total billed charges,2168,80,,1734.4,percent of total billed charges,78% of total billed charges,2113.8,78,,1691.04,percent of total billed charges,78% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,1707.3,63,,1365.84,percent of total billed charges,63% of total billed charges,2303.5,85,,1842.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1249.81,93,,,fee schedule,93% of CMS OPPS rate,2140.9,79,,1712.72,percent of total billed charges,79% of total billed charges,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,1343.89,100,,,Fee Schedule,100% of CMS OPPS rate,450,2574.5,
INSRT MIDLINE CATH 3Y> US GUID,761036410,CDM,761,RC,36410,HCPCS,outpatient,,,367,256.9,,289.93,79,,231.94,percent of total billed charges,79% of total billed charges,330.3,90,,264.24,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,283.4,77.22,,226.72,percent of total billed charges,77.22% of total billed charges,242.59,66.1,,194.07,percent of total billed charges,66.1% of total billed charges,304.61,83,,243.69,percent of total billed charges,83% of total,348.65,95,,278.92,percent of total billed charges ,95% of total billed charges,293.6,80,,234.88,percent of total billed charges,78% of total billed charges,286.26,78,,229.008,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,231.21,63,,184.97,percent of total billed charges,63% of total billed charges,311.95,85,,249.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,289.93,79,,231.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,231.21,450,
BS CICC NON-TUNNEL<5 YRS,761036555,CDM,761,RC,36555,HCPCS,outpatient,,,1784,1248.8,,1409.36,79,,1127.49,percent of total billed charges,79% of total billed charges,1605.6,90,,1284.48,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,1123.92,63,,899.14,percent of total billed charges,63% of total billed charges,1377.6,77.22,,1102.08,percent of total billed charges,77.22% of total billed charges,1179.22,66.1,,943.38,percent of total billed charges,66.1% of total billed charges,1480.72,83,,1184.58,percent of total billed charges,83% of total,1694.8,95,,1355.84,percent of total billed charges ,95% of total billed charges,1427.2,80,,1141.76,percent of total billed charges,78% of total billed charges,1391.52,78,,1113.216,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1123.92,63,,899.14,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1605.6,90,,1284.48,percent of total billed charges,90% of total billed charges,1427.2,80,,1141.76,percent of total billed charges,80% of total billed charges,1123.92,63,,899.14,percent of total billed charges,63% of total billed charges,1516.4,85,,1213.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,1409.36,79,,1127.49,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
TR CENTRAL LINE PLACEMENT >5YR,761036556,CDM,761,RC,36556,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2250.96,77.22,,1800.77,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
INSRT PIC CATHW/O PORT/PMP >5Y,761036569,CDM,761,RC,36569,HCPCS,outpatient,,,3348,2343.6,,2644.92,79,,2115.94,percent of total billed charges,79% of total billed charges,3013.2,90,,2410.56,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,2585.33,77.22,,2068.26,percent of total billed charges,77.22% of total billed charges,2213.03,66.1,,1770.42,percent of total billed charges,66.1% of total billed charges,2778.84,83,,2223.07,percent of total billed charges,83% of total,3180.6,95,,2544.48,percent of total billed charges ,95% of total billed charges,2678.4,80,,2142.72,percent of total billed charges,78% of total billed charges,2611.44,78,,2089.152,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,3013.2,90,,2410.56,percent of total billed charges,90% of total billed charges,2678.4,80,,2142.72,percent of total billed charges,80% of total billed charges,2109.24,63,,1687.39,percent of total billed charges,63% of total billed charges,2845.8,85,,2276.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2644.92,79,,2115.94,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,3180.6,
SPEC SERV INSRT PICVAD CATH>5Y,761036571,CDM,761,RC,36571,HCPCS,outpatient,,,5542,3879.4,,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,4279.53,77.22,,3423.62,percent of total billed charges,77.22% of total billed charges,3663.26,66.1,,2930.61,percent of total billed charges,66.1% of total billed charges,4599.86,83,,3679.89,percent of total billed charges,83% of total,5264.9,95,,4211.92,percent of total billed charges ,95% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,78% of total billed charges,4322.76,78,,3458.208,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,80% of total billed charges,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,4710.7,85,,3768.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,5264.9,
INSJ PICC RS&I 5 YR+,761036573,CDM,761,RC,36573,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2142.64,160,,,Fee Schedule,160% of CMS OPPS rate,1740.89,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2250.96,77.22,,1800.77,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,1245.41,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,1339.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,2769.25,
BLOOD COLLECT IMPLNT VAD,761036591,CDM,761,RC,36591,HCPCS,outpatient,,,189,132.3,,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,170.1,90,,136.08,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,145.95,77.22,,116.76,percent of total billed charges,77.22% of total billed charges,124.93,66.1,,99.94,percent of total billed charges,66.1% of total billed charges,156.87,83,,125.5,percent of total billed charges,83% of total,179.55,95,,143.64,percent of total billed charges ,95% of total billed charges,151.2,80,,120.96,percent of total billed charges,78% of total billed charges,147.42,78,,117.936,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,119.07,63,,95.26,percent of total billed charges,63% of total billed charges,160.65,85,,128.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,149.31,79,,119.45,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
TR REPLACE GTUB NO REVJ TRC,761043762,CDM,761,RC,43762,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,447.1,77.22,,357.68,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,550.05,
TR REPL GTUBE REVJ GSTRST TRC,761043763,CDM,761,RC,43763,HCPCS,outpatient,,,579,405.3,,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,521.1,90,,416.88,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,447.1,77.22,,357.68,percent of total billed charges,77.22% of total billed charges,382.72,66.1,,306.18,percent of total billed charges,66.1% of total billed charges,480.57,83,,384.46,percent of total billed charges,83% of total,550.05,95,,440.04,percent of total billed charges ,95% of total billed charges,463.2,80,,370.56,percent of total billed charges,78% of total billed charges,451.62,78,,361.296,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,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,364.77,63,,291.82,percent of total billed charges,63% of total billed charges,492.15,85,,393.72,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,457.41,79,,365.93,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,550.05,
ABD PARACENTESIS NO GUIDANCE,761049082,CDM,761,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
TR INSERT NON-DWELL BLDR CATH,761051701,CDM,761,RC,51701,HCPCS,outpatient,,,277,193.9,,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,213.9,77.22,,171.12,percent of total billed charges,77.22% of total billed charges,183.1,66.1,,146.48,percent of total billed charges,66.1% of total billed charges,229.91,83,,183.93,percent of total billed charges,83% of total,263.15,95,,210.52,percent of total billed charges ,95% of total billed charges,221.6,80,,177.28,percent of total billed charges,78% of total billed charges,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
TR INSERT TEMPER BLADDER CATH,761051702,CDM,761,RC,51702,HCPCS,outpatient,,,283,198.1,,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,218.53,77.22,,174.82,percent of total billed charges,77.22% of total billed charges,187.06,66.1,,149.65,percent of total billed charges,66.1% of total billed charges,234.89,83,,187.91,percent of total billed charges,83% of total,268.85,95,,215.08,percent of total billed charges ,95% of total billed charges,226.4,80,,181.12,percent of total billed charges,78% of total billed charges,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
ABSCESS VULVA/PERINEAL TR ROOM,761056405,CDM,761,RC,56405,HCPCS,outpatient,,,688,481.6,,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,619.2,90,,495.36,percent of total billed charges,90% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,429.19,160,,,Fee Schedule,160% of CMS OPPS rate,348.71,130,,,Fee Schedule,130% of CMS OPPS rate,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,531.27,77.22,,425.02,percent of total billed charges,77.22% of total billed charges,454.77,66.1,,363.82,percent of total billed charges,66.1% of total billed charges,571.04,83,,456.83,percent of total billed charges,83% of total,653.6,95,,522.88,percent of total billed charges ,95% of total billed charges,550.4,80,,440.32,percent of total billed charges,78% of total billed charges,536.64,78,,429.312,percent of total billed charges,78% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,433.44,63,,346.75,percent of total billed charges,63% of total billed charges,584.8,85,,467.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,249.46,93,,,fee schedule,93% of CMS OPPS rate,543.52,79,,434.82,percent of total billed charges,79% of total billed charges,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,268.24,100,,,Fee Schedule,100% of CMS OPPS rate,249.46,653.6,
INSERTION OF IUD,761058300,CDM,761,RC,58300,HCPCS,outpatient,,,740,518,,584.6,79,,467.68,percent of total billed charges,79% of total billed charges,666,90,,532.8,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,466.2,63,,372.96,percent of total billed charges,63% of total billed charges,571.43,77.22,,457.14,percent of total billed charges,77.22% of total billed charges,489.14,66.1,,391.31,percent of total billed charges,66.1% of total billed charges,614.2,83,,491.36,percent of total billed charges,83% of total,703,95,,562.4,percent of total billed charges ,95% of total billed charges,592,80,,473.6,percent of total billed charges,78% of total billed charges,577.2,78,,461.76,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,466.2,63,,372.96,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,466.2,63,,372.96,percent of total billed charges,63% of total billed charges,629,85,,503.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,584.6,79,,467.68,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,703,
INSERTION OF IUD LARC,7610583LC,CDM,761,RC,58300,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
"TR AMNIOCENTESIS,DIAGNOSTIC",761059000,CDM,761,RC,59000,HCPCS,outpatient,,,264,184.8,,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,1075.52,160,,,Fee Schedule,160% of CMS OPPS rate,873.86,130,,,Fee Schedule,130% of CMS OPPS rate,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,203.86,77.22,,163.09,percent of total billed charges,77.22% of total billed charges,174.5,66.1,,139.6,percent of total billed charges,66.1% of total billed charges,219.12,83,,175.3,percent of total billed charges,83% of total,250.8,95,,200.64,percent of total billed charges ,95% of total billed charges,211.2,80,,168.96,percent of total billed charges,78% of total billed charges,205.92,78,,164.736,percent of total billed charges,78% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,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,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,625.15,93,,,fee schedule,93% of CMS OPPS rate,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,166.32,1075.52,
CERCLAGE SUTURE REM ANESTHESIA,761059899,CDM,761,RC,59871,HCPCS,outpatient,,,3907,2734.9,,3086.53,79,,2469.22,percent of total billed charges,79% of total billed charges,3516.3,90,,2813.04,percent of total billed charges,90% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,4182.66,160,,,Fee Schedule,160% of CMS OPPS rate,3398.41,130,,,Fee Schedule,130% of CMS OPPS rate,2461.41,63,,1969.13,percent of total billed charges,63% of total billed charges,3016.99,77.22,,2413.59,percent of total billed charges,77.22% of total billed charges,2582.53,66.1,,2066.02,percent of total billed charges,66.1% of total billed charges,3242.81,83,,2594.25,percent of total billed charges,83% of total,3711.65,95,,2969.32,percent of total billed charges ,95% of total billed charges,3125.6,80,,2500.48,percent of total billed charges,78% of total billed charges,3047.46,78,,2437.968,percent of total billed charges,78% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2461.41,63,,1969.13,percent of total billed charges,63% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,3516.3,90,,2813.04,percent of total billed charges,90% of total billed charges,3125.6,80,,2500.48,percent of total billed charges,80% of total billed charges,2461.41,63,,1969.13,percent of total billed charges,63% of total billed charges,3320.95,85,,2656.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2431.17,93,,,fee schedule,93% of CMS OPPS rate,3086.53,79,,2469.22,percent of total billed charges,79% of total billed charges,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,2614.16,100,,,Fee Schedule,100% of CMS OPPS rate,450,4182.66,
TR DX LUMBAR SPINAL PUNCTURE,761062270,CDM,761,RC,62270,HCPCS,outpatient,,,1978,1384.6,,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1527.41,77.22,,1221.93,percent of total billed charges,77.22% of total billed charges,1307.46,66.1,,1045.97,percent of total billed charges,66.1% of total billed charges,1641.74,83,,1313.39,percent of total billed charges,83% of total,1879.1,95,,1503.28,percent of total billed charges ,95% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,78% of total billed charges,1542.84,78,,1234.272,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,80% of total billed charges,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1681.3,85,,1345.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1879.1,
TR TREAT EPIDURAL SPINE LESION,761062273,CDM,761,RC,62273,HCPCS,outpatient,,,1358,950.6,,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1048.65,77.22,,838.92,percent of total billed charges,77.22% of total billed charges,897.64,66.1,,718.11,percent of total billed charges,66.1% of total billed charges,1127.14,83,,901.71,percent of total billed charges,83% of total,1290.1,95,,1032.08,percent of total billed charges ,95% of total billed charges,1086.4,80,,869.12,percent of total billed charges,78% of total billed charges,1059.24,78,,847.392,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,1086.4,80,,869.12,percent of total billed charges,80% of total billed charges,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1154.3,85,,923.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1290.1,
INJ SUB CERV/THOR WO GUIDE,761062320,CDM,761,RC,62320,HCPCS,outpatient,,,1267,886.9,,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,978.38,77.22,,782.7,percent of total billed charges,77.22% of total billed charges,837.49,66.1,,669.99,percent of total billed charges,66.1% of total billed charges,1051.61,83,,841.29,percent of total billed charges,83% of total,1203.65,95,,962.92,percent of total billed charges ,95% of total billed charges,1013.6,80,,810.88,percent of total billed charges,78% of total billed charges,988.26,78,,790.608,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,1013.6,80,,810.88,percent of total billed charges,80% of total billed charges,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,1076.95,85,,861.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1203.65,
INJ SUB CERV/THOR W GUIDE,761062321,CDM,761,RC,62321,HCPCS,outpatient,,,1267,886.9,,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,978.38,77.22,,782.7,percent of total billed charges,77.22% of total billed charges,837.49,66.1,,669.99,percent of total billed charges,66.1% of total billed charges,1051.61,83,,841.29,percent of total billed charges,83% of total,1203.65,95,,962.92,percent of total billed charges ,95% of total billed charges,1013.6,80,,810.88,percent of total billed charges,78% of total billed charges,988.26,78,,790.608,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,1013.6,80,,810.88,percent of total billed charges,80% of total billed charges,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,1076.95,85,,861.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1203.65,
INJ SUB LUMBAR/SACRAL WO GUIDE,761062322,CDM,761,RC,62322,HCPCS,outpatient,,,1267,886.9,,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,978.38,77.22,,782.7,percent of total billed charges,77.22% of total billed charges,837.49,66.1,,669.99,percent of total billed charges,66.1% of total billed charges,1051.61,83,,841.29,percent of total billed charges,83% of total,1203.65,95,,962.92,percent of total billed charges ,95% of total billed charges,1013.6,80,,810.88,percent of total billed charges,78% of total billed charges,988.26,78,,790.608,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,1013.6,80,,810.88,percent of total billed charges,80% of total billed charges,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,1076.95,85,,861.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1219.44,
INJ SUB LUMBAR/SACRAL W GUIDE,761062323,CDM,761,RC,62323,HCPCS,outpatient,,,1267,886.9,,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,978.38,77.22,,782.7,percent of total billed charges,77.22% of total billed charges,837.49,66.1,,669.99,percent of total billed charges,66.1% of total billed charges,1051.61,83,,841.29,percent of total billed charges,83% of total,1203.65,95,,962.92,percent of total billed charges ,95% of total billed charges,1013.6,80,,810.88,percent of total billed charges,78% of total billed charges,988.26,78,,790.608,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1140.3,90,,912.24,percent of total billed charges,90% of total billed charges,1013.6,80,,810.88,percent of total billed charges,80% of total billed charges,798.21,63,,638.57,percent of total billed charges,63% of total billed charges,1076.95,85,,861.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1000.93,79,,800.74,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1203.65,
INJ CERVICAL/THORACIC WO GUIDE,761062324,CDM,761,RC,62324,HCPCS,outpatient,,,1597,1117.9,,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,1437.3,90,,1149.84,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1233.2,77.22,,986.56,percent of total billed charges,77.22% of total billed charges,1055.62,66.1,,844.5,percent of total billed charges,66.1% of total billed charges,1325.51,83,,1060.41,percent of total billed charges,83% of total,1517.15,95,,1213.72,percent of total billed charges ,95% of total billed charges,1277.6,80,,1022.08,percent of total billed charges,78% of total billed charges,1245.66,78,,996.528,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1357.45,85,,1085.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1517.15,
INJ CERVICAL/THORACIC W GUIDE,761062325,CDM,761,RC,62325,HCPCS,outpatient,,,1597,1117.9,,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,1437.3,90,,1149.84,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1233.2,77.22,,986.56,percent of total billed charges,77.22% of total billed charges,1055.62,66.1,,844.5,percent of total billed charges,66.1% of total billed charges,1325.51,83,,1060.41,percent of total billed charges,83% of total,1517.15,95,,1213.72,percent of total billed charges ,95% of total billed charges,1277.6,80,,1022.08,percent of total billed charges,78% of total billed charges,1245.66,78,,996.528,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1357.45,85,,1085.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1517.15,
INJ LUMBAR/SACRAL WO GUIDE,761062326,CDM,761,RC,62326,HCPCS,outpatient,,,1597,1117.9,,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,1437.3,90,,1149.84,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1233.2,77.22,,986.56,percent of total billed charges,77.22% of total billed charges,1055.62,66.1,,844.5,percent of total billed charges,66.1% of total billed charges,1325.51,83,,1060.41,percent of total billed charges,83% of total,1517.15,95,,1213.72,percent of total billed charges ,95% of total billed charges,1277.6,80,,1022.08,percent of total billed charges,78% of total billed charges,1245.66,78,,996.528,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1357.45,85,,1085.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1517.15,
INJ LUMBAR/SACRAL W GUIDE,761062327,CDM,761,RC,62327,HCPCS,outpatient,,,1597,1117.9,,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,1437.3,90,,1149.84,percent of total billed charges,90% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1219.44,160,,,Fee Schedule,160% of CMS OPPS rate,990.79,130,,,Fee Schedule,130% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1233.2,77.22,,986.56,percent of total billed charges,77.22% of total billed charges,1055.62,66.1,,844.5,percent of total billed charges,66.1% of total billed charges,1325.51,83,,1060.41,percent of total billed charges,83% of total,1517.15,95,,1213.72,percent of total billed charges ,95% of total billed charges,1277.6,80,,1022.08,percent of total billed charges,78% of total billed charges,1245.66,78,,996.528,percent of total billed charges,78% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,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,1006.11,63,,804.89,percent of total billed charges,63% of total billed charges,1357.45,85,,1085.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,708.79,93,,,fee schedule,93% of CMS OPPS rate,1261.63,79,,1009.3,percent of total billed charges,79% of total billed charges,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,762.15,100,,,Fee Schedule,100% of CMS OPPS rate,450,1517.15,
NON-BILLABLE CHARGE IV INF,761090000,CDM,761,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
IRRIGA IMPLANT DEV/DRUG DEL,761096523,CDM,761,RC,96523,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
NON SEL DEBRIDEMENT W/O ANES,761097602,CDM,761,RC,97602,HCPCS,outpatient,,,673,471.1,,531.67,79,,425.34,percent of total billed charges,79% of total billed charges,605.7,90,,484.56,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,519.69,77.22,,415.75,percent of total billed charges,77.22% of total billed charges,444.85,66.1,,355.88,percent of total billed charges,66.1% of total billed charges,558.59,83,,446.87,percent of total billed charges,83% of total,639.35,95,,511.48,percent of total billed charges ,95% of total billed charges,538.4,80,,430.72,percent of total billed charges,78% of total billed charges,524.94,78,,419.952,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,605.7,90,,484.56,percent of total billed charges,90% of total billed charges,538.4,80,,430.72,percent of total billed charges,80% of total billed charges,423.99,63,,339.19,percent of total billed charges,63% of total billed charges,572.05,85,,457.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,531.67,79,,425.34,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,639.35,
TR URINE SPEC COLL STRAIT CATH,7610P9612,CDM,761,RC,P9612,HCPCS,outpatient,,,33,23.1,,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,29.7,90,,23.76,percent of total billed charges,90% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,14.13,160,,,fee schedule,160% of CMS fee schedule,11.48,130,,,fee schedule,130% of CMS fee schedule,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,25.48,77.22,,20.38,percent of total billed charges,77.22% of total billed charges,21.81,66.1,,17.45,percent of total billed charges,66.1% of total billed charges,27.39,83,,21.91,percent of total billed charges,83% of total,31.35,95,,25.08,percent of total billed charges ,95% of total billed charges,26.4,80,,21.12,percent of total billed charges,78% of total billed charges,25.74,78,,20.592,percent of total billed charges,78% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,8.83,100,,,fee schedule ,100% of CMS 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,20.79,63,,16.63,percent of total billed charges,63% of total billed charges,28.05,85,,22.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,8.21,93,,,fee schedule,93% of CMS fee schedule,26.07,79,,20.86,percent of total billed charges,79% of total billed charges,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.21,450,
OB EPIDURAL BLOOD PATCH,761162273,CDM,761,RC,62273,HCPCS,outpatient,,,1358,950.6,,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1048.65,77.22,,838.92,percent of total billed charges,77.22% of total billed charges,897.64,66.1,,718.11,percent of total billed charges,66.1% of total billed charges,1127.14,83,,901.71,percent of total billed charges,83% of total,1290.1,95,,1032.08,percent of total billed charges ,95% of total billed charges,1086.4,80,,869.12,percent of total billed charges,78% of total billed charges,1059.24,78,,847.392,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,1086.4,80,,869.12,percent of total billed charges,80% of total billed charges,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1154.3,85,,923.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1290.1,
DRAIN COMPL SINGL SKIN ABSCESS,762010061,CDM,761,RC,10061,HCPCS,outpatient,,,719,503.3,,568.01,79,,454.41,percent of total billed charges,79% of total billed charges,647.1,90,,517.68,percent of total billed charges,90% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,533.46,160,,,Fee Schedule,160% of CMS OPPS rate,433.43,130,,,Fee Schedule,130% of CMS OPPS rate,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,555.21,77.22,,444.17,percent of total billed charges,77.22% of total billed charges,475.26,66.1,,380.21,percent of total billed charges,66.1% of total billed charges,596.77,83,,477.42,percent of total billed charges,83% of total,683.05,95,,546.44,percent of total billed charges ,95% of total billed charges,575.2,80,,460.16,percent of total billed charges,78% of total billed charges,560.82,78,,448.656,percent of total billed charges,78% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,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,452.97,63,,362.38,percent of total billed charges,63% of total billed charges,611.15,85,,488.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,310.07,93,,,fee schedule,93% of CMS OPPS rate,568.01,79,,454.41,percent of total billed charges,79% of total billed charges,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,333.41,100,,,Fee Schedule,100% of CMS OPPS rate,310.07,683.05,
OBS EX BENIGN LESION 0.6-1.0CM,762011421,CDM,761,RC,11421,HCPCS,outpatient,,,1347,942.9,,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,1212.3,90,,969.84,percent of total billed charges,90% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,941.28,160,,,Fee Schedule,160% of CMS OPPS rate,764.79,130,,,Fee Schedule,130% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1040.15,77.22,,832.12,percent of total billed charges,77.22% of total billed charges,890.37,66.1,,712.3,percent of total billed charges,66.1% of total billed charges,1118.01,83,,894.41,percent of total billed charges,83% of total,1279.65,95,,1023.72,percent of total billed charges ,95% of total billed charges,1077.6,80,,862.08,percent of total billed charges,78% of total billed charges,1050.66,78,,840.528,percent of total billed charges,78% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,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,848.61,63,,678.89,percent of total billed charges,63% of total billed charges,1144.95,85,,915.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,547.12,93,,,fee schedule,93% of CMS OPPS rate,1064.13,79,,851.3,percent of total billed charges,79% of total billed charges,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,588.29,100,,,Fee Schedule,100% of CMS OPPS rate,450,1279.65,
OBS RML SIMPLE SING NAIL PLATE,762011730,CDM,761,RC,11730,HCPCS,outpatient,,,518,362.6,,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,466.2,90,,372.96,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,400,77.22,,320,percent of total billed charges,77.22% of total billed charges,342.4,66.1,,273.92,percent of total billed charges,66.1% of total billed charges,429.94,83,,343.95,percent of total billed charges,83% of total,492.1,95,,393.68,percent of total billed charges ,95% of total billed charges,414.4,80,,331.52,percent of total billed charges,78% of total billed charges,404.04,78,,323.232,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,326.34,63,,261.07,percent of total billed charges,63% of total billed charges,440.3,85,,352.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,409.22,79,,327.38,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,492.1,
OBS RPR SUPERFICIAL WOUND <2.5,762012001,CDM,761,RC,12001,HCPCS,outpatient,,,516,361.2,,407.64,79,,326.11,percent of total billed charges,79% of total billed charges,464.4,90,,371.52,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,398.46,77.22,,318.77,percent of total billed charges,77.22% of total billed charges,341.08,66.1,,272.86,percent of total billed charges,66.1% of total billed charges,428.28,83,,342.62,percent of total billed charges,83% of total,490.2,95,,392.16,percent of total billed charges ,95% of total billed charges,412.8,80,,330.24,percent of total billed charges,78% of total billed charges,402.48,78,,321.984,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,464.4,90,,371.52,percent of total billed charges,90% of total billed charges,412.8,80,,330.24,percent of total billed charges,80% of total billed charges,325.08,63,,260.06,percent of total billed charges,63% of total billed charges,438.6,85,,350.88,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,407.64,79,,326.11,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,490.2,
RPR SPRFICIAL WOUND 2.6-7.5CM,762012002,CDM,761,RC,12002,HCPCS,outpatient,,,776,543.2,,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,698.4,90,,558.72,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,599.23,77.22,,479.38,percent of total billed charges,77.22% of total billed charges,512.94,66.1,,410.35,percent of total billed charges,66.1% of total billed charges,644.08,83,,515.26,percent of total billed charges,83% of total,737.2,95,,589.76,percent of total billed charges ,95% of total billed charges,620.8,80,,496.64,percent of total billed charges,78% of total billed charges,605.28,78,,484.224,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,488.88,63,,391.1,percent of total billed charges,63% of total billed charges,659.6,85,,527.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,613.04,79,,490.43,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,737.2,
OBS TX OF BURN(S),762016020,CDM,761,RC,16020,HCPCS,outpatient,,,597,417.9,,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.84,160,,,Fee Schedule,160% of CMS OPPS rate,217.62,130,,,Fee Schedule,130% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,461,77.22,,368.8,percent of total billed charges,77.22% of total billed charges,394.62,66.1,,315.7,percent of total billed charges,66.1% of total billed charges,495.51,83,,396.41,percent of total billed charges,83% of total,567.15,95,,453.72,percent of total billed charges ,95% of total billed charges,477.6,80,,382.08,percent of total billed charges,78% of total billed charges,465.66,78,,372.528,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,537.3,90,,429.84,percent of total billed charges,90% of total billed charges,477.6,80,,382.08,percent of total billed charges,80% of total billed charges,376.11,63,,300.89,percent of total billed charges,63% of total billed charges,507.45,85,,405.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.68,93,,,fee schedule,93% of CMS OPPS rate,471.63,79,,377.3,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,155.68,567.15,
OBS DRAIN/INJ JOINT BURSA,762020610,CDM,761,RC,20610,HCPCS,outpatient,,,711,497.7,,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,396.25,160,,,Fee Schedule,160% of CMS OPPS rate,321.95,130,,,Fee Schedule,130% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,549.03,77.22,,439.22,percent of total billed charges,77.22% of total billed charges,469.97,66.1,,375.98,percent of total billed charges,66.1% of total billed charges,590.13,83,,472.1,percent of total billed charges,83% of total,675.45,95,,540.36,percent of total billed charges ,95% of total billed charges,568.8,80,,455.04,percent of total billed charges,78% of total billed charges,554.58,78,,443.664,percent of total billed charges,78% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,639.9,90,,511.92,percent of total billed charges,90% of total billed charges,568.8,80,,455.04,percent of total billed charges,80% of total billed charges,447.93,63,,358.34,percent of total billed charges,63% of total billed charges,604.35,85,,483.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,230.31,93,,,fee schedule,93% of CMS OPPS rate,561.69,79,,449.35,percent of total billed charges,79% of total billed charges,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,247.65,100,,,Fee Schedule,100% of CMS OPPS rate,230.31,675.45,
CLSD TX FING DL W/ MAN & ANES,762026775,CDM,761,RC,26775,HCPCS,outpatient,,,1092,764.4,,862.68,79,,690.14,percent of total billed charges,79% of total billed charges,982.8,90,,786.24,percent of total billed charges,90% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,359.28,160,,,Fee Schedule,160% of CMS OPPS rate,291.92,130,,,Fee Schedule,130% of CMS OPPS rate,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,843.24,77.22,,674.59,percent of total billed charges,77.22% of total billed charges,721.81,66.1,,577.45,percent of total billed charges,66.1% of total billed charges,906.36,83,,725.09,percent of total billed charges,83% of total,1037.4,95,,829.92,percent of total billed charges ,95% of total billed charges,873.6,80,,698.88,percent of total billed charges,78% of total billed charges,851.76,78,,681.408,percent of total billed charges,78% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,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,687.96,63,,550.37,percent of total billed charges,63% of total billed charges,928.2,85,,742.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,208.83,93,,,fee schedule,93% of CMS OPPS rate,862.68,79,,690.14,percent of total billed charges,79% of total billed charges,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,224.56,100,,,Fee Schedule,100% of CMS OPPS rate,208.83,1037.4,
OBS INSERT EMERGENCY AIRWAY,762031500,CDM,761,RC,31500,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,314.29,77.22,,251.43,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,450,
OBS INSERT NON TUN CV CATH >5Y,762036556,CDM,761,RC,36556,HCPCS,outpatient,,,2915,2040.5,,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2250.96,77.22,,1800.77,percent of total billed charges,77.22% of total billed charges,1926.82,66.1,,1541.46,percent of total billed charges,66.1% of total billed charges,2419.45,83,,1935.56,percent of total billed charges,83% of total,2769.25,95,,2215.4,percent of total billed charges ,95% of total billed charges,2332,80,,1865.6,percent of total billed charges,78% of total billed charges,2273.7,78,,1818.96,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2623.5,90,,2098.8,percent of total billed charges,90% of total billed charges,2332,80,,1865.6,percent of total billed charges,80% of total billed charges,1836.45,63,,1469.16,percent of total billed charges,63% of total billed charges,2477.75,85,,1982.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,2302.85,79,,1842.28,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,4264.43,
OBS INSERT PICVAD CATH > 5YRS,762036571,CDM,761,RC,36571,HCPCS,outpatient,,,5542,3879.4,,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4264.43,160,,,Fee Schedule,160% of CMS OPPS rate,3464.86,130,,,Fee Schedule,130% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,4279.53,77.22,,3423.62,percent of total billed charges,77.22% of total billed charges,3663.26,66.1,,2930.61,percent of total billed charges,66.1% of total billed charges,4599.86,83,,3679.89,percent of total billed charges,83% of total,5264.9,95,,4211.92,percent of total billed charges ,95% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,78% of total billed charges,4322.76,78,,3458.208,percent of total billed charges,78% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,4987.8,90,,3990.24,percent of total billed charges,90% of total billed charges,4433.6,80,,3546.88,percent of total billed charges,80% of total billed charges,3491.46,63,,2793.17,percent of total billed charges,63% of total billed charges,4710.7,85,,3768.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2478.69,93,,,fee schedule,93% of CMS OPPS rate,4378.18,79,,3502.54,percent of total billed charges,79% of total billed charges,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,2665.28,100,,,Fee Schedule,100% of CMS OPPS rate,450,5264.9,
DECLOT VASCULAR DEVICE,762036593,CDM,761,RC,36593,HCPCS,outpatient,,,774,541.8,,611.46,79,,489.17,percent of total billed charges,79% of total billed charges,696.6,90,,557.28,percent of total billed charges,90% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,453.08,160,,,Fee Schedule,160% of CMS OPPS rate,368.13,130,,,Fee Schedule,130% of CMS OPPS rate,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,597.68,77.22,,478.14,percent of total billed charges,77.22% of total billed charges,511.61,66.1,,409.29,percent of total billed charges,66.1% of total billed charges,642.42,83,,513.94,percent of total billed charges,83% of total,735.3,95,,588.24,percent of total billed charges ,95% of total billed charges,619.2,80,,495.36,percent of total billed charges,78% of total billed charges,603.72,78,,482.976,percent of total billed charges,78% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,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,487.62,63,,390.1,percent of total billed charges,63% of total billed charges,657.9,85,,526.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,263.35,93,,,fee schedule,93% of CMS OPPS rate,611.46,79,,489.17,percent of total billed charges,79% of total billed charges,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,283.18,100,,,Fee Schedule,100% of CMS OPPS rate,263.35,735.3,
OBS PUNCTURE PERITONEAL CAVITY,762049080,CDM,761,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
OBS REMOVAL ABDOMINAL FLUID,762049081,CDM,761,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
PARACENTESIS NO GUIDANCE,762049082,CDM,761,RC,49082,HCPCS,outpatient,,,1632,1142.4,,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1212.75,160,,,Fee Schedule,160% of CMS OPPS rate,985.36,130,,,Fee Schedule,130% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1260.23,77.22,,1008.18,percent of total billed charges,77.22% of total billed charges,1078.75,66.1,,863,percent of total billed charges,66.1% of total billed charges,1354.56,83,,1083.65,percent of total billed charges,83% of total,1550.4,95,,1240.32,percent of total billed charges ,95% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,78% of total billed charges,1272.96,78,,1018.368,percent of total billed charges,78% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,1468.8,90,,1175.04,percent of total billed charges,90% of total billed charges,1305.6,80,,1044.48,percent of total billed charges,80% of total billed charges,1028.16,63,,822.53,percent of total billed charges,63% of total billed charges,1387.2,85,,1109.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,704.91,93,,,fee schedule,93% of CMS OPPS rate,1289.28,79,,1031.42,percent of total billed charges,79% of total billed charges,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,757.97,100,,,Fee Schedule,100% of CMS OPPS rate,450,1550.4,
OBS IRRIGATION OF BLADDER,762051700,CDM,761,RC,51700,HCPCS,outpatient,,,698,488.6,,551.42,79,,441.14,percent of total billed charges,79% of total billed charges,628.2,90,,502.56,percent of total billed charges,90% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,330.64,160,,,Fee Schedule,160% of CMS OPPS rate,268.64,130,,,Fee Schedule,130% of CMS OPPS rate,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,539,77.22,,431.2,percent of total billed charges,77.22% of total billed charges,461.38,66.1,,369.1,percent of total billed charges,66.1% of total billed charges,579.34,83,,463.47,percent of total billed charges,83% of total,663.1,95,,530.48,percent of total billed charges ,95% of total billed charges,558.4,80,,446.72,percent of total billed charges,78% of total billed charges,544.44,78,,435.552,percent of total billed charges,78% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,628.2,90,,502.56,percent of total billed charges,90% of total billed charges,558.4,80,,446.72,percent of total billed charges,80% of total billed charges,439.74,63,,351.79,percent of total billed charges,63% of total billed charges,593.3,85,,474.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,192.18,93,,,fee schedule,93% of CMS OPPS rate,551.42,79,,441.14,percent of total billed charges,79% of total billed charges,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,206.65,100,,,Fee Schedule,100% of CMS OPPS rate,192.18,663.1,
OBS INSERT STRAIGHT CATH,762051701,CDM,761,RC,51701,HCPCS,outpatient,,,277,193.9,,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,249.3,90,,199.44,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,213.9,77.22,,171.12,percent of total billed charges,77.22% of total billed charges,183.1,66.1,,146.48,percent of total billed charges,66.1% of total billed charges,229.91,83,,183.93,percent of total billed charges,83% of total,263.15,95,,210.52,percent of total billed charges ,95% of total billed charges,221.6,80,,177.28,percent of total billed charges,78% of total billed charges,216.06,78,,172.848,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,174.51,63,,139.61,percent of total billed charges,63% of total billed charges,235.45,85,,188.36,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,218.83,79,,175.06,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
OBS INSERT FOLEY CATH,762051702,CDM,761,RC,51702,HCPCS,outpatient,,,283,198.1,,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,254.7,90,,203.76,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,218.53,77.22,,174.82,percent of total billed charges,77.22% of total billed charges,187.06,66.1,,149.65,percent of total billed charges,66.1% of total billed charges,234.89,83,,187.91,percent of total billed charges,83% of total,268.85,95,,215.08,percent of total billed charges ,95% of total billed charges,226.4,80,,181.12,percent of total billed charges,78% of total billed charges,220.74,78,,176.592,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,178.29,63,,142.63,percent of total billed charges,63% of total billed charges,240.55,85,,192.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,223.57,79,,178.86,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
OBS I&D BARTHOLIN CYST,762056420,CDM,761,RC,56420,HCPCS,outpatient,,,332,232.4,,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,298.8,90,,239.04,percent of total billed charges,90% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,266.58,160,,,Fee Schedule,160% of CMS OPPS rate,216.6,130,,,Fee Schedule,130% of CMS OPPS rate,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,256.37,77.22,,205.1,percent of total billed charges,77.22% of total billed charges,219.45,66.1,,175.56,percent of total billed charges,66.1% of total billed charges,275.56,83,,220.45,percent of total billed charges,83% of total,315.4,95,,252.32,percent of total billed charges ,95% of total billed charges,265.6,80,,212.48,percent of total billed charges,78% of total billed charges,258.96,78,,207.168,percent of total billed charges,78% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,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,209.16,63,,167.33,percent of total billed charges,63% of total billed charges,282.2,85,,225.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,154.94,93,,,fee schedule,93% of CMS OPPS rate,262.28,79,,209.82,percent of total billed charges,79% of total billed charges,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,166.62,100,,,Fee Schedule,100% of CMS OPPS rate,154.94,450,
AMNIOCENTESIS DIAGNOSTIC,762059000,CDM,761,RC,59000,HCPCS,outpatient,,,264,184.8,,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,237.6,90,,190.08,percent of total billed charges,90% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,1075.52,160,,,Fee Schedule,160% of CMS OPPS rate,873.86,130,,,Fee Schedule,130% of CMS OPPS rate,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,203.86,77.22,,163.09,percent of total billed charges,77.22% of total billed charges,174.5,66.1,,139.6,percent of total billed charges,66.1% of total billed charges,219.12,83,,175.3,percent of total billed charges,83% of total,250.8,95,,200.64,percent of total billed charges ,95% of total billed charges,211.2,80,,168.96,percent of total billed charges,78% of total billed charges,205.92,78,,164.736,percent of total billed charges,78% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,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,166.32,63,,133.06,percent of total billed charges,63% of total billed charges,224.4,85,,179.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,625.15,93,,,fee schedule,93% of CMS OPPS rate,208.56,79,,166.85,percent of total billed charges,79% of total billed charges,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,672.2,100,,,Fee Schedule,100% of CMS OPPS rate,166.32,1075.52,
OBS SPINAL FLUID TAP DIAGNOSTI,762062270,CDM,761,RC,62270,HCPCS,outpatient,,,1978,1384.6,,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1527.41,77.22,,1221.93,percent of total billed charges,77.22% of total billed charges,1307.46,66.1,,1045.97,percent of total billed charges,66.1% of total billed charges,1641.74,83,,1313.39,percent of total billed charges,83% of total,1879.1,95,,1503.28,percent of total billed charges ,95% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,78% of total billed charges,1542.84,78,,1234.272,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1780.2,90,,1424.16,percent of total billed charges,90% of total billed charges,1582.4,80,,1265.92,percent of total billed charges,80% of total billed charges,1246.14,63,,996.91,percent of total billed charges,63% of total billed charges,1681.3,85,,1345.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1562.62,79,,1250.1,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1879.1,
OBS THER SPINAL PUNCT DRG CSF,762062272,CDM,761,RC,62272,HCPCS,outpatient,,,543,380.1,,428.97,79,,343.18,percent of total billed charges,79% of total billed charges,488.7,90,,390.96,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,419.3,77.22,,335.44,percent of total billed charges,77.22% of total billed charges,358.92,66.1,,287.14,percent of total billed charges,66.1% of total billed charges,450.69,83,,360.55,percent of total billed charges,83% of total,515.85,95,,412.68,percent of total billed charges ,95% of total billed charges,434.4,80,,347.52,percent of total billed charges,78% of total billed charges,423.54,78,,338.832,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,488.7,90,,390.96,percent of total billed charges,90% of total billed charges,434.4,80,,347.52,percent of total billed charges,80% of total billed charges,342.09,63,,273.67,percent of total billed charges,63% of total billed charges,461.55,85,,369.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,428.97,79,,343.18,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,342.09,925.2,
OBS INJECT SPINE L/S (CD),762062311,CDM,761,RC,,,outpatient,,,1950,1365,,1540.5,79,,1232.4,percent of total billed charges,79% of total billed charges,1755,90,,1404,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,1505.79,77.22,,1204.63,percent of total billed charges,77.22% of total billed charges,1288.95,66.1,,1031.16,percent of total billed charges,66.1% of total billed charges,1618.5,83,,1294.8,percent of total billed charges,83% of total,1852.5,95,,1482,percent of total billed charges ,95% of total billed charges,1560,80,,1248,percent of total billed charges,78% of total billed charges,1521,78,,1216.8,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,1755,90,,1404,percent of total billed charges,90% of total billed charges,1560,80,,1248,percent of total billed charges,80% of total billed charges,1228.5,63,,982.8,percent of total billed charges,63% of total billed charges,1657.5,85,,1326,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,1540.5,79,,1232.4,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,1852.5,
OBS IRRIGATION OF IMPLANT,762096523,CDM,761,RC,96523,HCPCS,outpatient,,,110,77,,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,99,90,,79.2,percent of total billed charges,90% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,81.83,160,,,Fee Schedule,160% of CMS OPPS rate,66.49,130,,,Fee Schedule,130% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,84.94,77.22,,67.95,percent of total billed charges,77.22% of total billed charges,72.71,66.1,,58.17,percent of total billed charges,66.1% of total billed charges,91.3,83,,73.04,percent of total billed charges,83% of total,104.5,95,,83.6,percent of total billed charges ,95% of total billed charges,88,80,,70.4,percent of total billed charges,78% of total billed charges,85.8,78,,68.64,percent of total billed charges,78% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,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,69.3,63,,55.44,percent of total billed charges,63% of total billed charges,93.5,85,,74.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,47.56,93,,,fee schedule,93% of CMS OPPS rate,86.9,79,,69.52,percent of total billed charges,79% of total billed charges,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,51.14,100,,,Fee Schedule,100% of CMS OPPS rate,47.56,450,
OBS EPIDURAL SPINE LESION,762100125,CDM,761,RC,62273,HCPCS,outpatient,,,1358,950.6,,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1048.65,77.22,,838.92,percent of total billed charges,77.22% of total billed charges,897.64,66.1,,718.11,percent of total billed charges,66.1% of total billed charges,1127.14,83,,901.71,percent of total billed charges,83% of total,1290.1,95,,1032.08,percent of total billed charges ,95% of total billed charges,1086.4,80,,869.12,percent of total billed charges,78% of total billed charges,1059.24,78,,847.392,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,1086.4,80,,869.12,percent of total billed charges,80% of total billed charges,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1154.3,85,,923.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1290.1,
ANEST CRNA EPIDERAL BLOOD PATC,964000300,CDM,761,RC,62273,HCPCS,outpatient,,,1358,950.6,,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,925.2,160,,,Fee Schedule,160% of CMS OPPS rate,751.72,130,,,Fee Schedule,130% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1048.65,77.22,,838.92,percent of total billed charges,77.22% of total billed charges,897.64,66.1,,718.11,percent of total billed charges,66.1% of total billed charges,1127.14,83,,901.71,percent of total billed charges,83% of total,1290.1,95,,1032.08,percent of total billed charges ,95% of total billed charges,1086.4,80,,869.12,percent of total billed charges,78% of total billed charges,1059.24,78,,847.392,percent of total billed charges,78% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,1222.2,90,,977.76,percent of total billed charges,90% of total billed charges,1086.4,80,,869.12,percent of total billed charges,80% of total billed charges,855.54,63,,684.43,percent of total billed charges,63% of total billed charges,1154.3,85,,923.44,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,537.76,93,,,fee schedule,93% of CMS OPPS rate,1072.82,79,,858.26,percent of total billed charges,79% of total billed charges,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,578.25,100,,,Fee Schedule,100% of CMS OPPS rate,450,1290.1,
ANES INSERT AIRWAY,964031500,CDM,761,RC,31500,HCPCS,outpatient,,,407,284.9,,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,366.3,90,,293.04,percent of total billed charges,90% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,326.77,160,,,Fee Schedule,160% of CMS OPPS rate,265.5,130,,,Fee Schedule,130% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,314.29,77.22,,251.43,percent of total billed charges,77.22% of total billed charges,269.03,66.1,,215.22,percent of total billed charges,66.1% of total billed charges,337.81,83,,270.25,percent of total billed charges,83% of total,386.65,95,,309.32,percent of total billed charges ,95% of total billed charges,325.6,80,,260.48,percent of total billed charges,78% of total billed charges,317.46,78,,253.968,percent of total billed charges,78% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,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,256.41,63,,205.13,percent of total billed charges,63% of total billed charges,345.95,85,,276.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,189.94,93,,,fee schedule,93% of CMS OPPS rate,321.53,79,,257.22,percent of total billed charges,79% of total billed charges,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,204.24,100,,,Fee Schedule,100% of CMS OPPS rate,189.94,450,
REMOVAL DEVITAL TIS 20 CM<,97597P,CDM,761,RC,97597,HCPCS,outpatient,,,92,64.4,,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,82.8,90,,66.24,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,71.04,77.22,,56.83,percent of total billed charges,77.22% of total billed charges,60.81,66.1,,48.65,percent of total billed charges,66.1% of total billed charges,76.36,83,,61.09,percent of total billed charges,83% of total,87.4,95,,69.92,percent of total billed charges ,95% of total billed charges,73.6,80,,58.88,percent of total billed charges,78% of total billed charges,71.76,78,,57.408,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,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,57.96,63,,46.37,percent of total billed charges,63% of total billed charges,78.2,85,,62.56,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,72.68,79,,58.14,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,57.96,450,
REMOVAL DEVITAL TIS 20 CM<,97597T,CDM,761,RC,97597,HCPCS,outpatient,,,138,96.6,,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,267.83,160,,,Fee Schedule,160% of CMS OPPS rate,217.61,130,,,Fee Schedule,130% of CMS OPPS rate,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,106.56,77.22,,85.25,percent of total billed charges,77.22% of total billed charges,91.22,66.1,,72.98,percent of total billed charges,66.1% of total billed charges,114.54,83,,91.63,percent of total billed charges,83% of total,131.1,95,,104.88,percent of total billed charges ,95% of total billed charges,110.4,80,,88.32,percent of total billed charges,78% of total billed charges,107.64,78,,86.112,percent of total billed charges,78% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,124.2,90,,99.36,percent of total billed charges,90% of total billed charges,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,86.94,63,,69.55,percent of total billed charges,63% of total billed charges,117.3,85,,93.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,155.66,93,,,fee schedule,93% of CMS OPPS rate,109.02,79,,87.22,percent of total billed charges,79% of total billed charges,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,167.4,100,,,Fee Schedule,100% of CMS OPPS rate,86.94,450,
REMOVAL DEVITAL TIS ADDL 20CM<,97598P,CDM,761,RC,97598,HCPCS,outpatient,,,32,22.4,,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,28.8,90,,23.04,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,24.71,77.22,,19.77,percent of total billed charges,77.22% of total billed charges,21.15,66.1,,16.92,percent of total billed charges,66.1% of total billed charges,26.56,83,,21.25,percent of total billed charges,83% of total,30.4,95,,24.32,percent of total billed charges ,95% of total billed charges,25.6,80,,20.48,percent of total billed charges,78% of total billed charges,24.96,78,,19.968,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,20.16,63,,16.13,percent of total billed charges,63% of total billed charges,27.2,85,,21.76,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,25.28,79,,20.22,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.16,450,
REMOVAL DEVITAL TIS ADDL 20CM<,97598T,CDM,761,RC,97598,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
I/D ISCHIO/PERIRECTAL ABS BEDS,230046040,CDM,762,RC,46040,HCPCS,outpatient,,,5615,3930.5,,4435.85,79,,3548.68,percent of total billed charges,79% of total billed charges,5053.5,90,,4042.8,percent of total billed charges,90% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,1578.77,160,,,Fee Schedule,160% of CMS OPPS rate,1282.75,130,,,Fee Schedule,130% of CMS OPPS rate,3537.45,63,,2829.96,percent of total billed charges,63% of total billed charges,4335.9,77.22,,3468.72,percent of total billed charges,77.22% of total billed charges,3711.52,66.1,,2969.22,percent of total billed charges,66.1% of total billed charges,4660.45,83,,3728.36,percent of total billed charges,83% of total,5334.25,95,,4267.4,percent of total billed charges ,95% of total billed charges,4492,80,,3593.6,percent of total billed charges,78% of total billed charges,4379.7,78,,3503.76,percent of total billed charges,78% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,3537.45,63,,2829.96,percent of total billed charges,63% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,5053.5,90,,4042.8,percent of total billed charges,90% of total billed charges,4492,80,,3593.6,percent of total billed charges,80% of total billed charges,3537.45,63,,2829.96,percent of total billed charges,63% of total billed charges,4772.75,85,,3818.2,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,917.66,93,,,fee schedule,93% of CMS OPPS rate,4435.85,79,,3548.68,percent of total billed charges,79% of total billed charges,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,986.72,100,,,Fee Schedule,100% of CMS OPPS rate,450,5334.25,
OBSERVATION RM MED 6-48 HRS,762001252,CDM,762,RC,G0378,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
OBSERVATION ROOM,762001254,CDM,762,RC,99218,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OBSERVATION R00M MED 1-5 HRS,762001255,CDM,762,RC,G0378,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
OBSERV CARE MEDSUR  DIRECT ADM,762001256,CDM,762,RC,G0379,HCPCS,outpatient,,,743,520.1,,586.97,79,,469.58,percent of total billed charges,79% of total billed charges,668.7,90,,534.96,percent of total billed charges,90% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,859.33,160,,,Fee Schedule,160% of CMS OPPS rate,698.2,130,,,Fee Schedule,130% of CMS OPPS rate,468.09,63,,374.47,percent of total billed charges,63% of total billed charges,573.74,77.22,,458.99,percent of total billed charges,77.22% of total billed charges,491.12,66.1,,392.9,percent of total billed charges,66.1% of total billed charges,616.69,83,,493.35,percent of total billed charges,83% of total,705.85,95,,564.68,percent of total billed charges ,95% of total billed charges,594.4,80,,475.52,percent of total billed charges,78% of total billed charges,579.54,78,,463.632,percent of total billed charges,78% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,468.09,63,,374.47,percent of total billed charges,63% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,668.7,90,,534.96,percent of total billed charges,90% of total billed charges,594.4,80,,475.52,percent of total billed charges,80% of total billed charges,468.09,63,,374.47,percent of total billed charges,63% of total billed charges,631.55,85,,505.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,499.48,93,,,fee schedule,93% of CMS OPPS rate,586.97,79,,469.58,percent of total billed charges,79% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,450,859.33,
OBSERVATION RM OB/GYN 1-5 HRS,762001257,CDM,762,RC,G0378,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
OBSERV CARE OB/GYN DIRECT ADM,762001258,CDM,762,RC,G0379,HCPCS,outpatient,,,743,520.1,,586.97,79,,469.58,percent of total billed charges,79% of total billed charges,668.7,90,,534.96,percent of total billed charges,90% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,859.33,160,,,Fee Schedule,160% of CMS OPPS rate,698.2,130,,,Fee Schedule,130% of CMS OPPS rate,468.09,63,,374.47,percent of total billed charges,63% of total billed charges,573.74,77.22,,458.99,percent of total billed charges,77.22% of total billed charges,491.12,66.1,,392.9,percent of total billed charges,66.1% of total billed charges,616.69,83,,493.35,percent of total billed charges,83% of total,705.85,95,,564.68,percent of total billed charges ,95% of total billed charges,594.4,80,,475.52,percent of total billed charges,78% of total billed charges,579.54,78,,463.632,percent of total billed charges,78% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,468.09,63,,374.47,percent of total billed charges,63% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,668.7,90,,534.96,percent of total billed charges,90% of total billed charges,594.4,80,,475.52,percent of total billed charges,80% of total billed charges,468.09,63,,374.47,percent of total billed charges,63% of total billed charges,631.55,85,,505.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,499.48,93,,,fee schedule,93% of CMS OPPS rate,586.97,79,,469.58,percent of total billed charges,79% of total billed charges,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,537.08,100,,,Fee Schedule,100% of CMS OPPS rate,450,859.33,
OBSERVATION RM OB/GYN 6-48 HRS,762001259,CDM,762,RC,G0378,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
OBSERVATION NON BILLABLE HR,762006000,CDM,762,RC,G0378,HCPCS,outpatient,,,78,54.6,,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,70.2,90,,56.16,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,60.23,77.22,,48.18,percent of total billed charges,77.22% of total billed charges,51.56,66.1,,41.25,percent of total billed charges,66.1% of total billed charges,64.74,83,,51.79,percent of total billed charges,83% of total,74.1,95,,59.28,percent of total billed charges ,95% of total billed charges,62.4,80,,49.92,percent of total billed charges,78% of total billed charges,60.84,78,,48.672,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,49.14,63,,39.31,percent of total billed charges,63% of total billed charges,66.3,85,,53.04,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,61.62,79,,49.3,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49.14,450,
HEPATITIS B ADM FEE 10MCG EA,250017346,CDM,771,RC,90471,HCPCS,outpatient,,,143,100.1,,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,110.42,77.22,,88.34,percent of total billed charges,77.22% of total billed charges,94.52,66.1,,75.62,percent of total billed charges,66.1% of total billed charges,118.69,83,,94.95,percent of total billed charges,83% of total,135.85,95,,108.68,percent of total billed charges ,95% of total billed charges,114.4,80,,91.52,percent of total billed charges,78% of total billed charges,111.54,78,,89.232,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,128.7,90,,102.96,percent of total billed charges,90% of total billed charges,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,90.09,63,,72.07,percent of total billed charges,63% of total billed charges,121.55,85,,97.24,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,112.97,79,,90.38,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
IV INF REGEN W POST ADM MONITR,260000243,CDM,771,RC,M0243,HCPCS,outpatient,,,901,630.7,,711.79,79,,569.43,percent of total billed charges,79% of total billed charges,810.9,90,,648.72,percent of total billed charges,90% of total billed charges,395.35,100,,,Fee Schedule,100% of CMS OPPS rate,632.57,160,,,Fee Schedule,160% of CMS OPPS rate,513.96,130,,,Fee Schedule,130% of CMS OPPS rate,567.63,63,,454.1,percent of total billed charges,63% of total billed charges,695.75,77.22,,556.6,percent of total billed charges,77.22% of total billed charges,595.56,66.1,,476.45,percent of total billed charges,66.1% of total billed charges,747.83,83,,598.26,percent of total billed charges,83% of total,855.95,95,,684.76,percent of total billed charges ,95% of total billed charges,720.8,80,,576.64,percent of total billed charges,78% of total billed charges,702.78,78,,562.224,percent of total billed charges,78% of total billed charges,395.35,100,,,Fee Schedule,100% of CMS OPPS rate,567.63,63,,454.1,percent of total billed charges,63% of total billed charges,395.35,100,,,Fee Schedule,100% of CMS OPPS rate,810.9,90,,648.72,percent of total billed charges,90% of total billed charges,720.8,80,,576.64,percent of total billed charges,80% of total billed charges,567.63,63,,454.1,percent of total billed charges,63% of total billed charges,765.85,85,,612.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,367.68,93,,,fee schedule,93% of CMS OPPS rate,711.79,79,,569.43,percent of total billed charges,79% of total billed charges,395.35,100,,,Fee Schedule,100% of CMS OPPS rate,395.35,100,,,Fee Schedule,100% of CMS OPPS rate,367.68,855.95,
IM VACCINE ADMINISTRATION,260090471,CDM,771,RC,90471,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
ADMIN VACC SKIN/MSCL 1,450090471,CDM,771,RC,90471,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
ADMIN VACC SKN/MSCL EA ADD VAC,450090472,CDM,771,RC,90472,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
SDC IMMUNIZATION ADMINISTRATIO,490090471,CDM,771,RC,90471,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
TR IM VACCINE ADMINISTRATION,761090471,CDM,771,RC,90471,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
TR EA ADDL VACCINE,761090472,CDM,771,RC,90472,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
OP VACCINE IM ADMINISTRATION,762090471,CDM,771,RC,90471,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
"OBS IMMUNIZATION ADMIN,EA ADD",762090472,CDM,771,RC,90472,HCPCS,outpatient,,,45,31.5,,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,40.5,90,,32.4,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,34.75,77.22,,27.8,percent of total billed charges,77.22% of total billed charges,29.75,66.1,,23.8,percent of total billed charges,66.1% of total billed charges,37.35,83,,29.88,percent of total billed charges,83% of total,42.75,95,,34.2,percent of total billed charges ,95% of total billed charges,36,80,,28.8,percent of total billed charges,78% of total billed charges,35.1,78,,28.08,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,28.35,63,,22.68,percent of total billed charges,63% of total billed charges,38.25,85,,30.6,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,35.55,79,,28.44,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28.35,450,
OBS ADMIN OF INFLUENZA VACCINE,7620G0008,CDM,771,RC,90471,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
OBS ADM OF PNEUMOCOCCAL VACC,7620G0009,CDM,771,RC,90471,HCPCS,outpatient,,,97,67.9,,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,87.3,90,,69.84,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,74.9,77.22,,59.92,percent of total billed charges,77.22% of total billed charges,64.12,66.1,,51.3,percent of total billed charges,66.1% of total billed charges,80.51,83,,64.41,percent of total billed charges,83% of total,92.15,95,,73.72,percent of total billed charges ,95% of total billed charges,77.6,80,,62.08,percent of total billed charges,78% of total billed charges,75.66,78,,60.528,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,61.11,63,,48.89,percent of total billed charges,63% of total billed charges,82.45,85,,65.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,76.63,79,,61.3,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,54.78,450,
MODERNA COVID-19 VAC ADM 1ST D,77100011A,CDM,771,RC,0011A,HCPCS,outpatient,,,21.93,15.35,,17.32,79,,13.86,percent of total billed charges,79% of total billed charges,19.74,90,,15.79,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.82,63,,11.06,percent of total billed charges,63% of total billed charges,16.93,77.22,,13.54,percent of total billed charges,77.22% of total billed charges,14.5,66.1,,11.6,percent of total billed charges,66.1% of total billed charges,18.2,83,,14.56,percent of total billed charges,83% of total,20.83,95,,16.66,percent of total billed charges ,95% of total billed charges,17.54,80,,14.03,percent of total billed charges,78% of total billed charges,17.11,78,,13.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.82,63,,11.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,19.74,90,,15.79,percent of total billed charges,90% of total billed charges,17.54,80,,14.03,percent of total billed charges,80% of total billed charges,13.82,63,,11.06,percent of total billed charges,63% of total billed charges,18.64,85,,14.912,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.32,79,,13.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.82,450,
MODERNA COVID-19 VAC ADM 2ND D,77100012A,CDM,771,RC,0012A,HCPCS,outpatient,,,21.93,15.35,,17.32,79,,13.86,percent of total billed charges,79% of total billed charges,19.74,90,,15.79,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.82,63,,11.06,percent of total billed charges,63% of total billed charges,16.93,77.22,,13.54,percent of total billed charges,77.22% of total billed charges,14.5,66.1,,11.6,percent of total billed charges,66.1% of total billed charges,18.2,83,,14.56,percent of total billed charges,83% of total,20.83,95,,16.66,percent of total billed charges ,95% of total billed charges,17.54,80,,14.03,percent of total billed charges,78% of total billed charges,17.11,78,,13.688,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,13.82,63,,11.06,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,19.74,90,,15.79,percent of total billed charges,90% of total billed charges,17.54,80,,14.03,percent of total billed charges,80% of total billed charges,13.82,63,,11.06,percent of total billed charges,63% of total billed charges,18.64,85,,14.912,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,17.32,79,,13.86,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.82,450,
JANSSEN COVID-19 VAC ADMIN,77100031A,CDM,771,RC,0031A,HCPCS,outpatient,,,28.39,19.87,,22.43,79,,17.94,percent of total billed charges,79% of total billed charges,25.55,90,,20.44,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.89,63,,14.31,percent of total billed charges,63% of total billed charges,21.92,77.22,,17.54,percent of total billed charges,77.22% of total billed charges,18.77,66.1,,15.02,percent of total billed charges,66.1% of total billed charges,23.56,83,,18.85,percent of total billed charges,83% of total,26.97,95,,21.58,percent of total billed charges ,95% of total billed charges,22.71,80,,18.17,percent of total billed charges,78% of total billed charges,22.14,78,,17.712,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,17.89,63,,14.31,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,25.55,90,,20.44,percent of total billed charges,90% of total billed charges,22.71,80,,18.17,percent of total billed charges,80% of total billed charges,17.89,63,,14.31,percent of total billed charges,63% of total billed charges,24.13,85,,19.304,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,22.43,79,,17.94,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.89,450,
ADMINSTRATION THROUGH 18YRSAGE,90460,CDM,771,RC,90460,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30.24,450,
SINGLE IM SUBQ INJECTION,90471,CDM,771,RC,90471,HCPCS,outpatient,,,48,33.6,,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,43.2,90,,34.56,percent of total billed charges,90% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,94.24,160,,,Fee Schedule,160% of CMS OPPS rate,76.57,130,,,Fee Schedule,130% of CMS OPPS rate,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,37.07,77.22,,29.66,percent of total billed charges,77.22% of total billed charges,31.73,66.1,,25.38,percent of total billed charges,66.1% of total billed charges,39.84,83,,31.87,percent of total billed charges,83% of total,45.6,95,,36.48,percent of total billed charges ,95% of total billed charges,38.4,80,,30.72,percent of total billed charges,78% of total billed charges,37.44,78,,29.952,percent of total billed charges,78% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,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,30.24,63,,24.19,percent of total billed charges,63% of total billed charges,40.8,85,,32.64,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,54.78,93,,,fee schedule,93% of CMS OPPS rate,37.92,79,,30.34,percent of total billed charges,79% of total billed charges,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,58.9,100,,,Fee Schedule,100% of CMS OPPS rate,30.24,450,
2 OR MORE ADMIN IM SUBQ INJ,90472,CDM,771,RC,90472,HCPCS,outpatient,,,37,25.9,,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,33.3,90,,26.64,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,28.57,77.22,,22.86,percent of total billed charges,77.22% of total billed charges,24.46,66.1,,19.57,percent of total billed charges,66.1% of total billed charges,30.71,83,,24.57,percent of total billed charges,83% of total,35.15,95,,28.12,percent of total billed charges ,95% of total billed charges,29.6,80,,23.68,percent of total billed charges,78% of total billed charges,28.86,78,,23.088,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,23.31,63,,18.65,percent of total billed charges,63% of total billed charges,31.45,85,,25.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,29.23,79,,23.38,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.31,450,
INFLUENZA ADMINISTRATION,G0008,CDM,771,RC,G0008,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,22.05,450,
PNEUMOCOCCAL ADMINISTRATION,G0009,CDM,771,RC,G0009,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.54,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,22.05,450,
TELENEUROLOGY INI IP/ER CONS,4500G0425,CDM,780,RC,G0425,HCPCS,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
TELEHEALTH ORIGIN SITE FACILIT,780000400,CDM,780,RC,Q3014,HCPCS,outpatient,,,35,24.5,,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,27.03,77.22,,21.62,percent of total billed charges,77.22% of total billed charges,23.14,66.1,,18.51,percent of total billed charges,66.1% of total billed charges,29.05,83,,23.24,percent of total billed charges,83% of total,33.25,95,,26.6,percent of total billed charges ,95% of total billed charges,28,80,,22.4,percent of total billed charges,78% of total billed charges,27.3,78,,21.84,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,31.5,90,,25.2,percent of total billed charges,90% of total billed charges,28,80,,22.4,percent of total billed charges,80% of total billed charges,22.05,63,,17.64,percent of total billed charges,63% of total billed charges,29.75,85,,23.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,27.65,79,,22.12,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.05,450,
AMP TELEHEALTH FACILITY FEE,780003014,CDM,780,RC,Q3014,HCPCS,outpatient,,,100,70,,79,79,,63.2,percent of total billed charges,79% of total billed charges,90,90,,72,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,77.22,77.22,,61.78,percent of total billed charges,77.22% of total billed charges,66.1,66.1,,52.88,percent of total billed charges,66.1% of total billed charges,83,83,,66.4,percent of total billed charges,83% of total,95,95,,76,percent of total billed charges ,95% of total billed charges,80,80,,64,percent of total billed charges,78% of total billed charges,78,78,,62.4,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,63,63,,50.4,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,63,63,,50.4,percent of total billed charges,63% of total billed charges,85,85,,68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,79,79,,63.2,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63,450,
TELEPSYCH DIAG EVAL W MED SERV,780090792,CDM,780,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OR LITHOTRIPSY,790001180,CDM,790,RC,50590,HCPCS,outpatient,,,14850,10395,,11731.5,79,,9385.2,percent of total billed charges,79% of total billed charges,13365,90,,10692,percent of total billed charges,90% of total billed charges,2915.02,100,,,Fee Schedule,100% of CMS OPPS rate,4664.02,160,,,Fee Schedule,160% of CMS OPPS rate,3789.52,130,,,Fee Schedule,130% of CMS OPPS rate,9355.5,63,,7484.4,percent of total billed charges,63% of total billed charges,11467.17,77.22,,9173.74,percent of total billed charges,77.22% of total billed charges,9815.85,66.1,,7852.68,percent of total billed charges,66.1% of total billed charges,12325.5,83,,9860.4,percent of total billed charges,83% of total,14107.5,95,,11286,percent of total billed charges ,95% of total billed charges,11880,80,,9504,percent of total billed charges,78% of total billed charges,11583,78,,9266.4,percent of total billed charges,78% of total billed charges,2915.02,100,,,Fee Schedule,100% of CMS OPPS rate,9355.5,63,,7484.4,percent of total billed charges,63% of total billed charges,2915.02,100,,,Fee Schedule,100% of CMS OPPS rate,13365,90,,10692,percent of total billed charges,90% of total billed charges,11880,80,,9504,percent of total billed charges,80% of total billed charges,9355.5,63,,7484.4,percent of total billed charges,63% of total billed charges,12622.5,85,,10098,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,2710.96,93,,,fee schedule,93% of CMS OPPS rate,11731.5,79,,9385.2,percent of total billed charges,79% of total billed charges,2915.02,100,,,Fee Schedule,100% of CMS OPPS rate,2915.02,100,,,Fee Schedule,100% of CMS OPPS rate,450,14107.5,
CAPD CON PERITONEAL DIA SGL EV,803090945,CDM,803,RC,,,outpatient,,,755,528.5,,596.45,79,,477.16,percent of total billed charges,79% of total billed charges,679.5,90,,543.6,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,583.01,77.22,,466.41,percent of total billed charges,77.22% of total billed charges,499.06,66.1,,399.25,percent of total billed charges,66.1% of total billed charges,626.65,83,,501.32,percent of total billed charges,83% of total,717.25,95,,573.8,percent of total billed charges ,95% of total billed charges,604,80,,483.2,percent of total billed charges,78% of total billed charges,588.9,78,,471.12,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,679.5,90,,543.6,percent of total billed charges,90% of total billed charges,604,80,,483.2,percent of total billed charges,80% of total billed charges,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,641.75,85,,513.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,596.45,79,,477.16,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,717.25,
CCPD CON CYC PERITONEAL DIA EV,804090937,CDM,804,RC,,,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,195.93,450,
OP CCPD CON CYC PERITON DIA EV,850090937,CDM,821,RC,90937,HCPCS,outpatient,,,311,217.7,,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,279.9,90,,223.92,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,240.15,77.22,,192.12,percent of total billed charges,77.22% of total billed charges,205.57,66.1,,164.46,percent of total billed charges,66.1% of total billed charges,258.13,83,,206.5,percent of total billed charges,83% of total,295.45,95,,236.36,percent of total billed charges ,95% of total billed charges,248.8,80,,199.04,percent of total billed charges,78% of total billed charges,242.58,78,,194.064,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,195.93,63,,156.74,percent of total billed charges,63% of total billed charges,264.35,85,,211.48,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,245.69,79,,196.55,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,195.93,450,
OP CAPD CON PERITON DIA SGL EV,840090945,CDM,840,RC,90945,HCPCS,outpatient,,,755,528.5,,596.45,79,,477.16,percent of total billed charges,79% of total billed charges,679.5,90,,543.6,percent of total billed charges,90% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,592.54,160,,,Fee Schedule,160% of CMS OPPS rate,481.45,130,,,Fee Schedule,130% of CMS OPPS rate,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,583.01,77.22,,466.41,percent of total billed charges,77.22% of total billed charges,499.06,66.1,,399.25,percent of total billed charges,66.1% of total billed charges,626.65,83,,501.32,percent of total billed charges,83% of total,717.25,95,,573.8,percent of total billed charges ,95% of total billed charges,604,80,,483.2,percent of total billed charges,78% of total billed charges,588.9,78,,471.12,percent of total billed charges,78% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,679.5,90,,543.6,percent of total billed charges,90% of total billed charges,604,80,,483.2,percent of total billed charges,80% of total billed charges,475.65,63,,380.52,percent of total billed charges,63% of total billed charges,641.75,85,,513.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,344.42,93,,,fee schedule,93% of CMS OPPS rate,596.45,79,,477.16,percent of total billed charges,79% of total billed charges,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,370.34,100,,,Fee Schedule,100% of CMS OPPS rate,344.42,717.25,
LTD BIL PHYS STUDY EXT ARTERIE,324093922,CDM,921,RC,93922,HCPCS,outpatient,,,312,218.4,,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,280.8,90,,224.64,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,240.93,77.22,,192.74,percent of total billed charges,77.22% of total billed charges,206.23,66.1,,164.98,percent of total billed charges,66.1% of total billed charges,258.96,83,,207.17,percent of total billed charges,83% of total,296.4,95,,237.12,percent of total billed charges ,95% of total billed charges,249.6,80,,199.68,percent of total billed charges,78% of total billed charges,243.36,78,,194.688,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,196.56,63,,157.25,percent of total billed charges,63% of total billed charges,265.2,85,,212.16,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,246.48,79,,197.18,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
COMP BIL PHYS STY EXT ART 3>LE,324093923,CDM,921,RC,93923,HCPCS,outpatient,,,399,279.3,,315.21,79,,252.17,percent of total billed charges,79% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.97,160,,,Fee Schedule,160% of CMS OPPS rate,169.78,130,,,Fee Schedule,130% of CMS OPPS rate,251.37,63,,201.1,percent of total billed charges,63% of total billed charges,308.11,77.22,,246.49,percent of total billed charges,77.22% of total billed charges,263.74,66.1,,210.99,percent of total billed charges,66.1% of total billed charges,331.17,83,,264.94,percent of total billed charges,83% of total,379.05,95,,303.24,percent of total billed charges ,95% of total billed charges,319.2,80,,255.36,percent of total billed charges,78% of total billed charges,311.22,78,,248.976,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,251.37,63,,201.1,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,251.37,63,,201.1,percent of total billed charges,63% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.46,93,,,fee schedule,93% of CMS OPPS rate,315.21,79,,252.17,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.46,450,
LTD BIL PHYS STDY EX ART 1-2LE,324993922,CDM,921,RC,93922,HCPCS,outpatient,,,156,109.2,,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,140.4,90,,112.32,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,120.46,77.22,,96.37,percent of total billed charges,77.22% of total billed charges,103.12,66.1,,82.5,percent of total billed charges,66.1% of total billed charges,129.48,83,,103.58,percent of total billed charges,83% of total,148.2,95,,118.56,percent of total billed charges ,95% of total billed charges,124.8,80,,99.84,percent of total billed charges,78% of total billed charges,121.68,78,,97.344,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,98.28,63,,78.62,percent of total billed charges,63% of total billed charges,132.6,85,,106.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,123.24,79,,98.59,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,98.28,450,
US RENAL ARTERY DOPPLER,402000047,CDM,921,RC,93976,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,210.04,77.22,,168.03,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US LIVER/SPLEEN DOPPLER,402000049,CDM,921,RC,93976,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,210.04,77.22,,168.03,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US VENA CAVA,402000064,CDM,921,RC,93979,HCPCS,outpatient,,,360,252,,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,324,90,,259.2,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,277.99,77.22,,222.39,percent of total billed charges,77.22% of total billed charges,237.96,66.1,,190.37,percent of total billed charges,66.1% of total billed charges,298.8,83,,239.04,percent of total billed charges,83% of total,342,95,,273.6,percent of total billed charges ,95% of total billed charges,288,80,,230.4,percent of total billed charges,78% of total billed charges,280.8,78,,224.64,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,226.8,63,,181.44,percent of total billed charges,63% of total billed charges,306,85,,244.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.49,93,,,fee schedule,93% of CMS OPPS rate,284.4,79,,227.52,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.49,450,
US DUPLEX ILIAC VASC COMPLETE,402000065,CDM,921,RC,93978,HCPCS,outpatient,,,584,408.8,,461.36,79,,369.09,percent of total billed charges,79% of total billed charges,525.6,90,,420.48,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,367.92,63,,294.34,percent of total billed charges,63% of total billed charges,450.96,77.22,,360.77,percent of total billed charges,77.22% of total billed charges,386.02,66.1,,308.82,percent of total billed charges,66.1% of total billed charges,484.72,83,,387.78,percent of total billed charges,83% of total,554.8,95,,443.84,percent of total billed charges ,95% of total billed charges,467.2,80,,373.76,percent of total billed charges,78% of total billed charges,455.52,78,,364.416,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,367.92,63,,294.34,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,525.6,90,,420.48,percent of total billed charges,90% of total billed charges,467.2,80,,373.76,percent of total billed charges,80% of total billed charges,367.92,63,,294.34,percent of total billed charges,63% of total billed charges,496.4,85,,397.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,461.36,79,,369.09,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,554.8,
UPPER EXTREM BILATERAL COMPLET,402001813,CDM,921,RC,93970,HCPCS,outpatient,,,1306,914.2,,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1008.49,77.22,,806.79,percent of total billed charges,77.22% of total billed charges,863.27,66.1,,690.62,percent of total billed charges,66.1% of total billed charges,1083.98,83,,867.18,percent of total billed charges,83% of total,1240.7,95,,992.56,percent of total billed charges ,95% of total billed charges,1044.8,80,,835.84,percent of total billed charges,78% of total billed charges,1018.68,78,,814.944,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,1044.8,80,,835.84,percent of total billed charges,80% of total billed charges,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1110.1,85,,888.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1240.7,
UPPER EXTREMITY UNILATERAL,402001814,CDM,921,RC,93971,HCPCS,outpatient,,,1013,709.1,,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,782.24,77.22,,625.79,percent of total billed charges,77.22% of total billed charges,669.59,66.1,,535.67,percent of total billed charges,66.1% of total billed charges,840.79,83,,672.63,percent of total billed charges,83% of total,962.35,95,,769.88,percent of total billed charges ,95% of total billed charges,810.4,80,,648.32,percent of total billed charges,78% of total billed charges,790.14,78,,632.112,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,810.4,80,,648.32,percent of total billed charges,80% of total billed charges,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,861.05,85,,688.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,962.35,
NON INVASIVE VASC STUDY LMTD,402001821,CDM,921,RC,93922,HCPCS,outpatient,,,260,182,,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,234,90,,187.2,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,200.77,77.22,,160.62,percent of total billed charges,77.22% of total billed charges,171.86,66.1,,137.49,percent of total billed charges,66.1% of total billed charges,215.8,83,,172.64,percent of total billed charges,83% of total,247,95,,197.6,percent of total billed charges ,95% of total billed charges,208,80,,166.4,percent of total billed charges,78% of total billed charges,202.8,78,,162.24,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,163.8,63,,131.04,percent of total billed charges,63% of total billed charges,221,85,,176.8,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,205.4,79,,164.32,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
VENOUS INSUFFICIENCY EXT UNILA,402001843,CDM,921,RC,93971,HCPCS,outpatient,,,1013,709.1,,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,782.24,77.22,,625.79,percent of total billed charges,77.22% of total billed charges,669.59,66.1,,535.67,percent of total billed charges,66.1% of total billed charges,840.79,83,,672.63,percent of total billed charges,83% of total,962.35,95,,769.88,percent of total billed charges ,95% of total billed charges,810.4,80,,648.32,percent of total billed charges,78% of total billed charges,790.14,78,,632.112,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,810.4,80,,648.32,percent of total billed charges,80% of total billed charges,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,861.05,85,,688.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,962.35,
VENOUS INSUFFICIENCY EXT BILA,402001844,CDM,921,RC,93970,HCPCS,outpatient,,,1306,914.2,,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1008.49,77.22,,806.79,percent of total billed charges,77.22% of total billed charges,863.27,66.1,,690.62,percent of total billed charges,66.1% of total billed charges,1083.98,83,,867.18,percent of total billed charges,83% of total,1240.7,95,,992.56,percent of total billed charges ,95% of total billed charges,1044.8,80,,835.84,percent of total billed charges,78% of total billed charges,1018.68,78,,814.944,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,1044.8,80,,835.84,percent of total billed charges,80% of total billed charges,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1110.1,85,,888.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1240.7,
DPLX SCN EXCRANIAL ART COM BIL,450093880,CDM,921,RC,93880,HCPCS,outpatient,,,869,608.3,,686.51,79,,549.21,percent of total billed charges,79% of total billed charges,782.1,90,,625.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,671.04,77.22,,536.83,percent of total billed charges,77.22% of total billed charges,574.41,66.1,,459.53,percent of total billed charges,66.1% of total billed charges,721.27,83,,577.02,percent of total billed charges,83% of total,825.55,95,,660.44,percent of total billed charges ,95% of total billed charges,695.2,80,,556.16,percent of total billed charges,78% of total billed charges,677.82,78,,542.256,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,782.1,90,,625.68,percent of total billed charges,90% of total billed charges,695.2,80,,556.16,percent of total billed charges,80% of total billed charges,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,738.65,85,,590.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,686.51,79,,549.21,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,825.55,
US LOWER EXT RT LEG FOR CLOT,921000175,CDM,921,RC,93971,HCPCS,outpatient,,,1013,709.1,,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,782.24,77.22,,625.79,percent of total billed charges,77.22% of total billed charges,669.59,66.1,,535.67,percent of total billed charges,66.1% of total billed charges,840.79,83,,672.63,percent of total billed charges,83% of total,962.35,95,,769.88,percent of total billed charges ,95% of total billed charges,810.4,80,,648.32,percent of total billed charges,78% of total billed charges,790.14,78,,632.112,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,810.4,80,,648.32,percent of total billed charges,80% of total billed charges,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,861.05,85,,688.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,962.35,
US ARTERIAL STUDY BILAT LEGS,921000391,CDM,921,RC,93925,HCPCS,outpatient,,,575,402.5,,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,444.02,77.22,,355.22,percent of total billed charges,77.22% of total billed charges,380.08,66.1,,304.06,percent of total billed charges,66.1% of total billed charges,477.25,83,,381.8,percent of total billed charges,83% of total,546.25,95,,437,percent of total billed charges ,95% of total billed charges,460,80,,368,percent of total billed charges,78% of total billed charges,448.5,78,,358.8,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,546.25,
US ARTERIAL UNILAT LEFT LEG,921000392,CDM,921,RC,93926,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,210.04,77.22,,168.03,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US ARTERIAL UNILAT RIGHT LEG,921000393,CDM,921,RC,93926,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,210.04,77.22,,168.03,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US ARTERIAL BILAT STUDY ARMS,921000394,CDM,921,RC,93930,HCPCS,outpatient,,,575,402.5,,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,444.02,77.22,,355.22,percent of total billed charges,77.22% of total billed charges,380.08,66.1,,304.06,percent of total billed charges,66.1% of total billed charges,477.25,83,,381.8,percent of total billed charges,83% of total,546.25,95,,437,percent of total billed charges ,95% of total billed charges,460,80,,368,percent of total billed charges,78% of total billed charges,448.5,78,,358.8,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,546.25,
US ARTERIAL UNILAT LEFT ARM,921000395,CDM,921,RC,93931,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,210.04,77.22,,168.03,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
US ARTERIAL UNILAT RIGHT ARM,921000396,CDM,921,RC,93931,HCPCS,outpatient,,,272,190.4,,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,244.8,90,,195.84,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,210.04,77.22,,168.03,percent of total billed charges,77.22% of total billed charges,179.79,66.1,,143.83,percent of total billed charges,66.1% of total billed charges,225.76,83,,180.61,percent of total billed charges,83% of total,258.4,95,,206.72,percent of total billed charges ,95% of total billed charges,217.6,80,,174.08,percent of total billed charges,78% of total billed charges,212.16,78,,169.728,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,171.36,63,,137.09,percent of total billed charges,63% of total billed charges,231.2,85,,184.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,214.88,79,,171.9,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
DUPLEX SCAN EXTCRAN ART/FU/LMT,921007030,CDM,921,RC,93882,HCPCS,outpatient,,,359,251.3,,283.61,79,,226.89,percent of total billed charges,79% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,277.22,77.22,,221.78,percent of total billed charges,77.22% of total billed charges,237.3,66.1,,189.84,percent of total billed charges,66.1% of total billed charges,297.97,83,,238.38,percent of total billed charges,83% of total,341.05,95,,272.84,percent of total billed charges ,95% of total billed charges,287.2,80,,229.76,percent of total billed charges,78% of total billed charges,280.02,78,,224.016,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,283.61,79,,226.89,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
DUPLEX SCAN EXT VEINS BILAT CO,921007031,CDM,921,RC,93970,HCPCS,outpatient,,,1306,914.2,,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1008.49,77.22,,806.79,percent of total billed charges,77.22% of total billed charges,863.27,66.1,,690.62,percent of total billed charges,66.1% of total billed charges,1083.98,83,,867.18,percent of total billed charges,83% of total,1240.7,95,,992.56,percent of total billed charges ,95% of total billed charges,1044.8,80,,835.84,percent of total billed charges,78% of total billed charges,1018.68,78,,814.944,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,1044.8,80,,835.84,percent of total billed charges,80% of total billed charges,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1110.1,85,,888.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1240.7,
DUPLEX SCAN EXT VEINS LEFT,921007032,CDM,921,RC,93971,HCPCS,outpatient,,,1013,709.1,,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,782.24,77.22,,625.79,percent of total billed charges,77.22% of total billed charges,669.59,66.1,,535.67,percent of total billed charges,66.1% of total billed charges,840.79,83,,672.63,percent of total billed charges,83% of total,962.35,95,,769.88,percent of total billed charges ,95% of total billed charges,810.4,80,,648.32,percent of total billed charges,78% of total billed charges,790.14,78,,632.112,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,810.4,80,,648.32,percent of total billed charges,80% of total billed charges,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,861.05,85,,688.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,962.35,
DUPLEX SCAN EXT VEINS RIGHT,921007033,CDM,921,RC,93971,HCPCS,outpatient,,,1013,709.1,,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,782.24,77.22,,625.79,percent of total billed charges,77.22% of total billed charges,669.59,66.1,,535.67,percent of total billed charges,66.1% of total billed charges,840.79,83,,672.63,percent of total billed charges,83% of total,962.35,95,,769.88,percent of total billed charges ,95% of total billed charges,810.4,80,,648.32,percent of total billed charges,78% of total billed charges,790.14,78,,632.112,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,810.4,80,,648.32,percent of total billed charges,80% of total billed charges,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,861.05,85,,688.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,962.35,
DUPLEX SCAN EXT VEINS.CMP BIL,921007050,CDM,921,RC,93970,HCPCS,outpatient,,,1306,914.2,,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1008.49,77.22,,806.79,percent of total billed charges,77.22% of total billed charges,863.27,66.1,,690.62,percent of total billed charges,66.1% of total billed charges,1083.98,83,,867.18,percent of total billed charges,83% of total,1240.7,95,,992.56,percent of total billed charges ,95% of total billed charges,1044.8,80,,835.84,percent of total billed charges,78% of total billed charges,1018.68,78,,814.944,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,1175.4,90,,940.32,percent of total billed charges,90% of total billed charges,1044.8,80,,835.84,percent of total billed charges,80% of total billed charges,822.78,63,,658.22,percent of total billed charges,63% of total billed charges,1110.1,85,,888.08,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,1031.74,79,,825.39,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,1240.7,
DUPLEX SCAN EXT VEINS/LMT,921007060,CDM,921,RC,93971,HCPCS,outpatient,,,1013,709.1,,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,782.24,77.22,,625.79,percent of total billed charges,77.22% of total billed charges,669.59,66.1,,535.67,percent of total billed charges,66.1% of total billed charges,840.79,83,,672.63,percent of total billed charges,83% of total,962.35,95,,769.88,percent of total billed charges ,95% of total billed charges,810.4,80,,648.32,percent of total billed charges,78% of total billed charges,790.14,78,,632.112,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,911.7,90,,729.36,percent of total billed charges,90% of total billed charges,810.4,80,,648.32,percent of total billed charges,80% of total billed charges,638.19,63,,510.55,percent of total billed charges,63% of total billed charges,861.05,85,,688.84,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,800.27,79,,640.22,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,962.35,
DUPLEX SCAN EXTCRAN ART/BILCMP,921007070,CDM,921,RC,93880,HCPCS,outpatient,,,869,608.3,,686.51,79,,549.21,percent of total billed charges,79% of total billed charges,782.1,90,,625.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,671.04,77.22,,536.83,percent of total billed charges,77.22% of total billed charges,574.41,66.1,,459.53,percent of total billed charges,66.1% of total billed charges,721.27,83,,577.02,percent of total billed charges,83% of total,825.55,95,,660.44,percent of total billed charges ,95% of total billed charges,695.2,80,,556.16,percent of total billed charges,78% of total billed charges,677.82,78,,542.256,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,782.1,90,,625.68,percent of total billed charges,90% of total billed charges,695.2,80,,556.16,percent of total billed charges,80% of total billed charges,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,738.65,85,,590.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,686.51,79,,549.21,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,825.55,
US BILAT ARTERIES LOWER EXT,921007080,CDM,921,RC,93925,HCPCS,outpatient,,,575,402.5,,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,517.5,90,,414,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,444.02,77.22,,355.22,percent of total billed charges,77.22% of total billed charges,380.08,66.1,,304.06,percent of total billed charges,66.1% of total billed charges,477.25,83,,381.8,percent of total billed charges,83% of total,546.25,95,,437,percent of total billed charges ,95% of total billed charges,460,80,,368,percent of total billed charges,78% of total billed charges,448.5,78,,358.8,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,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,362.25,63,,289.8,percent of total billed charges,63% of total billed charges,488.75,85,,391,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,454.25,79,,363.4,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,546.25,
CAROTID DUPLEX COMPLETE,921093880,CDM,921,RC,93880,HCPCS,outpatient,,,869,608.3,,686.51,79,,549.21,percent of total billed charges,79% of total billed charges,782.1,90,,625.68,percent of total billed charges,90% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,327.82,160,,,Fee Schedule,160% of CMS OPPS rate,266.36,130,,,Fee Schedule,130% of CMS OPPS rate,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,671.04,77.22,,536.83,percent of total billed charges,77.22% of total billed charges,574.41,66.1,,459.53,percent of total billed charges,66.1% of total billed charges,721.27,83,,577.02,percent of total billed charges,83% of total,825.55,95,,660.44,percent of total billed charges ,95% of total billed charges,695.2,80,,556.16,percent of total billed charges,78% of total billed charges,677.82,78,,542.256,percent of total billed charges,78% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,782.1,90,,625.68,percent of total billed charges,90% of total billed charges,695.2,80,,556.16,percent of total billed charges,80% of total billed charges,547.47,63,,437.98,percent of total billed charges,63% of total billed charges,738.65,85,,590.92,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,190.54,93,,,fee schedule,93% of CMS OPPS rate,686.51,79,,549.21,percent of total billed charges,79% of total billed charges,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,204.89,100,,,Fee Schedule,100% of CMS OPPS rate,190.54,825.55,
CAROTID DUPLEX LIMTED,921093882,CDM,921,RC,93882,HCPCS,outpatient,,,359,251.3,,283.61,79,,226.89,percent of total billed charges,79% of total billed charges,323.1,90,,258.48,percent of total billed charges,90% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,147.08,160,,,Fee Schedule,160% of CMS OPPS rate,119.5,130,,,Fee Schedule,130% of CMS OPPS rate,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,277.22,77.22,,221.78,percent of total billed charges,77.22% of total billed charges,237.3,66.1,,189.84,percent of total billed charges,66.1% of total billed charges,297.97,83,,238.38,percent of total billed charges,83% of total,341.05,95,,272.84,percent of total billed charges ,95% of total billed charges,287.2,80,,229.76,percent of total billed charges,78% of total billed charges,280.02,78,,224.016,percent of total billed charges,78% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,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,226.17,63,,180.94,percent of total billed charges,63% of total billed charges,305.15,85,,244.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,85.48,93,,,fee schedule,93% of CMS OPPS rate,283.61,79,,226.89,percent of total billed charges,79% of total billed charges,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,91.92,100,,,Fee Schedule,100% of CMS OPPS rate,85.48,450,
LOWER EXT ART PLETHYSMOGRAPHY,921093923,CDM,921,RC,93923,HCPCS,outpatient,,,399,279.3,,315.21,79,,252.17,percent of total billed charges,79% of total billed charges,359.1,90,,287.28,percent of total billed charges,90% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,208.97,160,,,Fee Schedule,160% of CMS OPPS rate,169.78,130,,,Fee Schedule,130% of CMS OPPS rate,251.37,63,,201.1,percent of total billed charges,63% of total billed charges,308.11,77.22,,246.49,percent of total billed charges,77.22% of total billed charges,263.74,66.1,,210.99,percent of total billed charges,66.1% of total billed charges,331.17,83,,264.94,percent of total billed charges,83% of total,379.05,95,,303.24,percent of total billed charges ,95% of total billed charges,319.2,80,,255.36,percent of total billed charges,78% of total billed charges,311.22,78,,248.976,percent of total billed charges,78% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,251.37,63,,201.1,percent of total billed charges,63% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,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,251.37,63,,201.1,percent of total billed charges,63% of total billed charges,339.15,85,,271.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,121.46,93,,,fee schedule,93% of CMS OPPS rate,315.21,79,,252.17,percent of total billed charges,79% of total billed charges,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,130.61,100,,,Fee Schedule,100% of CMS OPPS rate,121.46,450,
PHOTOTHERAPY DOUBLE,171100008,CDM,940,RC,96900,HCPCS,outpatient,,,1125,787.5,,888.75,79,,711,percent of total billed charges,79% of total billed charges,1012.5,90,,810,percent of total billed charges,90% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,53.65,160,,,Fee Schedule,160% of CMS OPPS rate,43.59,130,,,Fee Schedule,130% of CMS OPPS rate,708.75,63,,567,percent of total billed charges,63% of total billed charges,868.73,77.22,,694.98,percent of total billed charges,77.22% of total billed charges,743.63,66.1,,594.9,percent of total billed charges,66.1% of total billed charges,933.75,83,,747,percent of total billed charges,83% of total,1068.75,95,,855,percent of total billed charges ,95% of total billed charges,900,80,,720,percent of total billed charges,78% of total billed charges,877.5,78,,702,percent of total billed charges,78% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,708.75,63,,567,percent of total billed charges,63% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,1012.5,90,,810,percent of total billed charges,90% of total billed charges,900,80,,720,percent of total billed charges,80% of total billed charges,708.75,63,,567,percent of total billed charges,63% of total billed charges,956.25,85,,765,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,31.18,93,,,fee schedule,93% of CMS OPPS rate,888.75,79,,711,percent of total billed charges,79% of total billed charges,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,33.53,100,,,Fee Schedule,100% of CMS OPPS rate,31.18,1068.75,
THERAPEUTIC BLEEDING,390000028,CDM,940,RC,99195,HCPCS,outpatient,,,322,225.4,,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,289.8,90,,231.84,percent of total billed charges,90% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,170.9,160,,,Fee Schedule,160% of CMS OPPS rate,138.85,130,,,Fee Schedule,130% of CMS OPPS rate,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,248.65,77.22,,198.92,percent of total billed charges,77.22% of total billed charges,212.84,66.1,,170.27,percent of total billed charges,66.1% of total billed charges,267.26,83,,213.81,percent of total billed charges,83% of total,305.9,95,,244.72,percent of total billed charges ,95% of total billed charges,257.6,80,,206.08,percent of total billed charges,78% of total billed charges,251.16,78,,200.928,percent of total billed charges,78% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,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,202.86,63,,162.29,percent of total billed charges,63% of total billed charges,273.7,85,,218.96,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,99.33,93,,,fee schedule,93% of CMS OPPS rate,254.38,79,,203.5,percent of total billed charges,79% of total billed charges,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,106.81,100,,,Fee Schedule,100% of CMS OPPS rate,99.33,450,
ALLERGY INJECTION,95115,CDM,940,RC,95115,HCPCS,outpatient,,,30,21,,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,27,90,,21.6,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.55,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,23.17,77.22,,18.54,percent of total billed charges,77.22% of total billed charges,19.83,66.1,,15.86,percent of total billed charges,66.1% of total billed charges,24.9,83,,19.92,percent of total billed charges,83% of total,28.5,95,,22.8,percent of total billed charges ,95% of total billed charges,24,80,,19.2,percent of total billed charges,78% of total billed charges,23.4,78,,18.72,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,18.9,63,,15.12,percent of total billed charges,63% of total billed charges,25.5,85,,20.4,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,23.7,79,,18.96,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,18.9,450,
"ALLERGY INJECTION , 2 OR MORE",95117,CDM,940,RC,95117,HCPCS,outpatient,,,39,27.3,,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,35.1,90,,28.08,percent of total billed charges,90% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,63.55,160,,,Fee Schedule,160% of CMS OPPS rate,51.63,130,,,Fee Schedule,130% of CMS OPPS rate,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,30.12,77.22,,24.1,percent of total billed charges,77.22% of total billed charges,25.78,66.1,,20.62,percent of total billed charges,66.1% of total billed charges,32.37,83,,25.9,percent of total billed charges,83% of total,37.05,95,,29.64,percent of total billed charges ,95% of total billed charges,31.2,80,,24.96,percent of total billed charges,78% of total billed charges,30.42,78,,24.336,percent of total billed charges,78% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,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,24.57,63,,19.66,percent of total billed charges,63% of total billed charges,33.15,85,,26.52,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,36.93,93,,,fee schedule,93% of CMS OPPS rate,30.81,79,,24.65,percent of total billed charges,79% of total billed charges,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,39.72,100,,,Fee Schedule,100% of CMS OPPS rate,24.57,450,
BEHAV CHANGE SMOKING 3-10 MIN,493099406,CDM,942,RC,99406,HCPCS,outpatient,,,26,18.2,,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.4,90,,18.72,percent of total billed charges,90% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,38.38,160,,,Fee Schedule,160% of CMS OPPS rate,31.19,130,,,Fee Schedule,130% of CMS OPPS rate,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,20.08,77.22,,16.06,percent of total billed charges,77.22% of total billed charges,17.19,66.1,,13.75,percent of total billed charges,66.1% of total billed charges,21.58,83,,17.26,percent of total billed charges,83% of total,24.7,95,,19.76,percent of total billed charges ,95% of total billed charges,20.8,80,,16.64,percent of total billed charges,78% of total billed charges,20.28,78,,16.224,percent of total billed charges,78% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,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,16.38,63,,13.1,percent of total billed charges,63% of total billed charges,22.1,85,,17.68,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.3,93,,,fee schedule,93% of CMS OPPS rate,20.54,79,,16.43,percent of total billed charges,79% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,16.38,450,
BEHAV CHANGE SMOKING >10 MIN,493099407,CDM,942,RC,99407,HCPCS,outpatient,,,50,35,,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,45,90,,36,percent of total billed charges,90% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,38.38,160,,,Fee Schedule,160% of CMS OPPS rate,31.19,130,,,Fee Schedule,130% of CMS OPPS rate,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,38.61,77.22,,30.89,percent of total billed charges,77.22% of total billed charges,33.05,66.1,,26.44,percent of total billed charges,66.1% of total billed charges,41.5,83,,33.2,percent of total billed charges,83% of total,47.5,95,,38,percent of total billed charges ,95% of total billed charges,40,80,,32,percent of total billed charges,78% of total billed charges,39,78,,31.2,percent of total billed charges,78% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,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,31.5,63,,25.2,percent of total billed charges,63% of total billed charges,42.5,85,,34,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,22.3,93,,,fee schedule,93% of CMS OPPS rate,39.5,79,,31.6,percent of total billed charges,79% of total billed charges,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,23.99,100,,,Fee Schedule,100% of CMS OPPS rate,22.3,450,
WOUND/OSTOMY CARE TRAINING,942000001,CDM,942,RC,,,outpatient,,,125,87.5,,98.75,79,,79,percent of total billed charges,79% of total billed charges,112.5,90,,90,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,96.53,77.22,,77.22,percent of total billed charges,77.22% of total billed charges,82.63,66.1,,66.1,percent of total billed charges,66.1% of total billed charges,103.75,83,,83,percent of total billed charges,83% of total,118.75,95,,95,percent of total billed charges ,95% of total billed charges,100,80,,80,percent of total billed charges,78% of total billed charges,97.5,78,,78,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,78.75,63,,63,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,78.75,63,,63,percent of total billed charges,63% of total billed charges,106.25,85,,85,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,98.75,79,,79,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.75,450,
NON-BILLABLE CHG MED NUTRITION,942005555,CDM,942,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
INTIAL ASSESSMENT 15 MIN MN TH,942097802,CDM,942,RC,97802,HCPCS,outpatient,,,99,69.3,,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,89.1,90,,71.28,percent of total billed charges,90% of total billed charges,30,100,,,fee schedule,100% of CMS fee schedule,48,160,,,fee schedule,160% of CMS fee schedule,39,130,,,fee schedule,130% of CMS fee schedule,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,76.45,77.22,,61.16,percent of total billed charges,77.22% of total billed charges,65.44,66.1,,52.35,percent of total billed charges,66.1% of total billed charges,82.17,83,,65.74,percent of total billed charges,83% of total,94.05,95,,75.24,percent of total billed charges ,95% of total billed charges,79.2,80,,63.36,percent of total billed charges,78% of total billed charges,77.22,78,,61.776,percent of total billed charges,78% of total billed charges,30,100,,,fee schedule,100% of CMS fee schedule,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,30,100,,,fee schedule ,100% of CMS 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,62.37,63,,49.9,percent of total billed charges,63% of total billed charges,84.15,85,,67.32,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,27.9,93,,,fee schedule,93% of CMS fee schedule,78.21,79,,62.57,percent of total billed charges,79% of total billed charges,30,100,,,fee schedule,100% of CMS fee schedule,30,100,,,fee schedule,100% of CMS fee schedule,27.9,450,
RE-ASSESS/SUBSEQ 15 MIN MN THP,942097803,CDM,942,RC,97803,HCPCS,outpatient,,,84,58.8,,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,75.6,90,,60.48,percent of total billed charges,90% of total billed charges,25.58,100,,,fee schedule,100% of CMS fee schedule,40.93,160,,,fee schedule,160% of CMS fee schedule,33.25,130,,,fee schedule,130% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,64.86,77.22,,51.89,percent of total billed charges,77.22% of total billed charges,55.52,66.1,,44.42,percent of total billed charges,66.1% of total billed charges,69.72,83,,55.78,percent of total billed charges,83% of total,79.8,95,,63.84,percent of total billed charges ,95% of total billed charges,67.2,80,,53.76,percent of total billed charges,78% of total billed charges,65.52,78,,52.416,percent of total billed charges,78% of total billed charges,25.58,100,,,fee schedule,100% of CMS fee schedule,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,25.58,100,,,fee schedule ,100% of CMS 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,52.92,63,,42.34,percent of total billed charges,63% of total billed charges,71.4,85,,57.12,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,23.79,93,,,fee schedule,93% of CMS fee schedule,66.36,79,,53.09,percent of total billed charges,79% of total billed charges,25.58,100,,,fee schedule,100% of CMS fee schedule,25.58,100,,,fee schedule,100% of CMS fee schedule,23.79,450,
GROUP  30 MIN MED NUTRI THERPY,942097804,CDM,942,RC,97804,HCPCS,outpatient,,,46,32.2,,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,41.4,90,,33.12,percent of total billed charges,90% of total billed charges,14.52,100,,,fee schedule,100% of CMS fee schedule,23.23,160,,,fee schedule,160% of CMS fee schedule,18.88,130,,,fee schedule,130% of CMS fee schedule,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,35.52,77.22,,28.42,percent of total billed charges,77.22% of total billed charges,30.41,66.1,,24.33,percent of total billed charges,66.1% of total billed charges,38.18,83,,30.54,percent of total billed charges,83% of total,43.7,95,,34.96,percent of total billed charges ,95% of total billed charges,36.8,80,,29.44,percent of total billed charges,78% of total billed charges,35.88,78,,28.704,percent of total billed charges,78% of total billed charges,14.52,100,,,fee schedule,100% of CMS fee schedule,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,14.52,100,,,fee schedule ,100% of CMS 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,28.98,63,,23.18,percent of total billed charges,63% of total billed charges,39.1,85,,31.28,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,13.5,93,,,fee schedule,93% of CMS fee schedule,36.34,79,,29.07,percent of total billed charges,79% of total billed charges,14.52,100,,,fee schedule,100% of CMS fee schedule,14.52,100,,,fee schedule,100% of CMS fee schedule,13.5,450,
I&D SINGLE OR SIMPLE,10060,CDM,960,RC,10060,HCPCS,outpatient,,,315,220.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.84,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.84,99.84,
INCISION & DRAINAGE MULTIPLE,10061,CDM,960,RC,10061,HCPCS,outpatient,,,553,387.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.18,174.18,
FB REMOVAL SQ W/INC SMPL,10120,CDM,960,RC,10120,HCPCS,outpatient,,,400,280,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.05,99.05,
I&D HEMATOMA SEROMA OR FLUID,10140,CDM,960,RC,10140,HCPCS,outpatient,,,404,282.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.89,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.89,111.89,
DEB SKIN SUBCUTANEOUS TISSUE,11042,CDM,960,RC,11042,HCPCS,outpatient,,,350,245,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.66,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.66,57.66,
DEB SKIN SUBCUTAN TISSUE MUS,11043,CDM,960,RC,11043,HCPCS,outpatient,,,661,462.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.79,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.79,146.79,
TRIM SKIN LESION,11055,CDM,960,RC,11055,HCPCS,outpatient,,,75,52.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.01,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.01,15.01,
TANGENTIAL BIOP SKIN SGL LESIO,11102,CDM,960,RC,11102,HCPCS,outpatient,,,258,180.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.77,35.77,
SHAVING EPIDERMAN DERMAL LESN,11300,CDM,960,RC,11300,HCPCS,outpatient,,,157,109.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32.3,32.3,
ELECTRO CAUTERIZATION OF WART,11301,CDM,960,RC,11301,HCPCS,outpatient,,,257,179.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48.58,48.58,
SHAVE SKIN LESION 0.5 CM <,11305,CDM,960,RC,11305,HCPCS,outpatient,,,268,187.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.03,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36.03,36.03,
SHAVE SKIN LESION 0.6-1.0 CM,11306,CDM,960,RC,11306,HCPCS,outpatient,,,319,223.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.72,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46.72,46.72,
EXC BENIGN LESION,11401,CDM,960,RC,11401,HCPCS,outpatient,,,363,254.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.33,99.33,
EXC BENIGN LESION 1.1 - 2.0 CM,11402,CDM,960,RC,11402,HCPCS,outpatient,,,404,282.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.94,108.94,
EXC BENIGN LESION 2.1-3.0 CM,11403,CDM,960,RC,11403,HCPCS,outpatient,,,498,348.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.04,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,141.04,141.04,
EXC BENIGN LESION 0.6-1.0 CM,11421,CDM,960,RC,11421,HCPCS,outpatient,,,380,266,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.06,103.06,
EX BEN LES FAC EAR EYLID 1.1-2,11442,CDM,960,RC,11442,HCPCS,outpatient,,,525,367.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.29,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,138.29,138.29,
EXC MAL LES TRUNK ARM LEG 0.5C,11600,CDM,960,RC,11600,HCPCS,outpatient,,,467,326.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,115.35,115.35,
EXC MAL LES TRK ARM LEG >4.0CM,11606,CDM,960,RC,11606,HCPCS,outpatient,,,1171,819.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.19,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,301.19,301.19,
TRIMMING TOENAILS ANY NUMBER,11719,CDM,960,RC,11719,HCPCS,outpatient,,,49,34.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.16,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.16,7.16,
EXCISION/REMOVAL OF NAIL,11750,CDM,960,RC,11750,HCPCS,outpatient,,,488,341.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.57,96.57,
REPAIR LAC SCALP TRNK 2.6-7.5C,12032,CDM,960,RC,12032,HCPCS,outpatient,,,657,459.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.43,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,178.43,178.43,
DESTRUCTION 1 LES BENIGN CRYFR,17000,CDM,960,RC,17000,HCPCS,outpatient,,,172,120.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.36,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.36,51.36,
CRYOFREEZE 2 THRU 14 LESIONS,17003,CDM,960,RC,17003,HCPCS,outpatient,,,44,30.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.91,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,1.91,1.91,
DESTRUCTION BENIGN LES TO 14,17110,CDM,960,RC,17110,HCPCS,outpatient,,,287,200.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.79,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.79,63.79,
I&D SOFT TIS ABSCESS SUBFASCIA,20005,CDM,960,RC,,,outpatient,,,625,437.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,
DRAIN INJ JOINT BURSA WO US,20600,CDM,960,RC,20600,HCPCS,outpatient,,,143,100.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.39,34.39,
ASPIRATION JOINT/BURSA,20605,CDM,960,RC,20605,HCPCS,outpatient,,,196,137.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.35,35.35,
I&D COMPLICATED FINGER ABSCESS,26011,CDM,960,RC,26011,HCPCS,outpatient,,,861,602.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.8,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,175.8,175.8,
APPLY UNNABOOT,29580,CDM,960,RC,29580,HCPCS,outpatient,,,165,115.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.36,100,,,fee schedule,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.36,25.36,
BIOPSY ANORECTAL WALL,45100,CDM,960,RC,45100,HCPCS,outpatient,,,674,471.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288.56,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,288.56,288.56,
COLONOSCOPY,45378,CDM,960,RC,,,outpatient,,,875,612.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,
INSERT INDWELLING BLADDER CATH,51702,CDM,960,RC,51702,HCPCS,outpatient,,,163,114.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.24,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.24,24.24,
REM OF IMPACTD CERUMEN LAV IRR,69209,CDM,960,RC,69209,HCPCS,outpatient,,,127,88.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.12,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14.12,14.12,
REMOVE IMPACTED CERUMEN INSTRU,69210,CDM,960,RC,69210,HCPCS,outpatient,,,138,96.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.21,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31.21,31.21,
REMOVAL DEVITAL TIS 20 CM<,97597,CDM,960,RC,97597,HCPCS,outpatient,,,230,161,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.11,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.11,34.11,
REMOVAL DEVITAL TIS ADDL 20CM<,97598,CDM,960,RC,97598,HCPCS,outpatient,,,80,56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.65,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.65,23.65,
New Pt Lvl 2 (<30 min),99202,CDM,960,RC,99202,HCPCS,outpatient,,,203,142.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.39,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.39,45.39,
New Pt Lvl 2 (<30 min),99202P,CDM,960,RC,99202,HCPCS,outpatient,,,88,61.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.39,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.39,45.39,
New Pt Lvl 3 (<45 min),99203,CDM,960,RC,99203,HCPCS,outpatient,,,289,202.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.6,78.6,
New Pt Lvl 3 (<45 min),99203P,CDM,960,RC,99203,HCPCS,outpatient,,,174,121.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.6,78.6,
New Pt Lvl 4 (<60 min),99204,CDM,960,RC,99204,HCPCS,outpatient,,,440,308,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.79,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.79,127.79,
New Pt Lvl 4 (<60 min),99204P,CDM,960,RC,99204,HCPCS,outpatient,,,325,227.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.79,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.79,127.79,
New Pt Lvl 5 (60+min),99205,CDM,960,RC,99205,HCPCS,outpatient,,,555,388.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.69,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.69,173.69,
New Pt Lvl 5 (60+min),99205P,CDM,960,RC,99205,HCPCS,outpatient,,,440,308,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.69,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.69,173.69,
Estab Pt Lvl 1 (<10 min),99211,CDM,960,RC,99211,HCPCS,outpatient,,,130,91,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.38,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.38,8.38,
Estab Pt Lvl 1 (<10 min),99211P,CDM,960,RC,99211,HCPCS,outpatient,,,15,10.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.38,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.38,8.38,
Estab Pt Lvl 2 (<20 min),99212,CDM,960,RC,99212,HCPCS,outpatient,,,130,91,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.83,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.83,33.83,
Estab Pt Lvl 2 (<20 min),99212P,CDM,960,RC,99212,HCPCS,outpatient,,,15,10.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15,15,
Estab Pt Lvl 3 (<30 min),99213,CDM,960,RC,99213,HCPCS,outpatient,,,198,138.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.07,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.07,63.07,
Estab Pt Lvl 3 (<30 min),99213P,CDM,960,RC,99213,HCPCS,outpatient,,,83,58.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.07,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.07,63.07,
Estab Pt Lvl 4 (<40 min),99214,CDM,960,RC,99214,HCPCS,outpatient,,,290,203,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.98,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.98,92.98,
Estab Pt Lvl 4 (<40 min),99214P,CDM,960,RC,99214,HCPCS,outpatient,,,175,122.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.98,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.98,92.98,
Estab Pt Lvl 5 (40+min),99215,CDM,960,RC,99215,HCPCS,outpatient,,,390,273,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.88,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,137.88,137.88,
Estab Pt Lvl 5 (40+min),99215P,CDM,960,RC,99215,HCPCS,outpatient,,,275,192.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.88,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,137.88,137.88,
INITL HOSP ADM 30 MIN/LEVEL 1,99221,CDM,960,RC,99221,HCPCS,outpatient,,,277,193.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.4,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79.4,79.4,
INITL HOSP ADM 50 MIN/LEVEL 2,99222,CDM,960,RC,99222,HCPCS,outpatient,,,340,238,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.11,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.11,125.11,
HOSPITAL ADMISSIONS 3,99223,CDM,960,RC,99223,HCPCS,outpatient,,,501,350.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.76,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,165.76,165.76,
HOSP F/U VISIT LEVEL 1,99231,CDM,960,RC,99231,HCPCS,outpatient,,,118,82.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.47,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.47,47.47,
HOSP F/U VISIT LEVEL 2,99232,CDM,960,RC,99232,HCPCS,outpatient,,,199,139.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.45,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75.45,75.45,
HOSPITAL SUBSEQ CARE LEVEL3,99233,CDM,960,RC,99233,HCPCS,outpatient,,,284,198.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.53,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,113.53,113.53,
OBSERVATION FOLLOW-UP VISIT,99234,CDM,960,RC,,,outpatient,,,331,231.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,
HOSPITAL DISCHARGE,99238,CDM,960,RC,99238,HCPCS,outpatient,,,198,138.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.1,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.1,77.1,
"HOSPITAL DISCHARGE, 30 MIN >",99239,CDM,960,RC,99239,HCPCS,outpatient,,,290,203,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.89,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.89,108.89,
HOSPITAL INPT CONSULT LEVEL 2,99252,CDM,960,RC,99252,HCPCS,outpatient,,,275,192.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.22,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68.22,68.22,
HOSP INPT CONSULT LVL3 50 MIN,99253,CDM,960,RC,99253,HCPCS,outpatient,,,329,230.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.26,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,95.26,95.26,
IN PT CONSULT LEVEL 4 80 MIN,99254,CDM,960,RC,99254,HCPCS,outpatient,,,414,289.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.01,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.01,132.01,
HOSP INPT CONSULT LVL5 80 MIN,99255,CDM,960,RC,99255,HCPCS,outpatient,,,484,338.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.49,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,178.49,178.49,
CRITICAL CARE  HOUR 1,99291,CDM,960,RC,99291,HCPCS,outpatient,,,680,476,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.74,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,204.74,204.74,
CRITICAL CARE/EACH ADDL 30 MIN,99292,CDM,960,RC,99292,HCPCS,outpatient,,,335,234.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.19,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,103.19,103.19,
INITIAL NH/SB LOW COMPLEX,99304,CDM,960,RC,99304,HCPCS,outpatient,,,245,171.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.52,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76.52,76.52,
INIT NURS HOME CARE/SB/SKILLED,99305,CDM,960,RC,99305,HCPCS,outpatient,,,354,247.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.08,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.08,127.08,
NURSING HOME/SWING BED ADMIT,99306,CDM,960,RC,99306,HCPCS,outpatient,,,453,317.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.83,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.83,173.83,
NURSING HOME/SWING BED LEVEL 1,99307,CDM,960,RC,99307,HCPCS,outpatient,,,130,91,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.18,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.18,38.18,
NURSING HOME/SWING BED LEVEL 2,99308,CDM,960,RC,99308,HCPCS,outpatient,,,186,130.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.65,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70.65,70.65,
NURSING HOME/SWING BED LEVEL 3,99309,CDM,960,RC,99309,HCPCS,outpatient,,,247,172.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.32,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,102.32,102.32,
NURSING HOME/SWING BED LEVEL 4,99310,CDM,960,RC,99310,HCPCS,outpatient,,,367,256.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.29,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.29,146.29,
DISCHARGED FROM SWING BED,99315,CDM,960,RC,99315,HCPCS,outpatient,,,200,140,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.65,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77.65,77.65,
NH/SB DISCHARGE > 30 MIN,99316,CDM,960,RC,99316,HCPCS,outpatient,,,287,200.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.03,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.03,125.03,
NEW 18-39 YR PREVENTATIVE CARE,99385,CDM,960,RC,99385,HCPCS,outpatient,,,271,189.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.66,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.66,89.66,
NEW 18-39 YR PREVENTATIVE CARE,99385P,CDM,960,RC,99385,HCPCS,outpatient,,,156,109.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.66,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.66,89.66,
NEW PT PREVENT CARE 40-64 YRS,99386,CDM,960,RC,99386,HCPCS,outpatient,,,299,209.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.68,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.68,108.68,
NEW PT PREVENT CARE 40-64 YRS,99386P,CDM,960,RC,99386,HCPCS,outpatient,,,184,128.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.68,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,108.68,108.68,
PREVEN CARE NEW PT 65 AND OVER,99387,CDM,960,RC,99387,HCPCS,outpatient,,,323,226.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.73,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,116.73,116.73,
PREVEN CARE NEW PT 65 AND OVER,99387P,CDM,960,RC,99387,HCPCS,outpatient,,,208,145.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.73,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,116.73,116.73,
PREVENTAT PHYSICAL 18-39 YEARS,99395,CDM,960,RC,99395,HCPCS,outpatient,,,228,159.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.91,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.91,81.91,
PREVENTAT PHYSICAL 18-39 YEARS,99395P,CDM,960,RC,99395,HCPCS,outpatient,,,113,79.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.91,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81.91,81.91,
PREVENTIVE PHYSICAL EST PT >65,99397,CDM,960,RC,99397,HCPCS,outpatient,,,268,187.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.5,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.5,93.5,
PREVENTIVE PHYSICAL EST PT >65,99397P,CDM,960,RC,99397,HCPCS,outpatient,,,153,107.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.5,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.5,93.5,
NEWBORN HOSP ADMIT,99460,CDM,960,RC,99460,HCPCS,outpatient,,,263,184.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.83,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88.83,88.83,
SUBSEQUENT HOSP CARE NEWBORN,99462,CDM,960,RC,99462,HCPCS,outpatient,,,126,88.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.07,100,,,fee schedule ,pays at line item charges due to status indicator see on CMS APC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39.07,39.07,
CHRON CARE MGMT 20 MIN,99490,CDM,960,RC,99490,HCPCS,outpatient,,,122,85.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.96,100,,,fee schedule ,pays at line item charges due to status indicator see on CMS APC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.96,47.96,
CHRON CARE MGMT 20 MIN,99490P,CDM,960,RC,99490,HCPCS,outpatient,,,49,34.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.96,100,,,fee schedule ,pays at line item charges due to status indicator see on CMS APC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.96,47.96,
CHRON CARE MGMT 20 MIN,99490T,CDM,960,RC,99490,HCPCS,outpatient,,,73,51.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.96,100,,,fee schedule ,pays at line item charges due to status indicator see on CMS APC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47.96,47.96,
INITIAL FOOT EXAM PT LOPS,G0245,CDM,960,RC,G0245,HCPCS,outpatient,,,178,124.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.26,100,,,fee schedule ,pays at line item charges due to status indicator see on CMS APC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.26,38.26,
INITIAL FOOT EXAM PT LOPS,G0245P,CDM,960,RC,G0245,HCPCS,outpatient,,,63,44.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.26,100,,,fee schedule ,pays at line item charges due to status indicator see on CMS APC fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38.26,38.26,
LUMBSPINE COMPL  MIN 4V,9721418-1,CDM,972,RC,72110,HCPCS,outpatient,,,617,431.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.94,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.94,34.94,
PF PT QUAL NON-PHYS HC 5-10 MN,977002061,CDM,977,RC,98970,HCPCS,outpatient,,,36,25.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.29,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.29,11.29,
PF PT QUAL NON-PHY HC 11-20 MN,977002062,CDM,977,RC,98971,HCPCS,outpatient,,,63,44.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.01,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.01,20.01,
PF PT QUAL NON-PHYS HC 21>MIN,977002063,CDM,977,RC,98972,HCPCS,outpatient,,,98,68.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.5,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.5,29.5,
PF OT QUAL NON-PHYS HC 5-10 MN,978002061,CDM,978,RC,98970,HCPCS,outpatient,,,36,25.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.29,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11.29,11.29,
PF OT QUAL NON-PHY HC 11-20 MN,978002062,CDM,978,RC,98971,HCPCS,outpatient,,,63,44.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.01,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.01,20.01,
PF OT QUAL NON-PHYS HC 21>MIN,978002063,CDM,978,RC,98972,HCPCS,outpatient,,,98,68.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.5,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.5,29.5,
PF DRAINAGE OF SKIN ABSCESS,983010060,CDM,983,RC,10060,HCPCS,outpatient,,,411,287.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.84,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.84,99.84,
PF DRAINAGE OF SKIN ABSCESS,983010061,CDM,983,RC,10061,HCPCS,outpatient,,,623,436.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.18,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.18,174.18,
PF DRAINAGE OF PILONIDAL CYST,983010080,CDM,983,RC,10080,HCPCS,outpatient,,,352,246.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.98,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,98.98,98.98,
PF DRAINAGE OF PILONIDAL CYST,983010081,CDM,983,RC,10081,HCPCS,outpatient,,,592,414.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.02,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,163.02,163.02,
PF REMOVE FOREIGN BODY,983010120,CDM,983,RC,10120,HCPCS,outpatient,,,354,247.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.05,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,99.05,99.05,
PF REMOVE FOREIGN BODY COMPLIC,983010121,CDM,983,RC,10121,HCPCS,outpatient,,,647,452.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.51,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,174.51,174.51,
PF DRAINAGE OF HEMATOMA/FLUID,983010140,CDM,983,RC,10140,HCPCS,outpatient,,,410,287,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.89,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,111.89,111.89,
PF PUNCTURE DRAINAGE OF LESION,983010160,CDM,983,RC,10160,HCPCS,outpatient,,,328,229.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91,91,
PF COMPLEX DRAINAGE WOUND,983010180,CDM,983,RC,10180,HCPCS,outpatient,,,618,432.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.45,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,169.45,169.45,
PF DEB SUBQ TISSUE 20 SQ CM<,983011042,CDM,983,RC,11042,HCPCS,outpatient,,,215,150.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.66,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57.66,57.66,
PF DEBRIDE MUSC FASC 20 SQCM<,983011043,CDM,983,RC,11043,HCPCS,outpatient,,,548,383.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.79,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,146.79,146.79,
PF DEBRIDEMENT BONE 20 SQ CM<,983011044,CDM,983,RC,11044,HCPCS,outpatient,,,812,568.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.25,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,216.25,216.25,
PF DEBRIDE SUBQ TISSUE ADD-ON,983011045,CDM,983,RC,11045,HCPCS,outpatient,,,94,65.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.33,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.33,24.33,
PF DEBRIDE MUSC FASCIA ADD-ON,983011046,CDM,983,RC,11046,HCPCS,outpatient,,,200,140,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.72,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.72,52.72,
PF DEBRIDE BONE ADD-ON,983011047,CDM,983,RC,11047,HCPCS,outpatient,,,354,247.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.15,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,93.15,93.15,
PF TRIM SKIN LESION,983011055,CDM,983,RC,11055,HCPCS,outpatient,,,57,39.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.01,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.01,15.01,
PF TRIM SKIN LESIONS 2 TO 4,983011056,CDM,983,RC,11056,HCPCS,outpatient,,,81,56.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.22,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21.22,21.22,
PF TRIM SKIN LESIONS OVER 4,983011057,CDM,983,RC,11057,HCPCS,outpatient,,,106,74.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27.72,27.72,
PF TANGNTL BX SKIN SINGLE LES,983011102,CDM,983,RC,11102,HCPCS,outpatient,,,140,98,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.77,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.77,35.77,
PF TANGNTL BX SKIN EA SEP/ADDL,983011103,CDM,983,RC,11103,HCPCS,outpatient,,,81,56.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.74,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.74,20.74,
PF PUNCH BX SKIN SINGLE LESION,983011104,CDM,983,RC,11104,HCPCS,outpatient,,,175,122.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.49,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44.49,44.49,
PF PUNCH BX SKIN EA SEP/ADDL,983011105,CDM,983,RC,11105,HCPCS,outpatient,,,96,67.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.33,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24.33,24.33,
PF INCAL BX SKIN SINGLE LES,983011106,CDM,983,RC,11106,HCPCS,outpatient,,,213,149.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.84,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.84,53.84,
PF INCAL BX SKIN EA SEP/ADDL,983011107,CDM,983,RC,11107,HCPCS,outpatient,,,114,79.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.13,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29.13,29.13,
PF TRIM NAIL/S ANY NUMBER,983011719,CDM,983,RC,11719,HCPCS,outpatient,,,27,18.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.16,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.16,7.16,
PF DEBRIDE NAIL 1-5,983011720,CDM,983,RC,11720,HCPCS,outpatient,,,52,36.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.71,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13.71,13.71,
PF DEBRIDE NAIL 6 OR MORE,983011721,CDM,983,RC,11721,HCPCS,outpatient,,,88,61.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.84,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22.84,22.84,
PF REMOVAL OF NAIL PLATE,983011730,CDM,983,RC,11730,HCPCS,outpatient,,,194,135.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.48,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51.48,51.48,
PF REMOVE NAIL PLATE ADD-ON,983011732,CDM,983,RC,11732,HCPCS,outpatient,,,63,44.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.3,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.3,16.3,
PF REMOVAL OF NAIL BED,983011750,CDM,983,RC,11750,HCPCS,outpatient,,,354,247.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.57,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96.57,96.57,
PF WOUND PREP TRK/ARM/LEG,983015002,CDM,983,RC,15002,HCPCS,outpatient,,,794,555.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.9,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,208.9,208.9,
PF EPIDRM AUTOGRFT TNK/ARM/LEG,983015110,CDM,983,RC,15110,HCPCS,outpatient,,,2428,1699.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,682.75,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,682.75,682.75,
PF EPIDRM AUTOGFT T/A/L ADD-ON,983015111,CDM,983,RC,15111,HCPCS,outpatient,,,373,261.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.76,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97.76,97.76,
PF EPIDRM A-GRFT FACE/NCK/HF/G,983015115,CDM,983,RC,15115,HCPCS,outpatient,,,2407,1684.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,665.36,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,665.36,665.36,
PF EPIDRM A-GRFT F/N/HF/G ADDL,983015116,CDM,983,RC,15116,HCPCS,outpatient,,,538,376.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.88,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,132.88,132.88,
PF SKIN SUB GRAFT TRNK/ARM/LEG,983015271,CDM,983,RC,15271,HCPCS,outpatient,,,298,208.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.23,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,80.23,80.23,
PF SKIN SUB GRAFT T/A/L ADD-ON,983015272,CDM,983,RC,15272,HCPCS,outpatient,,,62,43.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.19,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16.19,16.19,
PF SKIN SUB GRFT T/AM/LG CHILD,983015273,CDM,983,RC,15273,HCPCS,outpatient,,,721,504.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.81,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,186.81,186.81,
PF SKIN SUB GFT T/A/L CHLD ADD,983015274,CDM,983,RC,15274,HCPCS,outpatient,,,165,115.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.63,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42.63,42.63,
PF SKIN SUB GRAFT FACE/NK/HF/G,983015275,CDM,983,RC,15275,HCPCS,outpatient,,,338,236.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.33,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,89.33,89.33,
PF SKIN SUB GRFT F/N/HF/G ADDL,983015276,CDM,983,RC,15276,HCPCS,outpatient,,,90,63,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.99,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.99,23.99,
PF SKIN SUB GFT F/N/HF/G CHILD,983015277,CDM,983,RC,15277,HCPCS,outpatient,,,815,570.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.9,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,212.9,212.9,
PF SKN SUB GFT F/N/HF/G CH ADD,983015278,CDM,983,RC,15278,HCPCS,outpatient,,,205,143.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.24,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53.24,53.24,
PF DRESS/DEBRID P-THICK BURN S,983016020,CDM,983,RC,16020,HCPCS,outpatient,,,187,130.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.61,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52.61,52.61,
PF DRESS/DEBRID P-THICK BURN M,983016025,CDM,983,RC,16025,HCPCS,outpatient,,,386,270.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.13,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,106.13,106.13,
PF DRESS/DEBRID P-THICK BURN L,983016030,CDM,983,RC,16030,HCPCS,outpatient,,,467,326.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.95,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,125.95,125.95,
PF CHEM CAUTERIZ GRANUL TISSUE,983017250,CDM,983,RC,17250,HCPCS,outpatient,,,127,88.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.47,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35.47,35.47,
PF APPLY RIGID LEG CAST,983029445,CDM,983,RC,29445,HCPCS,outpatient,,,360,252,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.45,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,94.45,94.45,
PF APPLICATION OF PASTE BOOT,983029580,CDM,983,RC,29580,HCPCS,outpatient,,,98,68.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.36,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.36,25.36,
PF APPLY MULTLAY COMPR LWR LEG,983029581,CDM,983,RC,29581,HCPCS,outpatient,,,99,69.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.58,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.58,25.58,
PF REMOVAL DEVITAL TISS 20 CM<,983095797,CDM,983,RC,95797,HCPCS,outpatient,,,84,58.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,
PF REMOVAL DEVITAL TIS 20 CM<,983097597,CDM,983,RC,97597,HCPCS,outpatient,,,84,58.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.11,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34.11,34.11,
PF REMVL DEVITAL TIS ADL 20CM<,983097598,CDM,983,RC,97598,HCPCS,outpatient,,,40,28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.65,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.65,23.65,
PF NEG PRESS WND THER <=50 SC,983097605,CDM,983,RC,97605,HCPCS,outpatient,,,141,98.7,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.33,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23.33,23.33,
PF NEG PRESS WND THER >50 SQCM,983097606,CDM,983,RC,97606,HCPCS,outpatient,,,166,116.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.58,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25.58,25.58,
PF NEG PRESS WND THER <50 SQCM,983097607,CDM,983,RC,97607,HCPCS,outpatient,,,80,56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.36,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20.36,20.36,
NEW WC PROF LEV 2  15 MIN,983099202,CDM,983,RC,99202,HCPCS,outpatient,,,176,123.2,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.39,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45.39,45.39,
EM NEW WC PROF LEV 3  30 MIN,983099203,CDM,983,RC,99203,HCPCS,outpatient,,,265,185.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.6,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78.6,78.6,
EM NEW WC PROF LEV 4  45 MIN,983099204,CDM,983,RC,99204,HCPCS,outpatient,,,448,313.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.79,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,127.79,127.79,
EM NEW WC PROF LEV 5  60 MIN,983099205,CDM,983,RC,99205,HCPCS,outpatient,,,585,409.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.69,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,173.69,173.69,
EM EST WC SIMPLE PROF LEVEL 1,983099211,CDM,983,RC,99211,HCPCS,outpatient,,,32,22.4,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.38,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8.38,8.38,
EST WC SIM PROF LEV 2  10 MIN,983099212,CDM,983,RC,99212,HCPCS,outpatient,,,89,62.3,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.83,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33.83,33.83,
EST WC SIMP PROF LEV 3  20 MIN,983099213,CDM,983,RC,99213,HCPCS,outpatient,,,177,123.9,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.07,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63.07,63.07,
EST WC SIMP PROF LEV 4  30 MIN,983099214,CDM,983,RC,99214,HCPCS,outpatient,,,273,191.1,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.98,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,92.98,92.98,
EST WC SIMP PROF LEV 5  40 MIN,983099215,CDM,983,RC,99215,HCPCS,outpatient,,,385,269.5,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.88,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,137.88,137.88,
EKG PROFESSIONAL FEE,9850690-1,CDM,985,RC,93010,HCPCS,outpatient,,,68,47.6,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.75,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,7.75,7.75,
HOLTER MONITOR PROF FEE,9850695-1,CDM,985,RC,93227,HCPCS,outpatient,,,164,114.8,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.42,100,,,fee schedule ,100% of CMS fee schedule,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17.42,17.42,
FINGER PRINT FELDER HR,3000085891,CDM,998,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
BACKGROUND CRIMINAL,300085890,CDM,998,RC,,,outpatient,,,25,17.5,,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,22.5,90,,18,percent of total billed charges,90% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,19.31,77.22,,15.45,percent of total billed charges,77.22% of total billed charges,16.53,66.1,,13.22,percent of total billed charges,66.1% of total billed charges,20.75,83,,16.6,percent of total billed charges,83% of total,23.75,95,,19,percent of total billed charges ,95% of total billed charges,20,80,,16,percent of total billed charges,78% of total billed charges,19.5,78,,15.6,percent of total billed charges,78% of total billed charges,,,,,other ,not seperately reimbursable,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,,,,,other ,not seperately reimbursable,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,15.75,63,,12.6,percent of total billed charges,63% of total billed charges,21.25,85,,17,percent of total billed charges,85% of total billed charges,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,19.75,79,,15.8,percent of total billed charges,79% of total billed charges,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15.75,450,
ALF PATIENT DAY STATISTIC,999500170,CDM,999,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
DUMMY CHARGE TO BILL ACCTS,999999999,CDM,999,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
"BALANCE FOWARD, DUE FROM PHYS",BAL FWD,CDM,999,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PHYSICIAN DENTAL INSURANCE,DNTL INS,CDM,999,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
ELECTRONIC DEVICE REIMBURSEMEN,ELECT REIM,CDM,999,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
PHYSICIAN HEALTH INS,HLTH INS,CDM,999,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
OFFICE RENT,RENT,CDM,999,RC,,,outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable ,450,100,,,case rate,pays based on per visit rate,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,450,450,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,MS-DRG,,,,,Inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325682.8,100,MS DRG,260546.24,case rate,100% of CMS IPPS rate,521092.48,160,MS DRG,416873.98,case rate,160% of CMS IPPS rate,423387.64,130,MS DRG,338710.11,case rate,130% of CMS IPPS rate,107393.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,112762.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,325682.8,100,MS DRG,260546.24,case rate,100% of CMS IPPS rate,107393.33,100,,,case rate,100% of CMS IPPS rate,325682.8,100,MS DRG,260546.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107393.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,919545.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,325682.8,100,MS DRG,260546.24,case rate,100% of CMS IPPS rate,325682.8,100,MS DRG,260546.24,case rate,100% of CMS IPPS rate,107393.3,919545.8,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150430.27,100,MS DRG,120344.22,case rate,100% of CMS IPPS rate,240688.43,160,MS DRG,192550.74,case rate,160% of CMS IPPS rate,195559.35,130,MS DRG,156447.48,case rate,130% of CMS IPPS rate,35855.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37647.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,150430.27,100,MS DRG,120344.22,case rate,100% of CMS IPPS rate,35855.22,100,,,case rate,100% of CMS IPPS rate,150430.27,100,MS DRG,120344.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35855.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1332013.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,150430.27,100,MS DRG,120344.22,case rate,100% of CMS IPPS rate,150430.27,100,MS DRG,120344.22,case rate,100% of CMS IPPS rate,35855.22,1332013,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257510.76,100,MS DRG,206008.61,case rate,100% of CMS IPPS rate,412017.22,160,MS DRG,329613.78,case rate,160% of CMS IPPS rate,334763.99,130,MS DRG,267811.19,case rate,130% of CMS IPPS rate,81709.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,85794.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,257510.76,100,MS DRG,206008.61,case rate,100% of CMS IPPS rate,81709.26,100,,,case rate,100% of CMS IPPS rate,257510.76,100,MS DRG,206008.61,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81709.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,844636.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,257510.76,100,MS DRG,206008.61,case rate,100% of CMS IPPS rate,257510.76,100,MS DRG,206008.61,case rate,100% of CMS IPPS rate,81709.26,844636.5,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179404.84,100,MS DRG,143523.87,case rate,100% of CMS IPPS rate,287047.74,160,MS DRG,229638.19,case rate,160% of CMS IPPS rate,233226.29,130,MS DRG,186581.03,case rate,130% of CMS IPPS rate,53871.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,56564.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,179404.84,100,MS DRG,143523.87,case rate,100% of CMS IPPS rate,53871.47,100,,,case rate,100% of CMS IPPS rate,179404.84,100,MS DRG,143523.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53871.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,613233.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,179404.84,100,MS DRG,143523.87,case rate,100% of CMS IPPS rate,179404.84,100,MS DRG,143523.87,case rate,100% of CMS IPPS rate,53871.47,613233.9,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128083.8,100,MS DRG,102467.04,case rate,100% of CMS IPPS rate,204934.08,160,MS DRG,163947.26,case rate,160% of CMS IPPS rate,166508.94,130,MS DRG,133207.15,case rate,130% of CMS IPPS rate,40601.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42631.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,128083.8,100,MS DRG,102467.04,case rate,100% of CMS IPPS rate,40601.48,100,,,case rate,100% of CMS IPPS rate,128083.8,100,MS DRG,102467.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40601.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,682001.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,128083.8,100,MS DRG,102467.04,case rate,100% of CMS IPPS rate,128083.8,100,MS DRG,102467.04,case rate,100% of CMS IPPS rate,40601.48,682001.9,
LIVER TRANSPLANT WITHOUT MCC,6,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63040.57,100,MS DRG,50432.46,case rate,100% of CMS IPPS rate,100864.91,160,MS DRG,80691.93,case rate,160% of CMS IPPS rate,81952.74,130,MS DRG,65562.19,case rate,130% of CMS IPPS rate,18487.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19412.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63040.57,100,MS DRG,50432.46,case rate,100% of CMS IPPS rate,18487.87,100,,,case rate,100% of CMS IPPS rate,63040.57,100,MS DRG,50432.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18487.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1000149.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,63040.57,100,MS DRG,50432.46,case rate,100% of CMS IPPS rate,63040.57,100,MS DRG,50432.46,case rate,100% of CMS IPPS rate,18487.87,1000150,
LUNG TRANSPLANT,7,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150693.37,100,MS DRG,120554.7,case rate,100% of CMS IPPS rate,241109.39,160,MS DRG,192887.51,case rate,160% of CMS IPPS rate,195901.38,130,MS DRG,156721.1,case rate,130% of CMS IPPS rate,49825.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52316.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,150693.37,100,MS DRG,120554.7,case rate,100% of CMS IPPS rate,49825.58,100,,,case rate,100% of CMS IPPS rate,150693.37,100,MS DRG,120554.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49825.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,883611.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,150693.37,100,MS DRG,120554.7,case rate,100% of CMS IPPS rate,150693.37,100,MS DRG,120554.7,case rate,100% of CMS IPPS rate,49825.58,883611.6,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68052.34,100,MS DRG,54441.87,case rate,100% of CMS IPPS rate,108883.74,160,MS DRG,87106.99,case rate,160% of CMS IPPS rate,88468.04,130,MS DRG,70774.43,case rate,130% of CMS IPPS rate,20744.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21781.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,68052.34,100,MS DRG,54441.87,case rate,100% of CMS IPPS rate,20744.52,100,,,case rate,100% of CMS IPPS rate,68052.34,100,MS DRG,54441.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20744.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,858614.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,68052.34,100,MS DRG,54441.87,case rate,100% of CMS IPPS rate,68052.34,100,MS DRG,54441.87,case rate,100% of CMS IPPS rate,20744.52,858614.8,
PANCREAS TRANSPLANT,10,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62765.67,100,MS DRG,50212.54,case rate,100% of CMS IPPS rate,100425.07,160,MS DRG,80340.06,case rate,160% of CMS IPPS rate,81595.37,130,MS DRG,65276.3,case rate,130% of CMS IPPS rate,30397.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31917.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62765.67,100,MS DRG,50212.54,case rate,100% of CMS IPPS rate,30397.54,100,,,case rate,100% of CMS IPPS rate,62765.67,100,MS DRG,50212.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30397.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,740174.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,62765.67,100,MS DRG,50212.54,case rate,100% of CMS IPPS rate,62765.67,100,MS DRG,50212.54,case rate,100% of CMS IPPS rate,30397.54,740175,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66808.83,100,MS DRG,53447.06,case rate,100% of CMS IPPS rate,106894.13,160,MS DRG,85515.3,case rate,160% of CMS IPPS rate,86851.48,130,MS DRG,69481.18,case rate,130% of CMS IPPS rate,20572.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21600.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,66808.83,100,MS DRG,53447.06,case rate,100% of CMS IPPS rate,20572.19,100,,,case rate,100% of CMS IPPS rate,66808.83,100,MS DRG,53447.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20572.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,700949.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,66808.83,100,MS DRG,53447.06,case rate,100% of CMS IPPS rate,66808.83,100,MS DRG,53447.06,case rate,100% of CMS IPPS rate,20572.19,700950,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53224.68,100,MS DRG,42579.74,case rate,100% of CMS IPPS rate,85159.49,160,MS DRG,68127.59,case rate,160% of CMS IPPS rate,69192.08,130,MS DRG,55353.66,case rate,130% of CMS IPPS rate,15645.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16427.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53224.68,100,MS DRG,42579.74,case rate,100% of CMS IPPS rate,15645.6,100,,,case rate,100% of CMS IPPS rate,53224.68,100,MS DRG,42579.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15645.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600857.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53224.68,100,MS DRG,42579.74,case rate,100% of CMS IPPS rate,53224.68,100,MS DRG,42579.74,case rate,100% of CMS IPPS rate,15645.6,600857.8,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37660.84,100,MS DRG,30128.67,case rate,100% of CMS IPPS rate,60257.34,160,MS DRG,48205.87,case rate,160% of CMS IPPS rate,48959.09,130,MS DRG,39167.27,case rate,130% of CMS IPPS rate,10103.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10608.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37660.84,100,MS DRG,30128.67,case rate,100% of CMS IPPS rate,10103.28,100,,,case rate,100% of CMS IPPS rate,37660.84,100,MS DRG,30128.67,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10103.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,613554.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37660.84,100,MS DRG,30128.67,case rate,100% of CMS IPPS rate,37660.84,100,MS DRG,30128.67,case rate,100% of CMS IPPS rate,10103.28,613554.2,
ALLOGENEIC BONE MARROW TRANSPLANT,14,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141190.14,100,MS DRG,112952.11,case rate,100% of CMS IPPS rate,225904.22,160,MS DRG,180723.38,case rate,160% of CMS IPPS rate,183547.18,130,MS DRG,146837.74,case rate,130% of CMS IPPS rate,49951.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52448.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,141190.14,100,MS DRG,112952.11,case rate,100% of CMS IPPS rate,49951.4,100,,,case rate,100% of CMS IPPS rate,141190.14,100,MS DRG,112952.11,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49951.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,651432.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,141190.14,100,MS DRG,112952.11,case rate,100% of CMS IPPS rate,141190.14,100,MS DRG,112952.11,case rate,100% of CMS IPPS rate,49951.4,651433,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,126161.6,160,MS DRG,100929.28,case rate,160% of CMS IPPS rate,102506.3,130,MS DRG,82005.04,case rate,130% of CMS IPPS rate,23012.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24162.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,23012.23,100,,,case rate,100% of CMS IPPS rate,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23012.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455889.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,23012.23,455889.2,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,126161.6,160,MS DRG,100929.28,case rate,160% of CMS IPPS rate,102506.3,130,MS DRG,82005.04,case rate,130% of CMS IPPS rate,23012.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24162.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,23012.23,100,,,case rate,100% of CMS IPPS rate,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23012.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,554953.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,78851,100,MS DRG,63080.8,case rate,100% of CMS IPPS rate,23012.23,554953.9,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440643.1,100,MS DRG,352514.48,case rate,100% of CMS IPPS rate,705028.96,160,MS DRG,564023.17,case rate,160% of CMS IPPS rate,572836.03,130,MS DRG,458268.82,case rate,130% of CMS IPPS rate,143782.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,150971.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,440643.1,100,MS DRG,352514.48,case rate,100% of CMS IPPS rate,143782.31,100,,,case rate,100% of CMS IPPS rate,440643.1,100,MS DRG,352514.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143782.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3247726.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,440643.1,100,MS DRG,352514.48,case rate,100% of CMS IPPS rate,440643.1,100,MS DRG,352514.48,case rate,100% of CMS IPPS rate,143782.3,3247726,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100281.96,100,MS DRG,80225.57,case rate,100% of CMS IPPS rate,160451.14,160,MS DRG,128360.91,case rate,160% of CMS IPPS rate,130366.55,130,MS DRG,104293.24,case rate,130% of CMS IPPS rate,30223.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31734.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,100281.96,100,MS DRG,80225.57,case rate,100% of CMS IPPS rate,30223.31,100,,,case rate,100% of CMS IPPS rate,100281.96,100,MS DRG,80225.57,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30223.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,913076.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,100281.96,100,MS DRG,80225.57,case rate,100% of CMS IPPS rate,100281.96,100,MS DRG,80225.57,case rate,100% of CMS IPPS rate,30223.31,913076.3,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105696.02,100,MS DRG,84556.82,case rate,100% of CMS IPPS rate,169113.63,160,MS DRG,135290.9,case rate,160% of CMS IPPS rate,137404.83,130,MS DRG,109923.86,case rate,130% of CMS IPPS rate,30733.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32270.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105696.02,100,MS DRG,84556.82,case rate,100% of CMS IPPS rate,30733.43,100,,,case rate,100% of CMS IPPS rate,105696.02,100,MS DRG,84556.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30733.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,938286.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,105696.02,100,MS DRG,84556.82,case rate,100% of CMS IPPS rate,105696.02,100,MS DRG,84556.82,case rate,100% of CMS IPPS rate,30733.43,938286.1,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78430.98,100,MS DRG,62744.78,case rate,100% of CMS IPPS rate,125489.57,160,MS DRG,100391.66,case rate,160% of CMS IPPS rate,101960.27,130,MS DRG,81568.22,case rate,130% of CMS IPPS rate,20362.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21380.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,78430.98,100,MS DRG,62744.78,case rate,100% of CMS IPPS rate,20362.5,100,,,case rate,100% of CMS IPPS rate,78430.98,100,MS DRG,62744.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20362.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1056860.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,78430.98,100,MS DRG,62744.78,case rate,100% of CMS IPPS rate,78430.98,100,MS DRG,62744.78,case rate,100% of CMS IPPS rate,20362.5,1056860,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52254.9,100,MS DRG,41803.92,case rate,100% of CMS IPPS rate,83607.84,160,MS DRG,66886.27,case rate,160% of CMS IPPS rate,67931.37,130,MS DRG,54345.1,case rate,130% of CMS IPPS rate,10530.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11056.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52254.9,100,MS DRG,41803.92,case rate,100% of CMS IPPS rate,10530.29,100,,,case rate,100% of CMS IPPS rate,52254.9,100,MS DRG,41803.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10530.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,847498.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52254.9,100,MS DRG,41803.92,case rate,100% of CMS IPPS rate,52254.9,100,MS DRG,41803.92,case rate,100% of CMS IPPS rate,10530.29,847498.3,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,23,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72855.28,100,MS DRG,58284.22,case rate,100% of CMS IPPS rate,116568.45,160,MS DRG,93254.76,case rate,160% of CMS IPPS rate,94711.86,130,MS DRG,75769.49,case rate,130% of CMS IPPS rate,21751.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22838.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72855.28,100,MS DRG,58284.22,case rate,100% of CMS IPPS rate,21751.04,100,,,case rate,100% of CMS IPPS rate,72855.28,100,MS DRG,58284.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21751.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,758737.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,72855.28,100,MS DRG,58284.22,case rate,100% of CMS IPPS rate,72855.28,100,MS DRG,58284.22,case rate,100% of CMS IPPS rate,21751.04,758737.6,
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,24,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50675.15,100,MS DRG,40540.12,case rate,100% of CMS IPPS rate,81080.24,160,MS DRG,64864.19,case rate,160% of CMS IPPS rate,65877.7,130,MS DRG,52702.16,case rate,130% of CMS IPPS rate,14494.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15218.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50675.15,100,MS DRG,40540.12,case rate,100% of CMS IPPS rate,14494.21,100,,,case rate,100% of CMS IPPS rate,50675.15,100,MS DRG,40540.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14494.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1239466.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,50675.15,100,MS DRG,40540.12,case rate,100% of CMS IPPS rate,50675.15,100,MS DRG,40540.12,case rate,100% of CMS IPPS rate,14494.21,1239467,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,25,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58074.82,100,MS DRG,46459.86,case rate,100% of CMS IPPS rate,92919.71,160,MS DRG,74335.77,case rate,160% of CMS IPPS rate,75497.27,130,MS DRG,60397.82,case rate,130% of CMS IPPS rate,17050.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17903.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58074.82,100,MS DRG,46459.86,case rate,100% of CMS IPPS rate,17050.91,100,,,case rate,100% of CMS IPPS rate,58074.82,100,MS DRG,46459.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17050.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,892749.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,58074.82,100,MS DRG,46459.86,case rate,100% of CMS IPPS rate,58074.82,100,MS DRG,46459.86,case rate,100% of CMS IPPS rate,17050.91,892749.1,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,26,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40815.61,100,MS DRG,32652.49,case rate,100% of CMS IPPS rate,65304.98,160,MS DRG,52243.98,case rate,160% of CMS IPPS rate,53060.29,130,MS DRG,42448.23,case rate,130% of CMS IPPS rate,11661.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12244.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40815.61,100,MS DRG,32652.49,case rate,100% of CMS IPPS rate,11661.1,100,,,case rate,100% of CMS IPPS rate,40815.61,100,MS DRG,32652.49,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11661.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1164608.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40815.61,100,MS DRG,32652.49,case rate,100% of CMS IPPS rate,40815.61,100,MS DRG,32652.49,case rate,100% of CMS IPPS rate,11661.1,1164608,
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,27,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34678.32,100,MS DRG,27742.66,case rate,100% of CMS IPPS rate,55485.31,160,MS DRG,44388.25,case rate,160% of CMS IPPS rate,45081.82,130,MS DRG,36065.46,case rate,130% of CMS IPPS rate,9408.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9879.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34678.32,100,MS DRG,27742.66,case rate,100% of CMS IPPS rate,9408.64,100,,,case rate,100% of CMS IPPS rate,34678.32,100,MS DRG,27742.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9408.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1697837,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34678.32,100,MS DRG,27742.66,case rate,100% of CMS IPPS rate,34678.32,100,MS DRG,27742.66,case rate,100% of CMS IPPS rate,9408.64,1697837,
SPINAL PROCEDURES WITH MCC,28,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77070.68,100,MS DRG,61656.54,case rate,100% of CMS IPPS rate,123313.09,160,MS DRG,98650.47,case rate,160% of CMS IPPS rate,100191.88,130,MS DRG,80153.5,case rate,130% of CMS IPPS rate,23178.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24337.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77070.68,100,MS DRG,61656.54,case rate,100% of CMS IPPS rate,23178.46,100,,,case rate,100% of CMS IPPS rate,77070.68,100,MS DRG,61656.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23178.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,829864.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,77070.68,100,MS DRG,61656.54,case rate,100% of CMS IPPS rate,77070.68,100,MS DRG,61656.54,case rate,100% of CMS IPPS rate,23178.46,829864.3,
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,29,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46420.81,100,MS DRG,37136.65,case rate,100% of CMS IPPS rate,74273.3,160,MS DRG,59418.64,case rate,160% of CMS IPPS rate,60347.05,130,MS DRG,48277.64,case rate,130% of CMS IPPS rate,12797.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13437.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46420.81,100,MS DRG,37136.65,case rate,100% of CMS IPPS rate,12797.62,100,,,case rate,100% of CMS IPPS rate,46420.81,100,MS DRG,37136.65,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12797.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,899400.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46420.81,100,MS DRG,37136.65,case rate,100% of CMS IPPS rate,46420.81,100,MS DRG,37136.65,case rate,100% of CMS IPPS rate,12797.62,899400.6,
SPINAL PROCEDURES WITHOUT CC/MCC,30,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33334.53,100,MS DRG,26667.62,case rate,100% of CMS IPPS rate,53335.25,160,MS DRG,42668.2,case rate,160% of CMS IPPS rate,43334.89,130,MS DRG,34667.91,case rate,130% of CMS IPPS rate,8484.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8908.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33334.53,100,MS DRG,26667.62,case rate,100% of CMS IPPS rate,8484.47,100,,,case rate,100% of CMS IPPS rate,33334.53,100,MS DRG,26667.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8484.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1040881.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33334.53,100,MS DRG,26667.62,case rate,100% of CMS IPPS rate,33334.53,100,MS DRG,26667.62,case rate,100% of CMS IPPS rate,8484.47,1040881,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54542.51,100,MS DRG,43634.01,case rate,100% of CMS IPPS rate,87268.02,160,MS DRG,69814.42,case rate,160% of CMS IPPS rate,70905.26,130,MS DRG,56724.21,case rate,130% of CMS IPPS rate,15976.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16775.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54542.51,100,MS DRG,43634.01,case rate,100% of CMS IPPS rate,15976.91,100,,,case rate,100% of CMS IPPS rate,54542.51,100,MS DRG,43634.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15976.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,505352.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,54542.51,100,MS DRG,43634.01,case rate,100% of CMS IPPS rate,54542.51,100,MS DRG,43634.01,case rate,100% of CMS IPPS rate,15976.91,505352.6,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31385.52,100,MS DRG,25108.42,case rate,100% of CMS IPPS rate,50216.83,160,MS DRG,40173.46,case rate,160% of CMS IPPS rate,40801.18,130,MS DRG,32640.94,case rate,130% of CMS IPPS rate,8142.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8549.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31385.52,100,MS DRG,25108.42,case rate,100% of CMS IPPS rate,8142.1,100,,,case rate,100% of CMS IPPS rate,31385.52,100,MS DRG,25108.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8142.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,809637.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31385.52,100,MS DRG,25108.42,case rate,100% of CMS IPPS rate,31385.52,100,MS DRG,25108.42,case rate,100% of CMS IPPS rate,8142.1,809637.1,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25121.98,100,MS DRG,20097.58,case rate,100% of CMS IPPS rate,40195.17,160,MS DRG,32156.14,case rate,160% of CMS IPPS rate,32658.57,130,MS DRG,26126.86,case rate,130% of CMS IPPS rate,6082.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6387.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25121.98,100,MS DRG,20097.58,case rate,100% of CMS IPPS rate,6082.94,100,,,case rate,100% of CMS IPPS rate,25121.98,100,MS DRG,20097.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6082.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1067560.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25121.98,100,MS DRG,20097.58,case rate,100% of CMS IPPS rate,25121.98,100,MS DRG,20097.58,case rate,100% of CMS IPPS rate,6082.94,1067561,
CAROTID ARTERY STENT PROCEDURES WITH MCC,34,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52003.6,100,MS DRG,41602.88,case rate,100% of CMS IPPS rate,83205.76,160,MS DRG,66564.61,case rate,160% of CMS IPPS rate,67604.68,130,MS DRG,54083.74,case rate,130% of CMS IPPS rate,14825.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15567.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52003.6,100,MS DRG,41602.88,case rate,100% of CMS IPPS rate,14825.9,100,,,case rate,100% of CMS IPPS rate,52003.6,100,MS DRG,41602.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14825.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1242735.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52003.6,100,MS DRG,41602.88,case rate,100% of CMS IPPS rate,52003.6,100,MS DRG,41602.88,case rate,100% of CMS IPPS rate,14825.9,1242736,
CAROTID ARTERY STENT PROCEDURES WITH CC,35,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33104.48,100,MS DRG,26483.58,case rate,100% of CMS IPPS rate,52967.17,160,MS DRG,42373.74,case rate,160% of CMS IPPS rate,43035.82,130,MS DRG,34428.66,case rate,130% of CMS IPPS rate,8672.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9106.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33104.48,100,MS DRG,26483.58,case rate,100% of CMS IPPS rate,8672.81,100,,,case rate,100% of CMS IPPS rate,33104.48,100,MS DRG,26483.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8672.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1227170.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33104.48,100,MS DRG,26483.58,case rate,100% of CMS IPPS rate,33104.48,100,MS DRG,26483.58,case rate,100% of CMS IPPS rate,8672.81,1227170,
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,36,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27308.14,100,MS DRG,21846.51,case rate,100% of CMS IPPS rate,43693.02,160,MS DRG,34954.42,case rate,160% of CMS IPPS rate,35500.58,130,MS DRG,28400.46,case rate,130% of CMS IPPS rate,6988.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7338.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27308.14,100,MS DRG,21846.51,case rate,100% of CMS IPPS rate,6988.8,100,,,case rate,100% of CMS IPPS rate,27308.14,100,MS DRG,21846.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6988.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1587438.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27308.14,100,MS DRG,21846.51,case rate,100% of CMS IPPS rate,27308.14,100,MS DRG,21846.51,case rate,100% of CMS IPPS rate,6988.8,1587438,
EXTRACRANIAL PROCEDURES WITH MCC,37,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45800.24,100,MS DRG,36640.19,case rate,100% of CMS IPPS rate,73280.38,160,MS DRG,58624.3,case rate,160% of CMS IPPS rate,59540.31,130,MS DRG,47632.25,case rate,130% of CMS IPPS rate,12661.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13294.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45800.24,100,MS DRG,36640.19,case rate,100% of CMS IPPS rate,12661.13,100,,,case rate,100% of CMS IPPS rate,45800.24,100,MS DRG,36640.19,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12661.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,666440.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45800.24,100,MS DRG,36640.19,case rate,100% of CMS IPPS rate,45800.24,100,MS DRG,36640.19,case rate,100% of CMS IPPS rate,12661.13,666440.7,
EXTRACRANIAL PROCEDURES WITH CC,38,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24850.64,100,MS DRG,19880.51,case rate,100% of CMS IPPS rate,39761.02,160,MS DRG,31808.82,case rate,160% of CMS IPPS rate,32305.83,130,MS DRG,25844.66,case rate,130% of CMS IPPS rate,6143.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6450.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24850.64,100,MS DRG,19880.51,case rate,100% of CMS IPPS rate,6143.18,100,,,case rate,100% of CMS IPPS rate,24850.64,100,MS DRG,19880.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6143.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1014201.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24850.64,100,MS DRG,19880.51,case rate,100% of CMS IPPS rate,24850.64,100,MS DRG,19880.51,case rate,100% of CMS IPPS rate,6143.18,1014201,
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,39,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19436.56,100,MS DRG,15549.25,case rate,100% of CMS IPPS rate,31098.5,160,MS DRG,24878.8,case rate,160% of CMS IPPS rate,25267.53,130,MS DRG,20214.02,case rate,130% of CMS IPPS rate,4339.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4556.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19436.56,100,MS DRG,15549.25,case rate,100% of CMS IPPS rate,4339.46,100,,,case rate,100% of CMS IPPS rate,19436.56,100,MS DRG,15549.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4339.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1167473.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19436.56,100,MS DRG,15549.25,case rate,100% of CMS IPPS rate,19436.56,100,MS DRG,15549.25,case rate,100% of CMS IPPS rate,4339.46,1167474,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51403.08,100,MS DRG,41122.46,case rate,100% of CMS IPPS rate,82244.93,160,MS DRG,65795.94,case rate,160% of CMS IPPS rate,66824,130,MS DRG,53459.2,case rate,130% of CMS IPPS rate,14381.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15100.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51403.08,100,MS DRG,41122.46,case rate,100% of CMS IPPS rate,14381.36,100,,,case rate,100% of CMS IPPS rate,51403.08,100,MS DRG,41122.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14381.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,629751.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,51403.08,100,MS DRG,41122.46,case rate,100% of CMS IPPS rate,51403.08,100,MS DRG,41122.46,case rate,100% of CMS IPPS rate,14381.36,629751.3,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32292.77,100,MS DRG,25834.22,case rate,100% of CMS IPPS rate,51668.43,160,MS DRG,41334.74,case rate,160% of CMS IPPS rate,41980.6,130,MS DRG,33584.48,case rate,130% of CMS IPPS rate,8609.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9039.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32292.77,100,MS DRG,25834.22,case rate,100% of CMS IPPS rate,8609.52,100,,,case rate,100% of CMS IPPS rate,32292.77,100,MS DRG,25834.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8609.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,875060.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32292.77,100,MS DRG,25834.22,case rate,100% of CMS IPPS rate,32292.77,100,MS DRG,25834.22,case rate,100% of CMS IPPS rate,8609.52,875060.8,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26501.17,100,MS DRG,21200.94,case rate,100% of CMS IPPS rate,42401.87,160,MS DRG,33921.5,case rate,160% of CMS IPPS rate,34451.52,130,MS DRG,27561.22,case rate,130% of CMS IPPS rate,6700.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7035.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26501.17,100,MS DRG,21200.94,case rate,100% of CMS IPPS rate,6700.96,100,,,case rate,100% of CMS IPPS rate,26501.17,100,MS DRG,21200.94,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6700.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,836750.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26501.17,100,MS DRG,21200.94,case rate,100% of CMS IPPS rate,26501.17,100,MS DRG,21200.94,case rate,100% of CMS IPPS rate,6700.96,836750.3,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28916.2,100,MS DRG,23132.96,case rate,100% of CMS IPPS rate,46265.92,160,MS DRG,37012.74,case rate,160% of CMS IPPS rate,37591.06,130,MS DRG,30072.85,case rate,130% of CMS IPPS rate,7672.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8056.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28916.2,100,MS DRG,23132.96,case rate,100% of CMS IPPS rate,7672.78,100,,,case rate,100% of CMS IPPS rate,28916.2,100,MS DRG,23132.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7672.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,185263.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28916.2,100,MS DRG,23132.96,case rate,100% of CMS IPPS rate,28916.2,100,MS DRG,23132.96,case rate,100% of CMS IPPS rate,7672.78,185263.2,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,28131.09,160,MS DRG,22504.87,case rate,160% of CMS IPPS rate,22856.51,130,MS DRG,18285.21,case rate,130% of CMS IPPS rate,3512.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3688.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,3512.89,100,,,case rate,100% of CMS IPPS rate,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3512.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425202.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,3512.89,425202,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23359.37,100,MS DRG,18687.5,case rate,100% of CMS IPPS rate,37374.99,160,MS DRG,29899.99,case rate,160% of CMS IPPS rate,30367.18,130,MS DRG,24293.74,case rate,130% of CMS IPPS rate,5715.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6001.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23359.37,100,MS DRG,18687.5,case rate,100% of CMS IPPS rate,5715.41,100,,,case rate,100% of CMS IPPS rate,23359.37,100,MS DRG,18687.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5715.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336333.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23359.37,100,MS DRG,18687.5,case rate,100% of CMS IPPS rate,23359.37,100,MS DRG,18687.5,case rate,100% of CMS IPPS rate,5715.41,336333.5,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18636.66,100,MS DRG,14909.33,case rate,100% of CMS IPPS rate,29818.66,160,MS DRG,23854.93,case rate,160% of CMS IPPS rate,24227.66,130,MS DRG,19382.13,case rate,130% of CMS IPPS rate,4159.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4367.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18636.66,100,MS DRG,14909.33,case rate,100% of CMS IPPS rate,4159.5,100,,,case rate,100% of CMS IPPS rate,18636.66,100,MS DRG,14909.33,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4159.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,317859.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18636.66,100,MS DRG,14909.33,case rate,100% of CMS IPPS rate,18636.66,100,MS DRG,14909.33,case rate,100% of CMS IPPS rate,4159.5,317859.3,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34219.38,100,MS DRG,27375.5,case rate,100% of CMS IPPS rate,54751.01,160,MS DRG,43800.81,case rate,160% of CMS IPPS rate,44485.19,130,MS DRG,35588.15,case rate,130% of CMS IPPS rate,9547.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10024.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34219.38,100,MS DRG,27375.5,case rate,100% of CMS IPPS rate,9547.03,100,,,case rate,100% of CMS IPPS rate,34219.38,100,MS DRG,27375.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9547.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243198.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34219.38,100,MS DRG,27375.5,case rate,100% of CMS IPPS rate,34219.38,100,MS DRG,27375.5,case rate,100% of CMS IPPS rate,9547.03,243198.1,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22058.06,100,MS DRG,17646.45,case rate,100% of CMS IPPS rate,35292.9,160,MS DRG,28234.32,case rate,160% of CMS IPPS rate,28675.48,130,MS DRG,22940.38,case rate,130% of CMS IPPS rate,5087.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5341.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22058.06,100,MS DRG,17646.45,case rate,100% of CMS IPPS rate,5087.48,100,,,case rate,100% of CMS IPPS rate,22058.06,100,MS DRG,17646.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5087.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259542.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22058.06,100,MS DRG,17646.45,case rate,100% of CMS IPPS rate,22058.06,100,MS DRG,17646.45,case rate,100% of CMS IPPS rate,5087.48,259542.6,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26360.77,100,MS DRG,21088.62,case rate,100% of CMS IPPS rate,42177.23,160,MS DRG,33741.78,case rate,160% of CMS IPPS rate,34269,130,MS DRG,27415.2,case rate,130% of CMS IPPS rate,7037.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7389.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26360.77,100,MS DRG,21088.62,case rate,100% of CMS IPPS rate,7037.6,100,,,case rate,100% of CMS IPPS rate,26360.77,100,MS DRG,21088.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7037.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312488.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26360.77,100,MS DRG,21088.62,case rate,100% of CMS IPPS rate,26360.77,100,MS DRG,21088.62,case rate,100% of CMS IPPS rate,7037.6,312488.5,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19981.62,100,MS DRG,15985.3,case rate,100% of CMS IPPS rate,31970.59,160,MS DRG,25576.47,case rate,160% of CMS IPPS rate,25976.11,130,MS DRG,20780.89,case rate,130% of CMS IPPS rate,4665.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4898.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19981.62,100,MS DRG,15985.3,case rate,100% of CMS IPPS rate,4665.05,100,,,case rate,100% of CMS IPPS rate,19981.62,100,MS DRG,15985.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4665.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,375914.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19981.62,100,MS DRG,15985.3,case rate,100% of CMS IPPS rate,19981.62,100,MS DRG,15985.3,case rate,100% of CMS IPPS rate,4665.05,375914.7,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16562.58,100,MS DRG,13250.06,case rate,100% of CMS IPPS rate,26500.13,160,MS DRG,21200.1,case rate,160% of CMS IPPS rate,21531.35,130,MS DRG,17225.08,case rate,130% of CMS IPPS rate,3402.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3572.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16562.58,100,MS DRG,13250.06,case rate,100% of CMS IPPS rate,3402.33,100,,,case rate,100% of CMS IPPS rate,16562.58,100,MS DRG,13250.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3402.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,481599.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16562.58,100,MS DRG,13250.06,case rate,100% of CMS IPPS rate,16562.58,100,MS DRG,13250.06,case rate,100% of CMS IPPS rate,3402.33,481600,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39042.37,100,MS DRG,31233.9,case rate,100% of CMS IPPS rate,62467.79,160,MS DRG,49974.23,case rate,160% of CMS IPPS rate,50755.08,130,MS DRG,40604.06,case rate,130% of CMS IPPS rate,10306.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10822.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39042.37,100,MS DRG,31233.9,case rate,100% of CMS IPPS rate,10306.87,100,,,case rate,100% of CMS IPPS rate,39042.37,100,MS DRG,31233.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10306.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624075.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39042.37,100,MS DRG,31233.9,case rate,100% of CMS IPPS rate,39042.37,100,MS DRG,31233.9,case rate,100% of CMS IPPS rate,10306.87,624075.9,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28057.32,100,MS DRG,22445.86,case rate,100% of CMS IPPS rate,44891.71,160,MS DRG,35913.37,case rate,160% of CMS IPPS rate,36474.52,130,MS DRG,29179.62,case rate,130% of CMS IPPS rate,6789.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7129.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28057.32,100,MS DRG,22445.86,case rate,100% of CMS IPPS rate,6789.79,100,,,case rate,100% of CMS IPPS rate,28057.32,100,MS DRG,22445.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6789.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,940298.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28057.32,100,MS DRG,22445.86,case rate,100% of CMS IPPS rate,28057.32,100,MS DRG,22445.86,case rate,100% of CMS IPPS rate,6789.79,940298.7,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23516.29,100,MS DRG,18813.03,case rate,100% of CMS IPPS rate,37626.06,160,MS DRG,30100.85,case rate,160% of CMS IPPS rate,30571.18,130,MS DRG,24456.94,case rate,130% of CMS IPPS rate,5355.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5623.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23516.29,100,MS DRG,18813.03,case rate,100% of CMS IPPS rate,5355.88,100,,,case rate,100% of CMS IPPS rate,23516.29,100,MS DRG,18813.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5355.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,981494.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23516.29,100,MS DRG,18813.03,case rate,100% of CMS IPPS rate,23516.29,100,MS DRG,18813.03,case rate,100% of CMS IPPS rate,5355.88,981494.5,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29606.38,100,MS DRG,23685.1,case rate,100% of CMS IPPS rate,47370.21,160,MS DRG,37896.17,case rate,160% of CMS IPPS rate,38488.29,130,MS DRG,30790.63,case rate,130% of CMS IPPS rate,7583.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7963.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29606.38,100,MS DRG,23685.1,case rate,100% of CMS IPPS rate,7583.94,100,,,case rate,100% of CMS IPPS rate,29606.38,100,MS DRG,23685.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7583.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,471533.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29606.38,100,MS DRG,23685.1,case rate,100% of CMS IPPS rate,29606.38,100,MS DRG,23685.1,case rate,100% of CMS IPPS rate,7583.94,471533.6,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17966.54,100,MS DRG,14373.23,case rate,100% of CMS IPPS rate,28746.46,160,MS DRG,22997.17,case rate,160% of CMS IPPS rate,23356.5,130,MS DRG,18685.2,case rate,130% of CMS IPPS rate,3876.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4070.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17966.54,100,MS DRG,14373.23,case rate,100% of CMS IPPS rate,3876.99,100,,,case rate,100% of CMS IPPS rate,17966.54,100,MS DRG,14373.23,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3876.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496054.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17966.54,100,MS DRG,14373.23,case rate,100% of CMS IPPS rate,17966.54,100,MS DRG,14373.23,case rate,100% of CMS IPPS rate,3876.99,496054.6,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14086.2,100,MS DRG,11268.96,case rate,100% of CMS IPPS rate,22537.92,160,MS DRG,18030.34,case rate,160% of CMS IPPS rate,18312.06,130,MS DRG,14649.65,case rate,130% of CMS IPPS rate,2624.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2755.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14086.2,100,MS DRG,11268.96,case rate,100% of CMS IPPS rate,2624.19,100,,,case rate,100% of CMS IPPS rate,14086.2,100,MS DRG,11268.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2624.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,579099.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14086.2,100,MS DRG,11268.96,case rate,100% of CMS IPPS rate,14086.2,100,MS DRG,11268.96,case rate,100% of CMS IPPS rate,2624.19,579099.9,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22691.62,100,MS DRG,18153.3,case rate,100% of CMS IPPS rate,36306.59,160,MS DRG,29045.27,case rate,160% of CMS IPPS rate,29499.11,130,MS DRG,23599.29,case rate,130% of CMS IPPS rate,5546.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5824.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22691.62,100,MS DRG,18153.3,case rate,100% of CMS IPPS rate,5546.89,100,,,case rate,100% of CMS IPPS rate,22691.62,100,MS DRG,18153.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5546.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,392521.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22691.62,100,MS DRG,18153.3,case rate,100% of CMS IPPS rate,22691.62,100,MS DRG,18153.3,case rate,100% of CMS IPPS rate,5546.89,392521.8,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16251.11,100,MS DRG,13000.89,case rate,100% of CMS IPPS rate,26001.78,160,MS DRG,20801.42,case rate,160% of CMS IPPS rate,21126.44,130,MS DRG,16901.15,case rate,130% of CMS IPPS rate,3360.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3528.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16251.11,100,MS DRG,13000.89,case rate,100% of CMS IPPS rate,3360.77,100,,,case rate,100% of CMS IPPS rate,16251.11,100,MS DRG,13000.89,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3360.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540762.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16251.11,100,MS DRG,13000.89,case rate,100% of CMS IPPS rate,16251.11,100,MS DRG,13000.89,case rate,100% of CMS IPPS rate,3360.77,540762.3,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,24636.99,160,MS DRG,19709.59,case rate,160% of CMS IPPS rate,20017.56,130,MS DRG,16014.05,case rate,130% of CMS IPPS rate,3050.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3202.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,3050.43,100,,,case rate,100% of CMS IPPS rate,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3050.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,637871.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,3050.43,637871.2,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,70,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27087.52,100,MS DRG,21670.02,case rate,100% of CMS IPPS rate,43340.03,160,MS DRG,34672.02,case rate,160% of CMS IPPS rate,35213.78,130,MS DRG,28171.02,case rate,130% of CMS IPPS rate,6629.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6960.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27087.52,100,MS DRG,21670.02,case rate,100% of CMS IPPS rate,6629.28,100,,,case rate,100% of CMS IPPS rate,27087.52,100,MS DRG,21670.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6629.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326250.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27087.52,100,MS DRG,21670.02,case rate,100% of CMS IPPS rate,27087.52,100,MS DRG,21670.02,case rate,100% of CMS IPPS rate,6629.28,326250.1,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,71,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18502.15,100,MS DRG,14801.72,case rate,100% of CMS IPPS rate,29603.44,160,MS DRG,23682.75,case rate,160% of CMS IPPS rate,24052.8,130,MS DRG,19242.24,case rate,130% of CMS IPPS rate,4018.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4218.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18502.15,100,MS DRG,14801.72,case rate,100% of CMS IPPS rate,4018.06,100,,,case rate,100% of CMS IPPS rate,18502.15,100,MS DRG,14801.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4018.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,341381.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18502.15,100,MS DRG,14801.72,case rate,100% of CMS IPPS rate,18502.15,100,MS DRG,14801.72,case rate,100% of CMS IPPS rate,4018.06,341381.1,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15212.9,100,MS DRG,12170.32,case rate,100% of CMS IPPS rate,24340.64,160,MS DRG,19472.51,case rate,160% of CMS IPPS rate,19776.77,130,MS DRG,15821.42,case rate,130% of CMS IPPS rate,2860.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3003.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15212.9,100,MS DRG,12170.32,case rate,100% of CMS IPPS rate,2860.18,100,,,case rate,100% of CMS IPPS rate,15212.9,100,MS DRG,12170.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2860.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,451403.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15212.9,100,MS DRG,12170.32,case rate,100% of CMS IPPS rate,15212.9,100,MS DRG,12170.32,case rate,100% of CMS IPPS rate,2860.18,451403.1,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23825.4,100,MS DRG,19060.32,case rate,100% of CMS IPPS rate,38120.64,160,MS DRG,30496.51,case rate,160% of CMS IPPS rate,30973.02,130,MS DRG,24778.42,case rate,130% of CMS IPPS rate,5892.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6187.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23825.4,100,MS DRG,19060.32,case rate,100% of CMS IPPS rate,5892.69,100,,,case rate,100% of CMS IPPS rate,23825.4,100,MS DRG,19060.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5892.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355923.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23825.4,100,MS DRG,19060.32,case rate,100% of CMS IPPS rate,23825.4,100,MS DRG,19060.32,case rate,100% of CMS IPPS rate,5892.69,355923,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18082.16,100,MS DRG,14465.73,case rate,100% of CMS IPPS rate,28931.46,160,MS DRG,23145.17,case rate,160% of CMS IPPS rate,23506.81,130,MS DRG,18805.45,case rate,130% of CMS IPPS rate,3974.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4172.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18082.16,100,MS DRG,14465.73,case rate,100% of CMS IPPS rate,3974.21,100,,,case rate,100% of CMS IPPS rate,18082.16,100,MS DRG,14465.73,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3974.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,373648.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18082.16,100,MS DRG,14465.73,case rate,100% of CMS IPPS rate,18082.16,100,MS DRG,14465.73,case rate,100% of CMS IPPS rate,3974.21,373648.2,
VIRAL MENINGITIS WITH CC/MCC,75,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28554.01,100,MS DRG,22843.21,case rate,100% of CMS IPPS rate,45686.42,160,MS DRG,36549.14,case rate,160% of CMS IPPS rate,37120.21,130,MS DRG,29696.17,case rate,130% of CMS IPPS rate,6337.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6654.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28554.01,100,MS DRG,22843.21,case rate,100% of CMS IPPS rate,6337.24,100,,,case rate,100% of CMS IPPS rate,28554.01,100,MS DRG,22843.21,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6337.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,386868.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28554.01,100,MS DRG,22843.21,case rate,100% of CMS IPPS rate,28554.01,100,MS DRG,22843.21,case rate,100% of CMS IPPS rate,6337.24,386868.7,
VIRAL MENINGITIS WITHOUT CC/MCC,76,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16858.71,100,MS DRG,13486.97,case rate,100% of CMS IPPS rate,26973.94,160,MS DRG,21579.15,case rate,160% of CMS IPPS rate,21916.32,130,MS DRG,17533.06,case rate,130% of CMS IPPS rate,3495.74,100,,,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,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16858.71,100,MS DRG,13486.97,case rate,100% of CMS IPPS rate,3495.74,100,,,case rate,100% of CMS IPPS rate,16858.71,100,MS DRG,13486.97,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3495.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319249.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16858.71,100,MS DRG,13486.97,case rate,100% of CMS IPPS rate,16858.71,100,MS DRG,13486.97,case rate,100% of CMS IPPS rate,3495.74,319249.1,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,77,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23800.62,100,MS DRG,19040.5,case rate,100% of CMS IPPS rate,38080.99,160,MS DRG,30464.79,case rate,160% of CMS IPPS rate,30940.81,130,MS DRG,24752.65,case rate,130% of CMS IPPS rate,5895.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6190.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23800.62,100,MS DRG,19040.5,case rate,100% of CMS IPPS rate,5895.36,100,,,case rate,100% of CMS IPPS rate,23800.62,100,MS DRG,19040.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5895.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431464.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23800.62,100,MS DRG,19040.5,case rate,100% of CMS IPPS rate,23800.62,100,MS DRG,19040.5,case rate,100% of CMS IPPS rate,5895.36,431464.8,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,78,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17972.44,100,MS DRG,14377.95,case rate,100% of CMS IPPS rate,28755.9,160,MS DRG,23004.72,case rate,160% of CMS IPPS rate,23364.17,130,MS DRG,18691.34,case rate,130% of CMS IPPS rate,3804.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3994.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17972.44,100,MS DRG,14377.95,case rate,100% of CMS IPPS rate,3804.55,100,,,case rate,100% of CMS IPPS rate,17972.44,100,MS DRG,14377.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3804.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490778.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17972.44,100,MS DRG,14377.95,case rate,100% of CMS IPPS rate,17972.44,100,MS DRG,14377.95,case rate,100% of CMS IPPS rate,3804.55,490778.6,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,79,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14715.02,100,MS DRG,11772.02,case rate,100% of CMS IPPS rate,23544.03,160,MS DRG,18835.22,case rate,160% of CMS IPPS rate,19129.53,130,MS DRG,15303.62,case rate,130% of CMS IPPS rate,2522.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2648.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14715.02,100,MS DRG,11772.02,case rate,100% of CMS IPPS rate,2522.39,100,,,case rate,100% of CMS IPPS rate,14715.02,100,MS DRG,11772.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2522.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455649.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14715.02,100,MS DRG,11772.02,case rate,100% of CMS IPPS rate,14715.02,100,MS DRG,11772.02,case rate,100% of CMS IPPS rate,2522.39,455650,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32033.22,100,MS DRG,25626.58,case rate,100% of CMS IPPS rate,51253.15,160,MS DRG,41002.52,case rate,160% of CMS IPPS rate,41643.19,130,MS DRG,33314.55,case rate,130% of CMS IPPS rate,7506.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7882.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32033.22,100,MS DRG,25626.58,case rate,100% of CMS IPPS rate,7506.93,100,,,case rate,100% of CMS IPPS rate,32033.22,100,MS DRG,25626.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7506.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,449439.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32033.22,100,MS DRG,25626.58,case rate,100% of CMS IPPS rate,32033.22,100,MS DRG,25626.58,case rate,100% of CMS IPPS rate,7506.93,449439.3,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16705.34,100,MS DRG,13364.27,case rate,100% of CMS IPPS rate,26728.54,160,MS DRG,21382.83,case rate,160% of CMS IPPS rate,21716.94,130,MS DRG,17373.55,case rate,130% of CMS IPPS rate,3449.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3622.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16705.34,100,MS DRG,13364.27,case rate,100% of CMS IPPS rate,3449.6,100,,,case rate,100% of CMS IPPS rate,16705.34,100,MS DRG,13364.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3449.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333724.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16705.34,100,MS DRG,13364.27,case rate,100% of CMS IPPS rate,16705.34,100,MS DRG,13364.27,case rate,100% of CMS IPPS rate,3449.6,333724.4,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32854.36,100,MS DRG,26283.49,case rate,100% of CMS IPPS rate,52566.98,160,MS DRG,42053.58,case rate,160% of CMS IPPS rate,42710.67,130,MS DRG,34168.54,case rate,130% of CMS IPPS rate,8845.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9288.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32854.36,100,MS DRG,26283.49,case rate,100% of CMS IPPS rate,8845.9,100,,,case rate,100% of CMS IPPS rate,32854.36,100,MS DRG,26283.49,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8845.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,469869.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32854.36,100,MS DRG,26283.49,case rate,100% of CMS IPPS rate,32854.36,100,MS DRG,26283.49,case rate,100% of CMS IPPS rate,8845.9,469869.2,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21977.84,100,MS DRG,17582.27,case rate,100% of CMS IPPS rate,35164.54,160,MS DRG,28131.63,case rate,160% of CMS IPPS rate,28571.19,130,MS DRG,22856.95,case rate,130% of CMS IPPS rate,5300.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5566.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21977.84,100,MS DRG,17582.27,case rate,100% of CMS IPPS rate,5300.98,100,,,case rate,100% of CMS IPPS rate,21977.84,100,MS DRG,17582.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5300.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,469115.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21977.84,100,MS DRG,17582.27,case rate,100% of CMS IPPS rate,21977.84,100,MS DRG,17582.27,case rate,100% of CMS IPPS rate,5300.98,469115,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16825.67,100,MS DRG,13460.54,case rate,100% of CMS IPPS rate,26921.07,160,MS DRG,21536.86,case rate,160% of CMS IPPS rate,21873.37,130,MS DRG,17498.7,case rate,130% of CMS IPPS rate,3645.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3827.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16825.67,100,MS DRG,13460.54,case rate,100% of CMS IPPS rate,3645.19,100,,,case rate,100% of CMS IPPS rate,16825.67,100,MS DRG,13460.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3645.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,525556.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16825.67,100,MS DRG,13460.54,case rate,100% of CMS IPPS rate,16825.67,100,MS DRG,13460.54,case rate,100% of CMS IPPS rate,3645.19,525556.4,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32789.48,100,MS DRG,26231.58,case rate,100% of CMS IPPS rate,52463.17,160,MS DRG,41970.54,case rate,160% of CMS IPPS rate,42626.32,130,MS DRG,34101.06,case rate,130% of CMS IPPS rate,8639.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9071.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32789.48,100,MS DRG,26231.58,case rate,100% of CMS IPPS rate,8639.26,100,,,case rate,100% of CMS IPPS rate,32789.48,100,MS DRG,26231.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8639.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428836.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32789.48,100,MS DRG,26231.58,case rate,100% of CMS IPPS rate,32789.48,100,MS DRG,26231.58,case rate,100% of CMS IPPS rate,8639.26,428836.1,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21514.19,100,MS DRG,17211.35,case rate,100% of CMS IPPS rate,34422.7,160,MS DRG,27538.16,case rate,160% of CMS IPPS rate,27968.45,130,MS DRG,22374.76,case rate,130% of CMS IPPS rate,5000.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5250.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21514.19,100,MS DRG,17211.35,case rate,100% of CMS IPPS rate,5000.55,100,,,case rate,100% of CMS IPPS rate,21514.19,100,MS DRG,17211.35,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5000.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365218.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21514.19,100,MS DRG,17211.35,case rate,100% of CMS IPPS rate,21514.19,100,MS DRG,17211.35,case rate,100% of CMS IPPS rate,5000.55,365218.2,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16430.45,100,MS DRG,13144.36,case rate,100% of CMS IPPS rate,26288.72,160,MS DRG,21030.98,case rate,160% of CMS IPPS rate,21359.59,130,MS DRG,17087.67,case rate,130% of CMS IPPS rate,3370.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3538.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16430.45,100,MS DRG,13144.36,case rate,100% of CMS IPPS rate,3370.3,100,,,case rate,100% of CMS IPPS rate,16430.45,100,MS DRG,13144.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3370.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,507872.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16430.45,100,MS DRG,13144.36,case rate,100% of CMS IPPS rate,16430.45,100,MS DRG,13144.36,case rate,100% of CMS IPPS rate,3370.3,507872.6,
CONCUSSION WITH MCC,88,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24070.79,100,MS DRG,19256.63,case rate,100% of CMS IPPS rate,38513.26,160,MS DRG,30810.61,case rate,160% of CMS IPPS rate,31292.03,130,MS DRG,25033.62,case rate,130% of CMS IPPS rate,5378.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5647.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24070.79,100,MS DRG,19256.63,case rate,100% of CMS IPPS rate,5378.38,100,,,case rate,100% of CMS IPPS rate,24070.79,100,MS DRG,19256.63,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5378.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,454221.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24070.79,100,MS DRG,19256.63,case rate,100% of CMS IPPS rate,24070.79,100,MS DRG,19256.63,case rate,100% of CMS IPPS rate,5378.38,454221.6,
CONCUSSION WITH CC,89,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19541.56,100,MS DRG,15633.25,case rate,100% of CMS IPPS rate,31266.5,160,MS DRG,25013.2,case rate,160% of CMS IPPS rate,25404.03,130,MS DRG,20323.22,case rate,130% of CMS IPPS rate,4087.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4291.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19541.56,100,MS DRG,15633.25,case rate,100% of CMS IPPS rate,4087.45,100,,,case rate,100% of CMS IPPS rate,19541.56,100,MS DRG,15633.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4087.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203922.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19541.56,100,MS DRG,15633.25,case rate,100% of CMS IPPS rate,19541.56,100,MS DRG,15633.25,case rate,100% of CMS IPPS rate,4087.45,203922.4,
CONCUSSION WITHOUT CC/MCC,90,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17003.82,100,MS DRG,13603.06,case rate,100% of CMS IPPS rate,27206.11,160,MS DRG,21764.89,case rate,160% of CMS IPPS rate,22104.97,130,MS DRG,17683.98,case rate,130% of CMS IPPS rate,3268.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3431.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17003.82,100,MS DRG,13603.06,case rate,100% of CMS IPPS rate,3268.51,100,,,case rate,100% of CMS IPPS rate,17003.82,100,MS DRG,13603.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3268.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365138.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17003.82,100,MS DRG,13603.06,case rate,100% of CMS IPPS rate,17003.82,100,MS DRG,13603.06,case rate,100% of CMS IPPS rate,3268.51,365138.1,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27084,100,MS DRG,21667.2,case rate,100% of CMS IPPS rate,43334.4,160,MS DRG,34667.52,case rate,160% of CMS IPPS rate,35209.2,130,MS DRG,28167.36,case rate,130% of CMS IPPS rate,6949.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7297.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27084,100,MS DRG,21667.2,case rate,100% of CMS IPPS rate,6949.92,100,,,case rate,100% of CMS IPPS rate,27084,100,MS DRG,21667.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6949.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,369154,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27084,100,MS DRG,21667.2,case rate,100% of CMS IPPS rate,27084,100,MS DRG,21667.2,case rate,100% of CMS IPPS rate,6949.92,369154,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18080.97,100,MS DRG,14464.78,case rate,100% of CMS IPPS rate,28929.55,160,MS DRG,23143.64,case rate,160% of CMS IPPS rate,23505.26,130,MS DRG,18804.21,case rate,130% of CMS IPPS rate,4036.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4238.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18080.97,100,MS DRG,14464.78,case rate,100% of CMS IPPS rate,4036.36,100,,,case rate,100% of CMS IPPS rate,18080.97,100,MS DRG,14464.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4036.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414221.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18080.97,100,MS DRG,14464.78,case rate,100% of CMS IPPS rate,18080.97,100,MS DRG,14464.78,case rate,100% of CMS IPPS rate,4036.36,414221.5,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15111.43,100,MS DRG,12089.14,case rate,100% of CMS IPPS rate,24178.29,160,MS DRG,19342.63,case rate,160% of CMS IPPS rate,19644.86,130,MS DRG,15715.89,case rate,130% of CMS IPPS rate,3009.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3159.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15111.43,100,MS DRG,12089.14,case rate,100% of CMS IPPS rate,3009.25,100,,,case rate,100% of CMS IPPS rate,15111.43,100,MS DRG,12089.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3009.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436009.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15111.43,100,MS DRG,12089.14,case rate,100% of CMS IPPS rate,15111.43,100,MS DRG,12089.14,case rate,100% of CMS IPPS rate,3009.25,436009.1,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48715.5,100,MS DRG,38972.4,case rate,100% of CMS IPPS rate,77944.8,160,MS DRG,62355.84,case rate,160% of CMS IPPS rate,63330.15,130,MS DRG,50664.12,case rate,130% of CMS IPPS rate,13910.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14606.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48715.5,100,MS DRG,38972.4,case rate,100% of CMS IPPS rate,13910.89,100,,,case rate,100% of CMS IPPS rate,48715.5,100,MS DRG,38972.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13910.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406480.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48715.5,100,MS DRG,38972.4,case rate,100% of CMS IPPS rate,48715.5,100,MS DRG,38972.4,case rate,100% of CMS IPPS rate,13910.89,406480.4,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34103.76,100,MS DRG,27283.01,case rate,100% of CMS IPPS rate,54566.02,160,MS DRG,43652.82,case rate,160% of CMS IPPS rate,44334.89,130,MS DRG,35467.91,case rate,130% of CMS IPPS rate,9139.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9596.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34103.76,100,MS DRG,27283.01,case rate,100% of CMS IPPS rate,9139.47,100,,,case rate,100% of CMS IPPS rate,34103.76,100,MS DRG,27283.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9139.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467931.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34103.76,100,MS DRG,27283.01,case rate,100% of CMS IPPS rate,34103.76,100,MS DRG,27283.01,case rate,100% of CMS IPPS rate,9139.47,467931.8,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31691.09,100,MS DRG,25352.87,case rate,100% of CMS IPPS rate,50705.74,160,MS DRG,40564.59,case rate,160% of CMS IPPS rate,41198.42,130,MS DRG,32958.74,case rate,130% of CMS IPPS rate,9139.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9596.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31691.09,100,MS DRG,25352.87,case rate,100% of CMS IPPS rate,9139.47,100,,,case rate,100% of CMS IPPS rate,31691.09,100,MS DRG,25352.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9139.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569937.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31691.09,100,MS DRG,25352.87,case rate,100% of CMS IPPS rate,31691.09,100,MS DRG,25352.87,case rate,100% of CMS IPPS rate,9139.47,569937.4,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48883.04,100,MS DRG,39106.43,case rate,100% of CMS IPPS rate,78212.86,160,MS DRG,62570.29,case rate,160% of CMS IPPS rate,63547.95,130,MS DRG,50838.36,case rate,130% of CMS IPPS rate,13666.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14349.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48883.04,100,MS DRG,39106.43,case rate,100% of CMS IPPS rate,13666.5,100,,,case rate,100% of CMS IPPS rate,48883.04,100,MS DRG,39106.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13666.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443431.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48883.04,100,MS DRG,39106.43,case rate,100% of CMS IPPS rate,48883.04,100,MS DRG,39106.43,case rate,100% of CMS IPPS rate,13666.5,443431.9,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31393.77,100,MS DRG,25115.02,case rate,100% of CMS IPPS rate,50230.03,160,MS DRG,40184.02,case rate,160% of CMS IPPS rate,40811.9,130,MS DRG,32649.52,case rate,130% of CMS IPPS rate,8270.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8684.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31393.77,100,MS DRG,25115.02,case rate,100% of CMS IPPS rate,8270.59,100,,,case rate,100% of CMS IPPS rate,31393.77,100,MS DRG,25115.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8270.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472753.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31393.77,100,MS DRG,25115.02,case rate,100% of CMS IPPS rate,31393.77,100,MS DRG,25115.02,case rate,100% of CMS IPPS rate,8270.59,472753.5,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21550.75,100,MS DRG,17240.6,case rate,100% of CMS IPPS rate,34481.2,160,MS DRG,27584.96,case rate,160% of CMS IPPS rate,28015.98,130,MS DRG,22412.78,case rate,130% of CMS IPPS rate,5312.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5577.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21550.75,100,MS DRG,17240.6,case rate,100% of CMS IPPS rate,5312.04,100,,,case rate,100% of CMS IPPS rate,21550.75,100,MS DRG,17240.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5312.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455454.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21550.75,100,MS DRG,17240.6,case rate,100% of CMS IPPS rate,21550.75,100,MS DRG,17240.6,case rate,100% of CMS IPPS rate,5312.04,455454.2,
SEIZURES WITH MCC,100,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29364.52,100,MS DRG,23491.62,case rate,100% of CMS IPPS rate,46983.23,160,MS DRG,37586.58,case rate,160% of CMS IPPS rate,38173.88,130,MS DRG,30539.1,case rate,130% of CMS IPPS rate,7569.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7947.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29364.52,100,MS DRG,23491.62,case rate,100% of CMS IPPS rate,7569.08,100,,,case rate,100% of CMS IPPS rate,29364.52,100,MS DRG,23491.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7569.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,537290.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29364.52,100,MS DRG,23491.62,case rate,100% of CMS IPPS rate,29364.52,100,MS DRG,23491.62,case rate,100% of CMS IPPS rate,7569.08,537290.2,
SEIZURES WITHOUT MCC,101,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16706.52,100,MS DRG,13365.22,case rate,100% of CMS IPPS rate,26730.43,160,MS DRG,21384.34,case rate,160% of CMS IPPS rate,21718.48,130,MS DRG,17374.78,case rate,130% of CMS IPPS rate,3514.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3689.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16706.52,100,MS DRG,13365.22,case rate,100% of CMS IPPS rate,3514.04,100,,,case rate,100% of CMS IPPS rate,16706.52,100,MS DRG,13365.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3514.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404357.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16706.52,100,MS DRG,13365.22,case rate,100% of CMS IPPS rate,16706.52,100,MS DRG,13365.22,case rate,100% of CMS IPPS rate,3514.04,404357.3,
HEADACHES WITH MCC,102,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20210.51,100,MS DRG,16168.41,case rate,100% of CMS IPPS rate,32336.82,160,MS DRG,25869.46,case rate,160% of CMS IPPS rate,26273.66,130,MS DRG,21018.93,case rate,130% of CMS IPPS rate,4420.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4641.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20210.51,100,MS DRG,16168.41,case rate,100% of CMS IPPS rate,4420.66,100,,,case rate,100% of CMS IPPS rate,20210.51,100,MS DRG,16168.41,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4420.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413714.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20210.51,100,MS DRG,16168.41,case rate,100% of CMS IPPS rate,20210.51,100,MS DRG,16168.41,case rate,100% of CMS IPPS rate,4420.66,413714.1,
HEADACHES WITHOUT MCC,103,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15913.7,100,MS DRG,12730.96,case rate,100% of CMS IPPS rate,25461.92,160,MS DRG,20369.54,case rate,160% of CMS IPPS rate,20687.81,130,MS DRG,16550.25,case rate,130% of CMS IPPS rate,3241.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3403.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15913.7,100,MS DRG,12730.96,case rate,100% of CMS IPPS rate,3241.44,100,,,case rate,100% of CMS IPPS rate,15913.7,100,MS DRG,12730.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3241.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431682.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15913.7,100,MS DRG,12730.96,case rate,100% of CMS IPPS rate,15913.7,100,MS DRG,12730.96,case rate,100% of CMS IPPS rate,3241.44,431682.6,
ORBITAL PROCEDURES WITH CC/MCC,113,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35556.1,100,MS DRG,28444.88,case rate,100% of CMS IPPS rate,56889.76,160,MS DRG,45511.81,case rate,160% of CMS IPPS rate,46222.93,130,MS DRG,36978.34,case rate,130% of CMS IPPS rate,8529.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8955.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35556.1,100,MS DRG,28444.88,case rate,100% of CMS IPPS rate,8529.46,100,,,case rate,100% of CMS IPPS rate,35556.1,100,MS DRG,28444.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8529.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,502753.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35556.1,100,MS DRG,28444.88,case rate,100% of CMS IPPS rate,35556.1,100,MS DRG,28444.88,case rate,100% of CMS IPPS rate,8529.46,502753.8,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20507.81,100,MS DRG,16406.25,case rate,100% of CMS IPPS rate,32812.5,160,MS DRG,26250,case rate,160% of CMS IPPS rate,26660.15,130,MS DRG,21328.12,case rate,130% of CMS IPPS rate,4506.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4732.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20507.81,100,MS DRG,16406.25,case rate,100% of CMS IPPS rate,4506.83,100,,,case rate,100% of CMS IPPS rate,20507.81,100,MS DRG,16406.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4506.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,788218.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20507.81,100,MS DRG,16406.25,case rate,100% of CMS IPPS rate,20507.81,100,MS DRG,16406.25,case rate,100% of CMS IPPS rate,4506.83,788218.8,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24431.8,100,MS DRG,19545.44,case rate,100% of CMS IPPS rate,39090.88,160,MS DRG,31272.7,case rate,160% of CMS IPPS rate,31761.34,130,MS DRG,25409.07,case rate,130% of CMS IPPS rate,5837.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6128.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24431.8,100,MS DRG,19545.44,case rate,100% of CMS IPPS rate,5837.03,100,,,case rate,100% of CMS IPPS rate,24431.8,100,MS DRG,19545.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5837.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510567.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24431.8,100,MS DRG,19545.44,case rate,100% of CMS IPPS rate,24431.8,100,MS DRG,19545.44,case rate,100% of CMS IPPS rate,5837.03,510567.5,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27574.78,100,MS DRG,22059.82,case rate,100% of CMS IPPS rate,44119.65,160,MS DRG,35295.72,case rate,160% of CMS IPPS rate,35847.21,130,MS DRG,28677.77,case rate,130% of CMS IPPS rate,6361.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6679.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27574.78,100,MS DRG,22059.82,case rate,100% of CMS IPPS rate,6361.64,100,,,case rate,100% of CMS IPPS rate,27574.78,100,MS DRG,22059.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6361.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472225.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27574.78,100,MS DRG,22059.82,case rate,100% of CMS IPPS rate,27574.78,100,MS DRG,22059.82,case rate,100% of CMS IPPS rate,6361.64,472225.2,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20113.76,100,MS DRG,16091.01,case rate,100% of CMS IPPS rate,32182.02,160,MS DRG,25745.62,case rate,160% of CMS IPPS rate,26147.89,130,MS DRG,20918.31,case rate,130% of CMS IPPS rate,3859.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4052.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20113.76,100,MS DRG,16091.01,case rate,100% of CMS IPPS rate,3859.07,100,,,case rate,100% of CMS IPPS rate,20113.76,100,MS DRG,16091.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3859.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,740161.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20113.76,100,MS DRG,16091.01,case rate,100% of CMS IPPS rate,20113.76,100,MS DRG,16091.01,case rate,100% of CMS IPPS rate,3859.07,740161.1,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21090.63,100,MS DRG,16872.5,case rate,100% of CMS IPPS rate,33745.01,160,MS DRG,26996.01,case rate,160% of CMS IPPS rate,27417.82,130,MS DRG,21934.26,case rate,130% of CMS IPPS rate,4434.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4656.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21090.63,100,MS DRG,16872.5,case rate,100% of CMS IPPS rate,4434.77,100,,,case rate,100% of CMS IPPS rate,21090.63,100,MS DRG,16872.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4434.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215265.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21090.63,100,MS DRG,16872.5,case rate,100% of CMS IPPS rate,21090.63,100,MS DRG,16872.5,case rate,100% of CMS IPPS rate,4434.77,215265,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14758.68,100,MS DRG,11806.94,case rate,100% of CMS IPPS rate,23613.89,160,MS DRG,18891.11,case rate,160% of CMS IPPS rate,19186.28,130,MS DRG,15349.02,case rate,130% of CMS IPPS rate,2586.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2715.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14758.68,100,MS DRG,11806.94,case rate,100% of CMS IPPS rate,2586.06,100,,,case rate,100% of CMS IPPS rate,14758.68,100,MS DRG,11806.94,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2586.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238736.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14758.68,100,MS DRG,11806.94,case rate,100% of CMS IPPS rate,14758.68,100,MS DRG,11806.94,case rate,100% of CMS IPPS rate,2586.06,238736.5,
NEUROLOGICAL EYE DISORDERS,123,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15460.65,100,MS DRG,12368.52,case rate,100% of CMS IPPS rate,24737.04,160,MS DRG,19789.63,case rate,160% of CMS IPPS rate,20098.85,130,MS DRG,16079.08,case rate,130% of CMS IPPS rate,3062.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3215.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15460.65,100,MS DRG,12368.52,case rate,100% of CMS IPPS rate,3062.25,100,,,case rate,100% of CMS IPPS rate,15460.65,100,MS DRG,12368.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3062.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490645.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15460.65,100,MS DRG,12368.52,case rate,100% of CMS IPPS rate,15460.65,100,MS DRG,12368.52,case rate,100% of CMS IPPS rate,3062.25,490645.8,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21570.81,100,MS DRG,17256.65,case rate,100% of CMS IPPS rate,34513.3,160,MS DRG,27610.64,case rate,160% of CMS IPPS rate,28042.05,130,MS DRG,22433.64,case rate,130% of CMS IPPS rate,4971.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5219.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21570.81,100,MS DRG,17256.65,case rate,100% of CMS IPPS rate,4971.2,100,,,case rate,100% of CMS IPPS rate,21570.81,100,MS DRG,17256.65,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4971.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422788.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21570.81,100,MS DRG,17256.65,case rate,100% of CMS IPPS rate,21570.81,100,MS DRG,17256.65,case rate,100% of CMS IPPS rate,4971.2,422788.7,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15383.97,100,MS DRG,12307.18,case rate,100% of CMS IPPS rate,24614.35,160,MS DRG,19691.48,case rate,160% of CMS IPPS rate,19999.16,130,MS DRG,15999.33,case rate,130% of CMS IPPS rate,3148.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3305.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15383.97,100,MS DRG,12307.18,case rate,100% of CMS IPPS rate,3148.03,100,,,case rate,100% of CMS IPPS rate,15383.97,100,MS DRG,12307.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3148.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,458012.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15383.97,100,MS DRG,12307.18,case rate,100% of CMS IPPS rate,15383.97,100,MS DRG,12307.18,case rate,100% of CMS IPPS rate,3148.03,458012.5,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37264.43,100,MS DRG,29811.54,case rate,100% of CMS IPPS rate,59623.09,160,MS DRG,47698.47,case rate,160% of CMS IPPS rate,48443.76,130,MS DRG,38755.01,case rate,130% of CMS IPPS rate,9192.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9652.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37264.43,100,MS DRG,29811.54,case rate,100% of CMS IPPS rate,9192.46,100,,,case rate,100% of CMS IPPS rate,37264.43,100,MS DRG,29811.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9192.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,633006.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37264.43,100,MS DRG,29811.54,case rate,100% of CMS IPPS rate,37264.43,100,MS DRG,29811.54,case rate,100% of CMS IPPS rate,9192.46,633006.1,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18295.7,100,MS DRG,14636.56,case rate,100% of CMS IPPS rate,29273.12,160,MS DRG,23418.5,case rate,160% of CMS IPPS rate,23784.41,130,MS DRG,19027.53,case rate,130% of CMS IPPS rate,3729.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3915.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18295.7,100,MS DRG,14636.56,case rate,100% of CMS IPPS rate,3729.45,100,,,case rate,100% of CMS IPPS rate,18295.7,100,MS DRG,14636.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3729.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,835031.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18295.7,100,MS DRG,14636.56,case rate,100% of CMS IPPS rate,18295.7,100,MS DRG,14636.56,case rate,100% of CMS IPPS rate,3729.45,835031.4,
MOUTH PROCEDURES WITH CC/MCC,137,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23727.47,100,MS DRG,18981.98,case rate,100% of CMS IPPS rate,37963.95,160,MS DRG,30371.16,case rate,160% of CMS IPPS rate,30845.71,130,MS DRG,24676.57,case rate,130% of CMS IPPS rate,5332.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5598.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23727.47,100,MS DRG,18981.98,case rate,100% of CMS IPPS rate,5332.25,100,,,case rate,100% of CMS IPPS rate,23727.47,100,MS DRG,18981.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5332.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418962.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23727.47,100,MS DRG,18981.98,case rate,100% of CMS IPPS rate,23727.47,100,MS DRG,18981.98,case rate,100% of CMS IPPS rate,5332.25,418962.7,
MOUTH PROCEDURES WITHOUT CC/MCC,138,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16188.58,100,MS DRG,12950.86,case rate,100% of CMS IPPS rate,25901.73,160,MS DRG,20721.38,case rate,160% of CMS IPPS rate,21045.15,130,MS DRG,16836.12,case rate,130% of CMS IPPS rate,3101.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3256.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16188.58,100,MS DRG,12950.86,case rate,100% of CMS IPPS rate,3101.52,100,,,case rate,100% of CMS IPPS rate,16188.58,100,MS DRG,12950.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3101.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,549484.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16188.58,100,MS DRG,12950.86,case rate,100% of CMS IPPS rate,16188.58,100,MS DRG,12950.86,case rate,100% of CMS IPPS rate,3101.52,549484.1,
SALIVARY GLAND PROCEDURES,139,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19987.52,100,MS DRG,15990.02,case rate,100% of CMS IPPS rate,31980.03,160,MS DRG,25584.02,case rate,160% of CMS IPPS rate,25983.78,130,MS DRG,20787.02,case rate,130% of CMS IPPS rate,5234.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5496.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19987.52,100,MS DRG,15990.02,case rate,100% of CMS IPPS rate,5234.64,100,,,case rate,100% of CMS IPPS rate,19987.52,100,MS DRG,15990.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5234.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,575538.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19987.52,100,MS DRG,15990.02,case rate,100% of CMS IPPS rate,19987.52,100,MS DRG,15990.02,case rate,100% of CMS IPPS rate,5234.64,575539,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50548.9,100,MS DRG,40439.12,case rate,100% of CMS IPPS rate,80878.24,160,MS DRG,64702.59,case rate,160% of CMS IPPS rate,65713.57,130,MS DRG,52570.86,case rate,130% of CMS IPPS rate,16124.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16930.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,50548.9,100,MS DRG,40439.12,case rate,100% of CMS IPPS rate,16124.08,100,,,case rate,100% of CMS IPPS rate,50548.9,100,MS DRG,40439.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16124.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273626.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,50548.9,100,MS DRG,40439.12,case rate,100% of CMS IPPS rate,50548.9,100,MS DRG,40439.12,case rate,100% of CMS IPPS rate,16124.08,273626.8,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30416.89,100,MS DRG,24333.51,case rate,100% of CMS IPPS rate,48667.02,160,MS DRG,38933.62,case rate,160% of CMS IPPS rate,39541.96,130,MS DRG,31633.57,case rate,130% of CMS IPPS rate,8191.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8600.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30416.89,100,MS DRG,24333.51,case rate,100% of CMS IPPS rate,8191.29,100,,,case rate,100% of CMS IPPS rate,30416.89,100,MS DRG,24333.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8191.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257823.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30416.89,100,MS DRG,24333.51,case rate,100% of CMS IPPS rate,30416.89,100,MS DRG,24333.51,case rate,100% of CMS IPPS rate,8191.29,257823.2,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24202.93,100,MS DRG,19362.34,case rate,100% of CMS IPPS rate,38724.69,160,MS DRG,30979.75,case rate,160% of CMS IPPS rate,31463.81,130,MS DRG,25171.05,case rate,130% of CMS IPPS rate,5994.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6294.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24202.93,100,MS DRG,19362.34,case rate,100% of CMS IPPS rate,5994.87,100,,,case rate,100% of CMS IPPS rate,24202.93,100,MS DRG,19362.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5994.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406678.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24202.93,100,MS DRG,19362.34,case rate,100% of CMS IPPS rate,24202.93,100,MS DRG,19362.34,case rate,100% of CMS IPPS rate,5994.87,406678.4,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45210.35,100,MS DRG,36168.28,case rate,100% of CMS IPPS rate,72336.56,160,MS DRG,57869.25,case rate,160% of CMS IPPS rate,58773.46,130,MS DRG,47018.77,case rate,130% of CMS IPPS rate,12588.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13218.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45210.35,100,MS DRG,36168.28,case rate,100% of CMS IPPS rate,12588.69,100,,,case rate,100% of CMS IPPS rate,45210.35,100,MS DRG,36168.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12588.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,494377.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45210.35,100,MS DRG,36168.28,case rate,100% of CMS IPPS rate,45210.35,100,MS DRG,36168.28,case rate,100% of CMS IPPS rate,12588.69,494377.2,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26391.45,100,MS DRG,21113.16,case rate,100% of CMS IPPS rate,42226.32,160,MS DRG,33781.06,case rate,160% of CMS IPPS rate,34308.89,130,MS DRG,27447.11,case rate,130% of CMS IPPS rate,6697.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7032.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26391.45,100,MS DRG,21113.16,case rate,100% of CMS IPPS rate,6697.52,100,,,case rate,100% of CMS IPPS rate,26391.45,100,MS DRG,21113.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6697.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,546225.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26391.45,100,MS DRG,21113.16,case rate,100% of CMS IPPS rate,26391.45,100,MS DRG,21113.16,case rate,100% of CMS IPPS rate,6697.52,546225.1,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20381.57,100,MS DRG,16305.26,case rate,100% of CMS IPPS rate,32610.51,160,MS DRG,26088.41,case rate,160% of CMS IPPS rate,26496.04,130,MS DRG,21196.83,case rate,130% of CMS IPPS rate,4517.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4742.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20381.57,100,MS DRG,16305.26,case rate,100% of CMS IPPS rate,4517.12,100,,,case rate,100% of CMS IPPS rate,20381.57,100,MS DRG,16305.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4517.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254695.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20381.57,100,MS DRG,16305.26,case rate,100% of CMS IPPS rate,20381.57,100,MS DRG,16305.26,case rate,100% of CMS IPPS rate,4517.12,254695.7,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30880.56,100,MS DRG,24704.45,case rate,100% of CMS IPPS rate,49408.9,160,MS DRG,39527.12,case rate,160% of CMS IPPS rate,40144.73,130,MS DRG,32115.78,case rate,130% of CMS IPPS rate,8746.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9183.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30880.56,100,MS DRG,24704.45,case rate,100% of CMS IPPS rate,8746.39,100,,,case rate,100% of CMS IPPS rate,30880.56,100,MS DRG,24704.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8746.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,392237.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30880.56,100,MS DRG,24704.45,case rate,100% of CMS IPPS rate,30880.56,100,MS DRG,24704.45,case rate,100% of CMS IPPS rate,8746.39,392237.9,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20555,100,MS DRG,16444,case rate,100% of CMS IPPS rate,32888,160,MS DRG,26310.4,case rate,160% of CMS IPPS rate,26721.5,130,MS DRG,21377.2,case rate,130% of CMS IPPS rate,4745.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4983.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20555,100,MS DRG,16444,case rate,100% of CMS IPPS rate,4745.87,100,,,case rate,100% of CMS IPPS rate,20555,100,MS DRG,16444,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4745.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,387492.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20555,100,MS DRG,16444,case rate,100% of CMS IPPS rate,20555,100,MS DRG,16444,case rate,100% of CMS IPPS rate,4745.87,387492.6,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16471.73,100,MS DRG,13177.38,case rate,100% of CMS IPPS rate,26354.77,160,MS DRG,21083.82,case rate,160% of CMS IPPS rate,21413.25,130,MS DRG,17130.6,case rate,130% of CMS IPPS rate,2910.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3055.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16471.73,100,MS DRG,13177.38,case rate,100% of CMS IPPS rate,2910.13,100,,,case rate,100% of CMS IPPS rate,16471.73,100,MS DRG,13177.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2910.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,508156.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16471.73,100,MS DRG,13177.38,case rate,100% of CMS IPPS rate,16471.73,100,MS DRG,13177.38,case rate,100% of CMS IPPS rate,2910.13,508156.5,
DYSEQUILIBRIUM,149,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,23617.66,160,MS DRG,18894.13,case rate,160% of CMS IPPS rate,19189.35,130,MS DRG,15351.48,case rate,130% of CMS IPPS rate,2849.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2992.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,2849.89,100,,,case rate,100% of CMS IPPS rate,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2849.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,608768.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,2849.89,608769,
EPISTAXIS WITH MCC,150,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21483.5,100,MS DRG,17186.8,case rate,100% of CMS IPPS rate,34373.6,160,MS DRG,27498.88,case rate,160% of CMS IPPS rate,27928.55,130,MS DRG,22342.84,case rate,130% of CMS IPPS rate,5269.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5533.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21483.5,100,MS DRG,17186.8,case rate,100% of CMS IPPS rate,5269.72,100,,,case rate,100% of CMS IPPS rate,21483.5,100,MS DRG,17186.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5269.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467139.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21483.5,100,MS DRG,17186.8,case rate,100% of CMS IPPS rate,21483.5,100,MS DRG,17186.8,case rate,100% of CMS IPPS rate,5269.72,467139.9,
EPISTAXIS WITHOUT MCC,151,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15067.79,100,MS DRG,12054.23,case rate,100% of CMS IPPS rate,24108.46,160,MS DRG,19286.77,case rate,160% of CMS IPPS rate,19588.13,130,MS DRG,15670.5,case rate,130% of CMS IPPS rate,2889.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3034.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15067.79,100,MS DRG,12054.23,case rate,100% of CMS IPPS rate,2889.92,100,,,case rate,100% of CMS IPPS rate,15067.79,100,MS DRG,12054.23,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2889.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,917439.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15067.79,100,MS DRG,12054.23,case rate,100% of CMS IPPS rate,15067.79,100,MS DRG,12054.23,case rate,100% of CMS IPPS rate,2889.92,917439.6,
OTITIS MEDIA AND URI WITH MCC,152,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19993.42,100,MS DRG,15994.74,case rate,100% of CMS IPPS rate,31989.47,160,MS DRG,25591.58,case rate,160% of CMS IPPS rate,25991.45,130,MS DRG,20793.16,case rate,130% of CMS IPPS rate,4326.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4542.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19993.42,100,MS DRG,15994.74,case rate,100% of CMS IPPS rate,4326.49,100,,,case rate,100% of CMS IPPS rate,19993.42,100,MS DRG,15994.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4326.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362592.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19993.42,100,MS DRG,15994.74,case rate,100% of CMS IPPS rate,19993.42,100,MS DRG,15994.74,case rate,100% of CMS IPPS rate,4326.49,362592.4,
OTITIS MEDIA AND URI WITHOUT MCC,153,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14644.23,100,MS DRG,11715.38,case rate,100% of CMS IPPS rate,23430.77,160,MS DRG,18744.62,case rate,160% of CMS IPPS rate,19037.5,130,MS DRG,15230,case rate,130% of CMS IPPS rate,2713.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2849.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14644.23,100,MS DRG,11715.38,case rate,100% of CMS IPPS rate,2713.4,100,,,case rate,100% of CMS IPPS rate,14644.23,100,MS DRG,11715.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2713.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277623.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14644.23,100,MS DRG,11715.38,case rate,100% of CMS IPPS rate,14644.23,100,MS DRG,11715.38,case rate,100% of CMS IPPS rate,2713.4,277623.4,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24122.7,100,MS DRG,19298.16,case rate,100% of CMS IPPS rate,38596.32,160,MS DRG,30877.06,case rate,160% of CMS IPPS rate,31359.51,130,MS DRG,25087.61,case rate,130% of CMS IPPS rate,6200.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6510.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24122.7,100,MS DRG,19298.16,case rate,100% of CMS IPPS rate,6200.37,100,,,case rate,100% of CMS IPPS rate,24122.7,100,MS DRG,19298.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6200.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380379.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24122.7,100,MS DRG,19298.16,case rate,100% of CMS IPPS rate,24122.7,100,MS DRG,19298.16,case rate,100% of CMS IPPS rate,6200.37,380379.1,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17143.05,100,MS DRG,13714.44,case rate,100% of CMS IPPS rate,27428.88,160,MS DRG,21943.1,case rate,160% of CMS IPPS rate,22285.97,130,MS DRG,17828.78,case rate,130% of CMS IPPS rate,3559.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3737.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17143.05,100,MS DRG,13714.44,case rate,100% of CMS IPPS rate,3559.41,100,,,case rate,100% of CMS IPPS rate,17143.05,100,MS DRG,13714.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3559.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,457903.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17143.05,100,MS DRG,13714.44,case rate,100% of CMS IPPS rate,17143.05,100,MS DRG,13714.44,case rate,100% of CMS IPPS rate,3559.41,457903.4,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13708.65,100,MS DRG,10966.92,case rate,100% of CMS IPPS rate,21933.84,160,MS DRG,17547.07,case rate,160% of CMS IPPS rate,17821.25,130,MS DRG,14257,case rate,130% of CMS IPPS rate,2563.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2691.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13708.65,100,MS DRG,10966.92,case rate,100% of CMS IPPS rate,2563.57,100,,,case rate,100% of CMS IPPS rate,13708.65,100,MS DRG,10966.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2563.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288970.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13708.65,100,MS DRG,10966.92,case rate,100% of CMS IPPS rate,13708.65,100,MS DRG,10966.92,case rate,100% of CMS IPPS rate,2563.57,288970.1,
DENTAL AND ORAL DISEASES WITH MCC,157,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26114.19,100,MS DRG,20891.35,case rate,100% of CMS IPPS rate,41782.7,160,MS DRG,33426.16,case rate,160% of CMS IPPS rate,33948.45,130,MS DRG,27158.76,case rate,130% of CMS IPPS rate,6243.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6555.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26114.19,100,MS DRG,20891.35,case rate,100% of CMS IPPS rate,6243.07,100,,,case rate,100% of CMS IPPS rate,26114.19,100,MS DRG,20891.35,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6243.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,553590.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26114.19,100,MS DRG,20891.35,case rate,100% of CMS IPPS rate,26114.19,100,MS DRG,20891.35,case rate,100% of CMS IPPS rate,6243.07,553590.1,
DENTAL AND ORAL DISEASES WITH CC,158,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17047.48,100,MS DRG,13637.98,case rate,100% of CMS IPPS rate,27275.97,160,MS DRG,21820.78,case rate,160% of CMS IPPS rate,22161.72,130,MS DRG,17729.38,case rate,130% of CMS IPPS rate,3586.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3765.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17047.48,100,MS DRG,13637.98,case rate,100% of CMS IPPS rate,3586.09,100,,,case rate,100% of CMS IPPS rate,17047.48,100,MS DRG,13637.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3586.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368099.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17047.48,100,MS DRG,13637.98,case rate,100% of CMS IPPS rate,17047.48,100,MS DRG,13637.98,case rate,100% of CMS IPPS rate,3586.09,368099.6,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13941.09,100,MS DRG,11152.87,case rate,100% of CMS IPPS rate,22305.74,160,MS DRG,17844.59,case rate,160% of CMS IPPS rate,18123.42,130,MS DRG,14498.74,case rate,130% of CMS IPPS rate,2514.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2640.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13941.09,100,MS DRG,11152.87,case rate,100% of CMS IPPS rate,2514.76,100,,,case rate,100% of CMS IPPS rate,13941.09,100,MS DRG,11152.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2514.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574840.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13941.09,100,MS DRG,11152.87,case rate,100% of CMS IPPS rate,13941.09,100,MS DRG,11152.87,case rate,100% of CMS IPPS rate,2514.76,574840.4,
MAJOR CHEST PROCEDURES WITH MCC,163,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61585.87,100,MS DRG,49268.7,case rate,100% of CMS IPPS rate,98537.39,160,MS DRG,78829.91,case rate,160% of CMS IPPS rate,80061.63,130,MS DRG,64049.3,case rate,130% of CMS IPPS rate,17572.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18451.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61585.87,100,MS DRG,49268.7,case rate,100% of CMS IPPS rate,17572.85,100,,,case rate,100% of CMS IPPS rate,61585.87,100,MS DRG,49268.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17572.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,699582.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,61585.87,100,MS DRG,49268.7,case rate,100% of CMS IPPS rate,61585.87,100,MS DRG,49268.7,case rate,100% of CMS IPPS rate,17572.85,699582.9,
MAJOR CHEST PROCEDURES WITH CC,164,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36064.58,100,MS DRG,28851.66,case rate,100% of CMS IPPS rate,57703.33,160,MS DRG,46162.66,case rate,160% of CMS IPPS rate,46883.95,130,MS DRG,37507.16,case rate,130% of CMS IPPS rate,9596.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10076,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36064.58,100,MS DRG,28851.66,case rate,100% of CMS IPPS rate,9596.21,100,,,case rate,100% of CMS IPPS rate,36064.58,100,MS DRG,28851.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9596.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,845758.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36064.58,100,MS DRG,28851.66,case rate,100% of CMS IPPS rate,36064.58,100,MS DRG,28851.66,case rate,100% of CMS IPPS rate,9596.21,845758.1,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28112.77,100,MS DRG,22490.22,case rate,100% of CMS IPPS rate,44980.43,160,MS DRG,35984.34,case rate,160% of CMS IPPS rate,36546.6,130,MS DRG,29237.28,case rate,130% of CMS IPPS rate,7106.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7461.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28112.77,100,MS DRG,22490.22,case rate,100% of CMS IPPS rate,7106.61,100,,,case rate,100% of CMS IPPS rate,28112.77,100,MS DRG,22490.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7106.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,976481.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28112.77,100,MS DRG,22490.22,case rate,100% of CMS IPPS rate,28112.77,100,MS DRG,22490.22,case rate,100% of CMS IPPS rate,7106.61,976481.4,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53848.79,100,MS DRG,43079.03,case rate,100% of CMS IPPS rate,86158.06,160,MS DRG,68926.45,case rate,160% of CMS IPPS rate,70003.43,130,MS DRG,56002.74,case rate,130% of CMS IPPS rate,14679.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15413.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53848.79,100,MS DRG,43079.03,case rate,100% of CMS IPPS rate,14679.5,100,,,case rate,100% of CMS IPPS rate,53848.79,100,MS DRG,43079.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14679.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,617627.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53848.79,100,MS DRG,43079.03,case rate,100% of CMS IPPS rate,53848.79,100,MS DRG,43079.03,case rate,100% of CMS IPPS rate,14679.5,617627,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27445.01,100,MS DRG,21956.01,case rate,100% of CMS IPPS rate,43912.02,160,MS DRG,35129.62,case rate,160% of CMS IPPS rate,35678.51,130,MS DRG,28542.81,case rate,130% of CMS IPPS rate,6966.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7314.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27445.01,100,MS DRG,21956.01,case rate,100% of CMS IPPS rate,6966.31,100,,,case rate,100% of CMS IPPS rate,27445.01,100,MS DRG,21956.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6966.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600347.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27445.01,100,MS DRG,21956.01,case rate,100% of CMS IPPS rate,27445.01,100,MS DRG,21956.01,case rate,100% of CMS IPPS rate,6966.31,600347.4,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21969.58,100,MS DRG,17575.66,case rate,100% of CMS IPPS rate,35151.33,160,MS DRG,28121.06,case rate,160% of CMS IPPS rate,28560.45,130,MS DRG,22848.36,case rate,130% of CMS IPPS rate,5161.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5419.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21969.58,100,MS DRG,17575.66,case rate,100% of CMS IPPS rate,5161.82,100,,,case rate,100% of CMS IPPS rate,21969.58,100,MS DRG,17575.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5161.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,951322.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21969.58,100,MS DRG,17575.66,case rate,100% of CMS IPPS rate,21969.58,100,MS DRG,17575.66,case rate,100% of CMS IPPS rate,5161.82,951322.3,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM,173,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42253.79,100,MS DRG,33803.03,case rate,100% of CMS IPPS rate,67606.06,160,MS DRG,54084.85,case rate,160% of CMS IPPS rate,54929.93,130,MS DRG,43943.94,case rate,130% of CMS IPPS rate,11699.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12284.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42253.79,100,MS DRG,33803.03,case rate,100% of CMS IPPS rate,11699.22,100,,,case rate,100% of CMS IPPS rate,42253.79,100,MS DRG,33803.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11699.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1024489.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42253.79,100,MS DRG,33803.03,case rate,100% of CMS IPPS rate,42253.79,100,MS DRG,33803.03,case rate,100% of CMS IPPS rate,11699.22,1024490,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22527.62,100,MS DRG,18022.1,case rate,100% of CMS IPPS rate,36044.19,160,MS DRG,28835.35,case rate,160% of CMS IPPS rate,29285.91,130,MS DRG,23428.73,case rate,130% of CMS IPPS rate,5372.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5640.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22527.62,100,MS DRG,18022.1,case rate,100% of CMS IPPS rate,5372.28,100,,,case rate,100% of CMS IPPS rate,22527.62,100,MS DRG,18022.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5372.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440172.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22527.62,100,MS DRG,18022.1,case rate,100% of CMS IPPS rate,22527.62,100,MS DRG,18022.1,case rate,100% of CMS IPPS rate,5372.28,440172.6,
PULMONARY EMBOLISM WITHOUT MCC,176,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15597.51,100,MS DRG,12478.01,case rate,100% of CMS IPPS rate,24956.02,160,MS DRG,19964.82,case rate,160% of CMS IPPS rate,20276.76,130,MS DRG,16221.41,case rate,130% of CMS IPPS rate,3105.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3260.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15597.51,100,MS DRG,12478.01,case rate,100% of CMS IPPS rate,3105.33,100,,,case rate,100% of CMS IPPS rate,15597.51,100,MS DRG,12478.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3105.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422564.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15597.51,100,MS DRG,12478.01,case rate,100% of CMS IPPS rate,15597.51,100,MS DRG,12478.01,case rate,100% of CMS IPPS rate,3105.33,422564.4,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25989.14,100,MS DRG,20791.31,case rate,100% of CMS IPPS rate,41582.62,160,MS DRG,33266.1,case rate,160% of CMS IPPS rate,33785.88,130,MS DRG,27028.7,case rate,130% of CMS IPPS rate,6163,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6471.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25989.14,100,MS DRG,20791.31,case rate,100% of CMS IPPS rate,6163,100,,,case rate,100% of CMS IPPS rate,25989.14,100,MS DRG,20791.31,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6163,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380139.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25989.14,100,MS DRG,20791.31,case rate,100% of CMS IPPS rate,25989.14,100,MS DRG,20791.31,case rate,100% of CMS IPPS rate,6163,380139.7,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17616.14,100,MS DRG,14092.91,case rate,100% of CMS IPPS rate,28185.82,160,MS DRG,22548.66,case rate,160% of CMS IPPS rate,22900.98,130,MS DRG,18320.78,case rate,130% of CMS IPPS rate,3782.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3971.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17616.14,100,MS DRG,14092.91,case rate,100% of CMS IPPS rate,3782.44,100,,,case rate,100% of CMS IPPS rate,17616.14,100,MS DRG,14092.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3782.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,321476.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17616.14,100,MS DRG,14092.91,case rate,100% of CMS IPPS rate,17616.14,100,MS DRG,14092.91,case rate,100% of CMS IPPS rate,3782.44,321476.8,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14980.48,100,MS DRG,11984.38,case rate,100% of CMS IPPS rate,23968.77,160,MS DRG,19175.02,case rate,160% of CMS IPPS rate,19474.62,130,MS DRG,15579.7,case rate,130% of CMS IPPS rate,2934.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3081.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14980.48,100,MS DRG,11984.38,case rate,100% of CMS IPPS rate,2934.53,100,,,case rate,100% of CMS IPPS rate,14980.48,100,MS DRG,11984.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2934.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412521.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14980.48,100,MS DRG,11984.38,case rate,100% of CMS IPPS rate,14980.48,100,MS DRG,11984.38,case rate,100% of CMS IPPS rate,2934.53,412521.3,
RESPIRATORY NEOPLASMS WITH MCC,180,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26482.29,100,MS DRG,21185.83,case rate,100% of CMS IPPS rate,42371.66,160,MS DRG,33897.33,case rate,160% of CMS IPPS rate,34426.98,130,MS DRG,27541.58,case rate,130% of CMS IPPS rate,6663.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6996.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26482.29,100,MS DRG,21185.83,case rate,100% of CMS IPPS rate,6663.59,100,,,case rate,100% of CMS IPPS rate,26482.29,100,MS DRG,21185.83,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6663.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408055.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26482.29,100,MS DRG,21185.83,case rate,100% of CMS IPPS rate,26482.29,100,MS DRG,21185.83,case rate,100% of CMS IPPS rate,6663.59,408055.1,
RESPIRATORY NEOPLASMS WITH CC,181,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18965.82,100,MS DRG,15172.66,case rate,100% of CMS IPPS rate,30345.31,160,MS DRG,24276.25,case rate,160% of CMS IPPS rate,24655.57,130,MS DRG,19724.46,case rate,130% of CMS IPPS rate,4233.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4444.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18965.82,100,MS DRG,15172.66,case rate,100% of CMS IPPS rate,4233.09,100,,,case rate,100% of CMS IPPS rate,18965.82,100,MS DRG,15172.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4233.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472039.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18965.82,100,MS DRG,15172.66,case rate,100% of CMS IPPS rate,18965.82,100,MS DRG,15172.66,case rate,100% of CMS IPPS rate,4233.09,472039.3,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15399.3,100,MS DRG,12319.44,case rate,100% of CMS IPPS rate,24638.88,160,MS DRG,19711.1,case rate,160% of CMS IPPS rate,20019.09,130,MS DRG,16015.27,case rate,130% of CMS IPPS rate,3193.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3352.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15399.3,100,MS DRG,12319.44,case rate,100% of CMS IPPS rate,3193.02,100,,,case rate,100% of CMS IPPS rate,15399.3,100,MS DRG,12319.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3193.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456239.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15399.3,100,MS DRG,12319.44,case rate,100% of CMS IPPS rate,15399.3,100,MS DRG,12319.44,case rate,100% of CMS IPPS rate,3193.02,456239.7,
MAJOR CHEST TRAUMA WITH MCC,183,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24550.97,100,MS DRG,19640.78,case rate,100% of CMS IPPS rate,39281.55,160,MS DRG,31425.24,case rate,160% of CMS IPPS rate,31916.26,130,MS DRG,25533.01,case rate,130% of CMS IPPS rate,6051.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6354.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24550.97,100,MS DRG,19640.78,case rate,100% of CMS IPPS rate,6051.68,100,,,case rate,100% of CMS IPPS rate,24550.97,100,MS DRG,19640.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6051.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,532771.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24550.97,100,MS DRG,19640.78,case rate,100% of CMS IPPS rate,24550.97,100,MS DRG,19640.78,case rate,100% of CMS IPPS rate,6051.68,532771.9,
MAJOR CHEST TRAUMA WITH CC,184,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18385.37,100,MS DRG,14708.3,case rate,100% of CMS IPPS rate,29416.59,160,MS DRG,23533.27,case rate,160% of CMS IPPS rate,23900.98,130,MS DRG,19120.78,case rate,130% of CMS IPPS rate,4072.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4275.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18385.37,100,MS DRG,14708.3,case rate,100% of CMS IPPS rate,4072.2,100,,,case rate,100% of CMS IPPS rate,18385.37,100,MS DRG,14708.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4072.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378409.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18385.37,100,MS DRG,14708.3,case rate,100% of CMS IPPS rate,18385.37,100,MS DRG,14708.3,case rate,100% of CMS IPPS rate,4072.2,378409.6,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14890.81,100,MS DRG,11912.65,case rate,100% of CMS IPPS rate,23825.3,160,MS DRG,19060.24,case rate,160% of CMS IPPS rate,19358.05,130,MS DRG,15486.44,case rate,130% of CMS IPPS rate,2965.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3113.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14890.81,100,MS DRG,11912.65,case rate,100% of CMS IPPS rate,2965.03,100,,,case rate,100% of CMS IPPS rate,14890.81,100,MS DRG,11912.65,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2965.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520453.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14890.81,100,MS DRG,11912.65,case rate,100% of CMS IPPS rate,14890.81,100,MS DRG,11912.65,case rate,100% of CMS IPPS rate,2965.03,520453.9,
PLEURAL EFFUSION WITH MCC,186,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24286.69,100,MS DRG,19429.35,case rate,100% of CMS IPPS rate,38858.7,160,MS DRG,31086.96,case rate,160% of CMS IPPS rate,31572.7,130,MS DRG,25258.16,case rate,130% of CMS IPPS rate,6023.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6325.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24286.69,100,MS DRG,19429.35,case rate,100% of CMS IPPS rate,6023.84,100,,,case rate,100% of CMS IPPS rate,24286.69,100,MS DRG,19429.35,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6023.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,402955.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24286.69,100,MS DRG,19429.35,case rate,100% of CMS IPPS rate,24286.69,100,MS DRG,19429.35,case rate,100% of CMS IPPS rate,6023.84,402955.3,
PLEURAL EFFUSION WITH CC,187,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17729.4,100,MS DRG,14183.52,case rate,100% of CMS IPPS rate,28367.04,160,MS DRG,22693.63,case rate,160% of CMS IPPS rate,23048.22,130,MS DRG,18438.58,case rate,130% of CMS IPPS rate,3827.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4019.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17729.4,100,MS DRG,14183.52,case rate,100% of CMS IPPS rate,3827.81,100,,,case rate,100% of CMS IPPS rate,17729.4,100,MS DRG,14183.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3827.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388334.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17729.4,100,MS DRG,14183.52,case rate,100% of CMS IPPS rate,17729.4,100,MS DRG,14183.52,case rate,100% of CMS IPPS rate,3827.81,388334.9,
PLEURAL EFFUSION WITHOUT CC/MCC,188,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14782.27,100,MS DRG,11825.82,case rate,100% of CMS IPPS rate,23651.63,160,MS DRG,18921.3,case rate,160% of CMS IPPS rate,19216.95,130,MS DRG,15373.56,case rate,130% of CMS IPPS rate,2799.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2939.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14782.27,100,MS DRG,11825.82,case rate,100% of CMS IPPS rate,2799.18,100,,,case rate,100% of CMS IPPS rate,14782.27,100,MS DRG,11825.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2799.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425410.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14782.27,100,MS DRG,11825.82,case rate,100% of CMS IPPS rate,14782.27,100,MS DRG,11825.82,case rate,100% of CMS IPPS rate,2799.18,425410.7,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20510.18,100,MS DRG,16408.14,case rate,100% of CMS IPPS rate,32816.29,160,MS DRG,26253.03,case rate,160% of CMS IPPS rate,26663.23,130,MS DRG,21330.58,case rate,130% of CMS IPPS rate,4717.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4953.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20510.18,100,MS DRG,16408.14,case rate,100% of CMS IPPS rate,4717.66,100,,,case rate,100% of CMS IPPS rate,20510.18,100,MS DRG,16408.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4717.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328440.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20510.18,100,MS DRG,16408.14,case rate,100% of CMS IPPS rate,20510.18,100,MS DRG,16408.14,case rate,100% of CMS IPPS rate,4717.66,328440.2,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18976.44,100,MS DRG,15181.15,case rate,100% of CMS IPPS rate,30362.3,160,MS DRG,24289.84,case rate,160% of CMS IPPS rate,24669.37,130,MS DRG,19735.5,case rate,130% of CMS IPPS rate,4281.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4495.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18976.44,100,MS DRG,15181.15,case rate,100% of CMS IPPS rate,4281.5,100,,,case rate,100% of CMS IPPS rate,18976.44,100,MS DRG,15181.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4281.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361881.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18976.44,100,MS DRG,15181.15,case rate,100% of CMS IPPS rate,18976.44,100,MS DRG,15181.15,case rate,100% of CMS IPPS rate,4281.5,361881.8,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15991.57,100,MS DRG,12793.26,case rate,100% of CMS IPPS rate,25586.51,160,MS DRG,20469.21,case rate,160% of CMS IPPS rate,20789.04,130,MS DRG,16631.23,case rate,130% of CMS IPPS rate,3275.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3439.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15991.57,100,MS DRG,12793.26,case rate,100% of CMS IPPS rate,3275.37,100,,,case rate,100% of CMS IPPS rate,15991.57,100,MS DRG,12793.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3275.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297896.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15991.57,100,MS DRG,12793.26,case rate,100% of CMS IPPS rate,15991.57,100,MS DRG,12793.26,case rate,100% of CMS IPPS rate,3275.37,297896.2,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13547.03,100,MS DRG,10837.62,case rate,100% of CMS IPPS rate,21675.25,160,MS DRG,17340.2,case rate,160% of CMS IPPS rate,17611.14,130,MS DRG,14088.91,case rate,130% of CMS IPPS rate,2467.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2590.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13547.03,100,MS DRG,10837.62,case rate,100% of CMS IPPS rate,2467.49,100,,,case rate,100% of CMS IPPS rate,13547.03,100,MS DRG,10837.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2467.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270638.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13547.03,100,MS DRG,10837.62,case rate,100% of CMS IPPS rate,13547.03,100,MS DRG,10837.62,case rate,100% of CMS IPPS rate,2467.49,270638.7,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21626.26,100,MS DRG,17301.01,case rate,100% of CMS IPPS rate,34602.02,160,MS DRG,27681.62,case rate,160% of CMS IPPS rate,28114.14,130,MS DRG,22491.31,case rate,130% of CMS IPPS rate,5023.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5274.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21626.26,100,MS DRG,17301.01,case rate,100% of CMS IPPS rate,5023.81,100,,,case rate,100% of CMS IPPS rate,21626.26,100,MS DRG,17301.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5023.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382197.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21626.26,100,MS DRG,17301.01,case rate,100% of CMS IPPS rate,21626.26,100,MS DRG,17301.01,case rate,100% of CMS IPPS rate,5023.81,382197.9,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15675.38,100,MS DRG,12540.3,case rate,100% of CMS IPPS rate,25080.61,160,MS DRG,20064.49,case rate,160% of CMS IPPS rate,20377.99,130,MS DRG,16302.39,case rate,130% of CMS IPPS rate,3126.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3282.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15675.38,100,MS DRG,12540.3,case rate,100% of CMS IPPS rate,3126.3,100,,,case rate,100% of CMS IPPS rate,15675.38,100,MS DRG,12540.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3126.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381835.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15675.38,100,MS DRG,12540.3,case rate,100% of CMS IPPS rate,15675.38,100,MS DRG,12540.3,case rate,100% of CMS IPPS rate,3126.3,381835.9,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13355.9,100,MS DRG,10684.72,case rate,100% of CMS IPPS rate,21369.44,160,MS DRG,17095.55,case rate,160% of CMS IPPS rate,17362.67,130,MS DRG,13890.14,case rate,130% of CMS IPPS rate,2374.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2492.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13355.9,100,MS DRG,10684.72,case rate,100% of CMS IPPS rate,2374.08,100,,,case rate,100% of CMS IPPS rate,13355.9,100,MS DRG,10684.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2374.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388773.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13355.9,100,MS DRG,10684.72,case rate,100% of CMS IPPS rate,13355.9,100,MS DRG,10684.72,case rate,100% of CMS IPPS rate,2374.08,388773.7,
INTERSTITIAL LUNG DISEASE WITH MCC,196,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28336.93,100,MS DRG,22669.54,case rate,100% of CMS IPPS rate,45339.09,160,MS DRG,36271.27,case rate,160% of CMS IPPS rate,36838.01,130,MS DRG,29470.41,case rate,130% of CMS IPPS rate,7183.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7542.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28336.93,100,MS DRG,22669.54,case rate,100% of CMS IPPS rate,7183.24,100,,,case rate,100% of CMS IPPS rate,28336.93,100,MS DRG,22669.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7183.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,354130.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28336.93,100,MS DRG,22669.54,case rate,100% of CMS IPPS rate,28336.93,100,MS DRG,22669.54,case rate,100% of CMS IPPS rate,7183.24,354130.4,
INTERSTITIAL LUNG DISEASE WITH CC,197,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17743.57,100,MS DRG,14194.86,case rate,100% of CMS IPPS rate,28389.71,160,MS DRG,22711.77,case rate,160% of CMS IPPS rate,23066.64,130,MS DRG,18453.31,case rate,130% of CMS IPPS rate,3774.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3963.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17743.57,100,MS DRG,14194.86,case rate,100% of CMS IPPS rate,3774.43,100,,,case rate,100% of CMS IPPS rate,17743.57,100,MS DRG,14194.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3774.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332426.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17743.57,100,MS DRG,14194.86,case rate,100% of CMS IPPS rate,17743.57,100,MS DRG,14194.86,case rate,100% of CMS IPPS rate,3774.43,332426.5,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15156.27,100,MS DRG,12125.02,case rate,100% of CMS IPPS rate,24250.03,160,MS DRG,19400.02,case rate,160% of CMS IPPS rate,19703.15,130,MS DRG,15762.52,case rate,130% of CMS IPPS rate,2565.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2694.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15156.27,100,MS DRG,12125.02,case rate,100% of CMS IPPS rate,2565.85,100,,,case rate,100% of CMS IPPS rate,15156.27,100,MS DRG,12125.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2565.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,444456.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15156.27,100,MS DRG,12125.02,case rate,100% of CMS IPPS rate,15156.27,100,MS DRG,12125.02,case rate,100% of CMS IPPS rate,2565.85,444456.8,
PNEUMOTHORAX WITH MCC,199,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26905.85,100,MS DRG,21524.68,case rate,100% of CMS IPPS rate,43049.36,160,MS DRG,34439.49,case rate,160% of CMS IPPS rate,34977.61,130,MS DRG,27982.09,case rate,130% of CMS IPPS rate,6730.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7066.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26905.85,100,MS DRG,21524.68,case rate,100% of CMS IPPS rate,6730.31,100,,,case rate,100% of CMS IPPS rate,26905.85,100,MS DRG,21524.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6730.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352189.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26905.85,100,MS DRG,21524.68,case rate,100% of CMS IPPS rate,26905.85,100,MS DRG,21524.68,case rate,100% of CMS IPPS rate,6730.31,352189.2,
PNEUMOTHORAX WITH CC,200,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18681.5,100,MS DRG,14945.2,case rate,100% of CMS IPPS rate,29890.4,160,MS DRG,23912.32,case rate,160% of CMS IPPS rate,24285.95,130,MS DRG,19428.76,case rate,130% of CMS IPPS rate,4222.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4433.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18681.5,100,MS DRG,14945.2,case rate,100% of CMS IPPS rate,4222.41,100,,,case rate,100% of CMS IPPS rate,18681.5,100,MS DRG,14945.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4222.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,356246.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18681.5,100,MS DRG,14945.2,case rate,100% of CMS IPPS rate,18681.5,100,MS DRG,14945.2,case rate,100% of CMS IPPS rate,4222.41,356246.5,
PNEUMOTHORAX WITHOUT CC/MCC,201,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14305.63,100,MS DRG,11444.5,case rate,100% of CMS IPPS rate,22889.01,160,MS DRG,18311.21,case rate,160% of CMS IPPS rate,18597.32,130,MS DRG,14877.86,case rate,130% of CMS IPPS rate,2581.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2710.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14305.63,100,MS DRG,11444.5,case rate,100% of CMS IPPS rate,2581.48,100,,,case rate,100% of CMS IPPS rate,14305.63,100,MS DRG,11444.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2581.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306869.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14305.63,100,MS DRG,11444.5,case rate,100% of CMS IPPS rate,14305.63,100,MS DRG,11444.5,case rate,100% of CMS IPPS rate,2581.48,306869.7,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17271.64,100,MS DRG,13817.31,case rate,100% of CMS IPPS rate,27634.62,160,MS DRG,22107.7,case rate,160% of CMS IPPS rate,22453.13,130,MS DRG,17962.5,case rate,130% of CMS IPPS rate,3685.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3869.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17271.64,100,MS DRG,13817.31,case rate,100% of CMS IPPS rate,3685.6,100,,,case rate,100% of CMS IPPS rate,17271.64,100,MS DRG,13817.31,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3685.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388372.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17271.64,100,MS DRG,13817.31,case rate,100% of CMS IPPS rate,17271.64,100,MS DRG,13817.31,case rate,100% of CMS IPPS rate,3685.6,388372.3,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14173.5,100,MS DRG,11338.8,case rate,100% of CMS IPPS rate,22677.6,160,MS DRG,18142.08,case rate,160% of CMS IPPS rate,18425.55,130,MS DRG,14740.44,case rate,130% of CMS IPPS rate,2655.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2788.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14173.5,100,MS DRG,11338.8,case rate,100% of CMS IPPS rate,2655.83,100,,,case rate,100% of CMS IPPS rate,14173.5,100,MS DRG,11338.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2655.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312272.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14173.5,100,MS DRG,11338.8,case rate,100% of CMS IPPS rate,14173.5,100,MS DRG,11338.8,case rate,100% of CMS IPPS rate,2655.83,312272.3,
RESPIRATORY SIGNS AND SYMPTOMS,204,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15683.63,100,MS DRG,12546.9,case rate,100% of CMS IPPS rate,25093.81,160,MS DRG,20075.05,case rate,160% of CMS IPPS rate,20388.72,130,MS DRG,16310.98,case rate,130% of CMS IPPS rate,3091.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3246.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15683.63,100,MS DRG,12546.9,case rate,100% of CMS IPPS rate,3091.99,100,,,case rate,100% of CMS IPPS rate,15683.63,100,MS DRG,12546.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3091.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,347471.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15683.63,100,MS DRG,12546.9,case rate,100% of CMS IPPS rate,15683.63,100,MS DRG,12546.9,case rate,100% of CMS IPPS rate,3091.99,347471.3,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27332.93,100,MS DRG,21866.34,case rate,100% of CMS IPPS rate,43732.69,160,MS DRG,34986.15,case rate,160% of CMS IPPS rate,35532.81,130,MS DRG,28426.25,case rate,130% of CMS IPPS rate,7197.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7557.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27332.93,100,MS DRG,21866.34,case rate,100% of CMS IPPS rate,7197.35,100,,,case rate,100% of CMS IPPS rate,27332.93,100,MS DRG,21866.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7197.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,462407.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27332.93,100,MS DRG,21866.34,case rate,100% of CMS IPPS rate,27332.93,100,MS DRG,21866.34,case rate,100% of CMS IPPS rate,7197.35,462408,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16752.53,100,MS DRG,13402.02,case rate,100% of CMS IPPS rate,26804.05,160,MS DRG,21443.24,case rate,160% of CMS IPPS rate,21778.29,130,MS DRG,17422.63,case rate,130% of CMS IPPS rate,3453.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3626.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16752.53,100,MS DRG,13402.02,case rate,100% of CMS IPPS rate,3453.42,100,,,case rate,100% of CMS IPPS rate,16752.53,100,MS DRG,13402.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3453.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,375886.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16752.53,100,MS DRG,13402.02,case rate,100% of CMS IPPS rate,16752.53,100,MS DRG,13402.02,case rate,100% of CMS IPPS rate,3453.42,375886.2,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87475.29,100,MS DRG,69980.23,case rate,100% of CMS IPPS rate,139960.46,160,MS DRG,111968.37,case rate,160% of CMS IPPS rate,113717.88,130,MS DRG,90974.3,case rate,130% of CMS IPPS rate,24656.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25889.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87475.29,100,MS DRG,69980.23,case rate,100% of CMS IPPS rate,24656.59,100,,,case rate,100% of CMS IPPS rate,87475.29,100,MS DRG,69980.23,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24656.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,526095.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,87475.29,100,MS DRG,69980.23,case rate,100% of CMS IPPS rate,87475.29,100,MS DRG,69980.23,case rate,100% of CMS IPPS rate,24656.59,526095.3,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37874.39,100,MS DRG,30299.51,case rate,100% of CMS IPPS rate,60599.02,160,MS DRG,48479.22,case rate,160% of CMS IPPS rate,49236.71,130,MS DRG,39389.37,case rate,130% of CMS IPPS rate,10232.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10743.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37874.39,100,MS DRG,30299.51,case rate,100% of CMS IPPS rate,10232.15,100,,,case rate,100% of CMS IPPS rate,37874.39,100,MS DRG,30299.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10232.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574447.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37874.39,100,MS DRG,30299.51,case rate,100% of CMS IPPS rate,37874.39,100,MS DRG,30299.51,case rate,100% of CMS IPPS rate,10232.15,574447.5,
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES,212,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133047.19,100,MS DRG,106437.75,case rate,100% of CMS IPPS rate,212875.5,160,MS DRG,170300.4,case rate,160% of CMS IPPS rate,172961.35,130,MS DRG,138369.08,case rate,130% of CMS IPPS rate,41533.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43610.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,133047.19,100,MS DRG,106437.75,case rate,100% of CMS IPPS rate,41533.65,100,,,case rate,100% of CMS IPPS rate,133047.19,100,MS DRG,106437.75,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41533.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,661066.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,133047.19,100,MS DRG,106437.75,case rate,100% of CMS IPPS rate,133047.19,100,MS DRG,106437.75,case rate,100% of CMS IPPS rate,41533.65,661066.5,
OTHER HEART ASSIST SYSTEM IMPLANT,215,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126488.72,100,MS DRG,101190.98,case rate,100% of CMS IPPS rate,202381.95,160,MS DRG,161905.56,case rate,160% of CMS IPPS rate,164435.34,130,MS DRG,131548.27,case rate,130% of CMS IPPS rate,40393.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42412.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,126488.72,100,MS DRG,101190.98,case rate,100% of CMS IPPS rate,40393.31,100,,,case rate,100% of CMS IPPS rate,126488.72,100,MS DRG,101190.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40393.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1357731.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,126488.72,100,MS DRG,101190.98,case rate,100% of CMS IPPS rate,126488.72,100,MS DRG,101190.98,case rate,100% of CMS IPPS rate,40393.31,1357731,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,216,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120477.66,100,MS DRG,96382.13,case rate,100% of CMS IPPS rate,192764.26,160,MS DRG,154211.41,case rate,160% of CMS IPPS rate,156620.96,130,MS DRG,125296.77,case rate,130% of CMS IPPS rate,36795.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38635.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,120477.66,100,MS DRG,96382.13,case rate,100% of CMS IPPS rate,36795.4,100,,,case rate,100% of CMS IPPS rate,120477.66,100,MS DRG,96382.13,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36795.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,876183.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,120477.66,100,MS DRG,96382.13,case rate,100% of CMS IPPS rate,120477.66,100,MS DRG,96382.13,case rate,100% of CMS IPPS rate,36795.4,876183.1,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,217,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81072.54,100,MS DRG,64858.03,case rate,100% of CMS IPPS rate,129716.06,160,MS DRG,103772.85,case rate,160% of CMS IPPS rate,105394.3,130,MS DRG,84315.44,case rate,130% of CMS IPPS rate,24621.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25852.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,81072.54,100,MS DRG,64858.03,case rate,100% of CMS IPPS rate,24621.13,100,,,case rate,100% of CMS IPPS rate,81072.54,100,MS DRG,64858.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24621.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1239364.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,81072.54,100,MS DRG,64858.03,case rate,100% of CMS IPPS rate,81072.54,100,MS DRG,64858.03,case rate,100% of CMS IPPS rate,24621.13,1239365,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC,218,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73184.45,100,MS DRG,58547.56,case rate,100% of CMS IPPS rate,117095.12,160,MS DRG,93676.1,case rate,160% of CMS IPPS rate,95139.79,130,MS DRG,76111.83,case rate,130% of CMS IPPS rate,22682.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23816.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73184.45,100,MS DRG,58547.56,case rate,100% of CMS IPPS rate,22682.06,100,,,case rate,100% of CMS IPPS rate,73184.45,100,MS DRG,58547.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22682.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2938708.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,73184.45,100,MS DRG,58547.56,case rate,100% of CMS IPPS rate,73184.45,100,MS DRG,58547.56,case rate,100% of CMS IPPS rate,22682.06,2938709,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,219,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96951.39,100,MS DRG,77561.11,case rate,100% of CMS IPPS rate,155122.22,160,MS DRG,124097.78,case rate,160% of CMS IPPS rate,126036.81,130,MS DRG,100829.45,case rate,130% of CMS IPPS rate,29499.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30974.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,96951.39,100,MS DRG,77561.11,case rate,100% of CMS IPPS rate,29499.68,100,,,case rate,100% of CMS IPPS rate,96951.39,100,MS DRG,77561.11,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29499.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1197318.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,96951.39,100,MS DRG,77561.11,case rate,100% of CMS IPPS rate,96951.39,100,MS DRG,77561.11,case rate,100% of CMS IPPS rate,29499.68,1197318,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,220,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67850.6,100,MS DRG,54280.48,case rate,100% of CMS IPPS rate,108560.96,160,MS DRG,86848.77,case rate,160% of CMS IPPS rate,88205.78,130,MS DRG,70564.62,case rate,130% of CMS IPPS rate,20193.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21203.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67850.6,100,MS DRG,54280.48,case rate,100% of CMS IPPS rate,20193.99,100,,,case rate,100% of CMS IPPS rate,67850.6,100,MS DRG,54280.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20193.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1315734.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,67850.6,100,MS DRG,54280.48,case rate,100% of CMS IPPS rate,67850.6,100,MS DRG,54280.48,case rate,100% of CMS IPPS rate,20193.99,1315734,
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,221,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60819.03,100,MS DRG,48655.22,case rate,100% of CMS IPPS rate,97310.45,160,MS DRG,77848.36,case rate,160% of CMS IPPS rate,79064.74,130,MS DRG,63251.79,case rate,130% of CMS IPPS rate,17509.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18385,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60819.03,100,MS DRG,48655.22,case rate,100% of CMS IPPS rate,17509.56,100,,,case rate,100% of CMS IPPS rate,60819.03,100,MS DRG,48655.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17509.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1299289.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,60819.03,100,MS DRG,48655.22,case rate,100% of CMS IPPS rate,60819.03,100,MS DRG,48655.22,case rate,100% of CMS IPPS rate,17509.56,1299290,
OTHER CARDIOTHORACIC PROCEDURES WITH MCC,228,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65421.4,100,MS DRG,52337.12,case rate,100% of CMS IPPS rate,104674.24,160,MS DRG,83739.39,case rate,160% of CMS IPPS rate,85047.82,130,MS DRG,68038.26,case rate,130% of CMS IPPS rate,18999.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19949.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65421.4,100,MS DRG,52337.12,case rate,100% of CMS IPPS rate,18999.13,100,,,case rate,100% of CMS IPPS rate,65421.4,100,MS DRG,52337.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18999.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1101365.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,65421.4,100,MS DRG,52337.12,case rate,100% of CMS IPPS rate,65421.4,100,MS DRG,52337.12,case rate,100% of CMS IPPS rate,18999.13,1101366,
OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,229,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43487.84,100,MS DRG,34790.27,case rate,100% of CMS IPPS rate,69580.54,160,MS DRG,55664.43,case rate,160% of CMS IPPS rate,56534.19,130,MS DRG,45227.35,case rate,130% of CMS IPPS rate,11842.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12435.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43487.84,100,MS DRG,34790.27,case rate,100% of CMS IPPS rate,11842.96,100,,,case rate,100% of CMS IPPS rate,43487.84,100,MS DRG,34790.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11842.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1280814.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43487.84,100,MS DRG,34790.27,case rate,100% of CMS IPPS rate,43487.84,100,MS DRG,34790.27,case rate,100% of CMS IPPS rate,11842.96,1280815,
CORONARY BYPASS WITH PTCA WITH MCC,231,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101717.76,100,MS DRG,81374.21,case rate,100% of CMS IPPS rate,162748.42,160,MS DRG,130198.74,case rate,160% of CMS IPPS rate,132233.09,130,MS DRG,105786.47,case rate,130% of CMS IPPS rate,32307.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33922.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,101717.76,100,MS DRG,81374.21,case rate,100% of CMS IPPS rate,32307.25,100,,,case rate,100% of CMS IPPS rate,101717.76,100,MS DRG,81374.21,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32307.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1081475.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,101717.76,100,MS DRG,81374.21,case rate,100% of CMS IPPS rate,101717.76,100,MS DRG,81374.21,case rate,100% of CMS IPPS rate,32307.25,1081476,
CORONARY BYPASS WITH PTCA WITHOUT MCC,232,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76156.33,100,MS DRG,60925.06,case rate,100% of CMS IPPS rate,121850.13,160,MS DRG,97480.1,case rate,160% of CMS IPPS rate,99003.23,130,MS DRG,79202.58,case rate,130% of CMS IPPS rate,23289.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24454.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76156.33,100,MS DRG,60925.06,case rate,100% of CMS IPPS rate,23289.79,100,,,case rate,100% of CMS IPPS rate,76156.33,100,MS DRG,60925.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23289.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1343455.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,76156.33,100,MS DRG,60925.06,case rate,100% of CMS IPPS rate,76156.33,100,MS DRG,60925.06,case rate,100% of CMS IPPS rate,23289.79,1343455,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,233,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97994.33,100,MS DRG,78395.46,case rate,100% of CMS IPPS rate,156790.93,160,MS DRG,125432.74,case rate,160% of CMS IPPS rate,127392.63,130,MS DRG,101914.1,case rate,130% of CMS IPPS rate,29800.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31290.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,97994.33,100,MS DRG,78395.46,case rate,100% of CMS IPPS rate,29800.49,100,,,case rate,100% of CMS IPPS rate,97994.33,100,MS DRG,78395.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29800.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1084978.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,97994.33,100,MS DRG,78395.46,case rate,100% of CMS IPPS rate,97994.33,100,MS DRG,78395.46,case rate,100% of CMS IPPS rate,29800.49,1084979,
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,234,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67299.64,100,MS DRG,53839.71,case rate,100% of CMS IPPS rate,107679.42,160,MS DRG,86143.54,case rate,160% of CMS IPPS rate,87489.53,130,MS DRG,69991.62,case rate,130% of CMS IPPS rate,20283.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21297.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67299.64,100,MS DRG,53839.71,case rate,100% of CMS IPPS rate,20283.58,100,,,case rate,100% of CMS IPPS rate,67299.64,100,MS DRG,53839.71,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20283.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1098607.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,67299.64,100,MS DRG,53839.71,case rate,100% of CMS IPPS rate,67299.64,100,MS DRG,53839.71,case rate,100% of CMS IPPS rate,20283.58,1098608,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,235,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75354.08,100,MS DRG,60283.26,case rate,100% of CMS IPPS rate,120566.53,160,MS DRG,96453.22,case rate,160% of CMS IPPS rate,97960.3,130,MS DRG,78368.24,case rate,130% of CMS IPPS rate,22433.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23555.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,75354.08,100,MS DRG,60283.26,case rate,100% of CMS IPPS rate,22433.87,100,,,case rate,100% of CMS IPPS rate,75354.08,100,MS DRG,60283.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22433.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1113014.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,75354.08,100,MS DRG,60283.26,case rate,100% of CMS IPPS rate,75354.08,100,MS DRG,60283.26,case rate,100% of CMS IPPS rate,22433.87,1113015,
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,236,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53652.95,100,MS DRG,42922.36,case rate,100% of CMS IPPS rate,85844.72,160,MS DRG,68675.78,case rate,160% of CMS IPPS rate,69748.84,130,MS DRG,55799.07,case rate,130% of CMS IPPS rate,15677.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16461.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53652.95,100,MS DRG,42922.36,case rate,100% of CMS IPPS rate,15677.63,100,,,case rate,100% of CMS IPPS rate,53652.95,100,MS DRG,42922.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15677.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1138323.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53652.95,100,MS DRG,42922.36,case rate,100% of CMS IPPS rate,53652.95,100,MS DRG,42922.36,case rate,100% of CMS IPPS rate,15677.63,1138323,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62685.45,100,MS DRG,50148.36,case rate,100% of CMS IPPS rate,100296.72,160,MS DRG,80237.38,case rate,160% of CMS IPPS rate,81491.09,130,MS DRG,65192.87,case rate,130% of CMS IPPS rate,19203.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20163.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62685.45,100,MS DRG,50148.36,case rate,100% of CMS IPPS rate,19203.48,100,,,case rate,100% of CMS IPPS rate,62685.45,100,MS DRG,50148.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19203.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,475178.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,62685.45,100,MS DRG,50148.36,case rate,100% of CMS IPPS rate,62685.45,100,MS DRG,50148.36,case rate,100% of CMS IPPS rate,19203.48,475179,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39117.88,100,MS DRG,31294.3,case rate,100% of CMS IPPS rate,62588.61,160,MS DRG,50070.89,case rate,160% of CMS IPPS rate,50853.24,130,MS DRG,40682.59,case rate,130% of CMS IPPS rate,11102.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11658.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39117.88,100,MS DRG,31294.3,case rate,100% of CMS IPPS rate,11102.94,100,,,case rate,100% of CMS IPPS rate,39117.88,100,MS DRG,31294.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11102.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448871.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39117.88,100,MS DRG,31294.3,case rate,100% of CMS IPPS rate,39117.88,100,MS DRG,31294.3,case rate,100% of CMS IPPS rate,11102.94,448871.3,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22421.44,100,MS DRG,17937.15,case rate,100% of CMS IPPS rate,35874.3,160,MS DRG,28699.44,case rate,160% of CMS IPPS rate,29147.87,130,MS DRG,23318.3,case rate,130% of CMS IPPS rate,5756.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6044.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22421.44,100,MS DRG,17937.15,case rate,100% of CMS IPPS rate,5756.58,100,,,case rate,100% of CMS IPPS rate,22421.44,100,MS DRG,17937.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5756.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437097.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22421.44,100,MS DRG,17937.15,case rate,100% of CMS IPPS rate,22421.44,100,MS DRG,17937.15,case rate,100% of CMS IPPS rate,5756.58,437097.9,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,242,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46738.17,100,MS DRG,37390.54,case rate,100% of CMS IPPS rate,74781.07,160,MS DRG,59824.86,case rate,160% of CMS IPPS rate,60759.62,130,MS DRG,48607.7,case rate,130% of CMS IPPS rate,12932.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13578.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46738.17,100,MS DRG,37390.54,case rate,100% of CMS IPPS rate,12932.2,100,,,case rate,100% of CMS IPPS rate,46738.17,100,MS DRG,37390.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12932.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1066149.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46738.17,100,MS DRG,37390.54,case rate,100% of CMS IPPS rate,46738.17,100,MS DRG,37390.54,case rate,100% of CMS IPPS rate,12932.2,1066150,
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,243,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32846.11,100,MS DRG,26276.89,case rate,100% of CMS IPPS rate,52553.78,160,MS DRG,42043.02,case rate,160% of CMS IPPS rate,42699.94,130,MS DRG,34159.95,case rate,130% of CMS IPPS rate,8588.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9018.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32846.11,100,MS DRG,26276.89,case rate,100% of CMS IPPS rate,8588.94,100,,,case rate,100% of CMS IPPS rate,32846.11,100,MS DRG,26276.89,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8588.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1397370.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32846.11,100,MS DRG,26276.89,case rate,100% of CMS IPPS rate,32846.11,100,MS DRG,26276.89,case rate,100% of CMS IPPS rate,8588.94,1397371,
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,244,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27559.44,100,MS DRG,22047.55,case rate,100% of CMS IPPS rate,44095.1,160,MS DRG,35276.08,case rate,160% of CMS IPPS rate,35827.27,130,MS DRG,28661.82,case rate,130% of CMS IPPS rate,6880.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7224.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27559.44,100,MS DRG,22047.55,case rate,100% of CMS IPPS rate,6880.53,100,,,case rate,100% of CMS IPPS rate,27559.44,100,MS DRG,22047.55,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6880.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1504162.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27559.44,100,MS DRG,22047.55,case rate,100% of CMS IPPS rate,27559.44,100,MS DRG,22047.55,case rate,100% of CMS IPPS rate,6880.53,1504162,
AICD GENERATOR PROCEDURES,245,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59436.3,100,MS DRG,47549.04,case rate,100% of CMS IPPS rate,95098.08,160,MS DRG,76078.46,case rate,160% of CMS IPPS rate,77267.19,130,MS DRG,61813.75,case rate,130% of CMS IPPS rate,18631.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19562.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59436.3,100,MS DRG,47549.04,case rate,100% of CMS IPPS rate,18631.22,100,,,case rate,100% of CMS IPPS rate,59436.3,100,MS DRG,47549.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18631.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1249412.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59436.3,100,MS DRG,47549.04,case rate,100% of CMS IPPS rate,59436.3,100,MS DRG,47549.04,case rate,100% of CMS IPPS rate,18631.22,1249412,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC,250,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33709.7,100,MS DRG,26967.76,case rate,100% of CMS IPPS rate,53935.52,160,MS DRG,43148.42,case rate,160% of CMS IPPS rate,43822.61,130,MS DRG,35058.09,case rate,130% of CMS IPPS rate,8816.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9257.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33709.7,100,MS DRG,26967.76,case rate,100% of CMS IPPS rate,8816.93,100,,,case rate,100% of CMS IPPS rate,33709.7,100,MS DRG,26967.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8816.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,931311.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33709.7,100,MS DRG,26967.76,case rate,100% of CMS IPPS rate,33709.7,100,MS DRG,26967.76,case rate,100% of CMS IPPS rate,8816.93,931311.5,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC,251,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24697.26,100,MS DRG,19757.81,case rate,100% of CMS IPPS rate,39515.62,160,MS DRG,31612.5,case rate,160% of CMS IPPS rate,32106.44,130,MS DRG,25685.15,case rate,130% of CMS IPPS rate,5957.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6255.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24697.26,100,MS DRG,19757.81,case rate,100% of CMS IPPS rate,5957.51,100,,,case rate,100% of CMS IPPS rate,24697.26,100,MS DRG,19757.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5957.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1507983.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24697.26,100,MS DRG,19757.81,case rate,100% of CMS IPPS rate,24697.26,100,MS DRG,19757.81,case rate,100% of CMS IPPS rate,5957.51,1507984,
OTHER VASCULAR PROCEDURES WITH MCC,252,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45543.05,100,MS DRG,36434.44,case rate,100% of CMS IPPS rate,72868.88,160,MS DRG,58295.1,case rate,160% of CMS IPPS rate,59205.97,130,MS DRG,47364.78,case rate,130% of CMS IPPS rate,13078.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13732.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45543.05,100,MS DRG,36434.44,case rate,100% of CMS IPPS rate,13078.61,100,,,case rate,100% of CMS IPPS rate,45543.05,100,MS DRG,36434.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13078.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,798099.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45543.05,100,MS DRG,36434.44,case rate,100% of CMS IPPS rate,45543.05,100,MS DRG,36434.44,case rate,100% of CMS IPPS rate,13078.61,798099.1,
OTHER VASCULAR PROCEDURES WITH CC,253,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36072.84,100,MS DRG,28858.27,case rate,100% of CMS IPPS rate,57716.54,160,MS DRG,46173.23,case rate,160% of CMS IPPS rate,46894.69,130,MS DRG,37515.75,case rate,130% of CMS IPPS rate,9733.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10220.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36072.84,100,MS DRG,28858.27,case rate,100% of CMS IPPS rate,9733.47,100,,,case rate,100% of CMS IPPS rate,36072.84,100,MS DRG,28858.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9733.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,898845.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36072.84,100,MS DRG,28858.27,case rate,100% of CMS IPPS rate,36072.84,100,MS DRG,28858.27,case rate,100% of CMS IPPS rate,9733.47,898845.3,
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,254,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26445.72,100,MS DRG,21156.58,case rate,100% of CMS IPPS rate,42313.15,160,MS DRG,33850.52,case rate,160% of CMS IPPS rate,34379.44,130,MS DRG,27503.55,case rate,130% of CMS IPPS rate,6669.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7003.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26445.72,100,MS DRG,21156.58,case rate,100% of CMS IPPS rate,6669.69,100,,,case rate,100% of CMS IPPS rate,26445.72,100,MS DRG,21156.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6669.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1360285.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26445.72,100,MS DRG,21156.58,case rate,100% of CMS IPPS rate,26445.72,100,MS DRG,21156.58,case rate,100% of CMS IPPS rate,6669.69,1360285,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38388.77,100,MS DRG,30711.02,case rate,100% of CMS IPPS rate,61422.03,160,MS DRG,49137.62,case rate,160% of CMS IPPS rate,49905.4,130,MS DRG,39924.32,case rate,130% of CMS IPPS rate,9975.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10474.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38388.77,100,MS DRG,30711.02,case rate,100% of CMS IPPS rate,9975.56,100,,,case rate,100% of CMS IPPS rate,38388.77,100,MS DRG,30711.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9975.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,482809.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38388.77,100,MS DRG,30711.02,case rate,100% of CMS IPPS rate,38388.77,100,MS DRG,30711.02,case rate,100% of CMS IPPS rate,9975.56,482809.6,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25320.19,100,MS DRG,20256.15,case rate,100% of CMS IPPS rate,40512.3,160,MS DRG,32409.84,case rate,160% of CMS IPPS rate,32916.25,130,MS DRG,26333,case rate,130% of CMS IPPS rate,6457.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6780.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25320.19,100,MS DRG,20256.15,case rate,100% of CMS IPPS rate,6457.33,100,,,case rate,100% of CMS IPPS rate,25320.19,100,MS DRG,20256.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6457.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437037.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25320.19,100,MS DRG,20256.15,case rate,100% of CMS IPPS rate,25320.19,100,MS DRG,20256.15,case rate,100% of CMS IPPS rate,6457.33,437037.2,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17666.87,100,MS DRG,14133.5,case rate,100% of CMS IPPS rate,28266.99,160,MS DRG,22613.59,case rate,160% of CMS IPPS rate,22966.93,130,MS DRG,18373.54,case rate,130% of CMS IPPS rate,3021.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3172.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17666.87,100,MS DRG,14133.5,case rate,100% of CMS IPPS rate,3021.84,100,,,case rate,100% of CMS IPPS rate,17666.87,100,MS DRG,14133.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3021.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396193.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17666.87,100,MS DRG,14133.5,case rate,100% of CMS IPPS rate,17666.87,100,MS DRG,14133.5,case rate,100% of CMS IPPS rate,3021.84,396193.3,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,258,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37931.01,100,MS DRG,30344.81,case rate,100% of CMS IPPS rate,60689.62,160,MS DRG,48551.7,case rate,160% of CMS IPPS rate,49310.31,130,MS DRG,39448.25,case rate,130% of CMS IPPS rate,10696.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11230.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37931.01,100,MS DRG,30344.81,case rate,100% of CMS IPPS rate,10696.14,100,,,case rate,100% of CMS IPPS rate,37931.01,100,MS DRG,30344.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10696.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,687535.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37931.01,100,MS DRG,30344.81,case rate,100% of CMS IPPS rate,37931.01,100,MS DRG,30344.81,case rate,100% of CMS IPPS rate,10696.14,687535.4,
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC,259,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27997.16,100,MS DRG,22397.73,case rate,100% of CMS IPPS rate,44795.46,160,MS DRG,35836.37,case rate,160% of CMS IPPS rate,36396.31,130,MS DRG,29117.05,case rate,130% of CMS IPPS rate,6701.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7036.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27997.16,100,MS DRG,22397.73,case rate,100% of CMS IPPS rate,6701.34,100,,,case rate,100% of CMS IPPS rate,27997.16,100,MS DRG,22397.73,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6701.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,994997.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27997.16,100,MS DRG,22397.73,case rate,100% of CMS IPPS rate,27997.16,100,MS DRG,22397.73,case rate,100% of CMS IPPS rate,6701.34,994997.4,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,260,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45087.65,100,MS DRG,36070.12,case rate,100% of CMS IPPS rate,72140.24,160,MS DRG,57712.19,case rate,160% of CMS IPPS rate,58613.95,130,MS DRG,46891.16,case rate,130% of CMS IPPS rate,12986.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13635.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45087.65,100,MS DRG,36070.12,case rate,100% of CMS IPPS rate,12986.34,100,,,case rate,100% of CMS IPPS rate,45087.65,100,MS DRG,36070.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12986.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,582809.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45087.65,100,MS DRG,36070.12,case rate,100% of CMS IPPS rate,45087.65,100,MS DRG,36070.12,case rate,100% of CMS IPPS rate,12986.34,582809.9,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC,261,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28176.47,100,MS DRG,22541.18,case rate,100% of CMS IPPS rate,45082.35,160,MS DRG,36065.88,case rate,160% of CMS IPPS rate,36629.41,130,MS DRG,29303.53,case rate,130% of CMS IPPS rate,7234.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7596.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28176.47,100,MS DRG,22541.18,case rate,100% of CMS IPPS rate,7234.71,100,,,case rate,100% of CMS IPPS rate,28176.47,100,MS DRG,22541.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7234.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,851895.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28176.47,100,MS DRG,22541.18,case rate,100% of CMS IPPS rate,28176.47,100,MS DRG,22541.18,case rate,100% of CMS IPPS rate,7234.71,851895.6,
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,262,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25386.26,100,MS DRG,20309.01,case rate,100% of CMS IPPS rate,40618.02,160,MS DRG,32494.42,case rate,160% of CMS IPPS rate,33002.14,130,MS DRG,26401.71,case rate,130% of CMS IPPS rate,5786.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6076.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25386.26,100,MS DRG,20309.01,case rate,100% of CMS IPPS rate,5786.7,100,,,case rate,100% of CMS IPPS rate,25386.26,100,MS DRG,20309.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5786.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1228385.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25386.26,100,MS DRG,20309.01,case rate,100% of CMS IPPS rate,25386.26,100,MS DRG,20309.01,case rate,100% of CMS IPPS rate,5786.7,1228386,
VEIN LIGATION AND STRIPPING,263,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39306.65,100,MS DRG,31445.32,case rate,100% of CMS IPPS rate,62890.64,160,MS DRG,50312.51,case rate,160% of CMS IPPS rate,51098.65,130,MS DRG,40878.92,case rate,130% of CMS IPPS rate,10225.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10736.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39306.65,100,MS DRG,31445.32,case rate,100% of CMS IPPS rate,10225.67,100,,,case rate,100% of CMS IPPS rate,39306.65,100,MS DRG,31445.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10225.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,664418.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39306.65,100,MS DRG,31445.32,case rate,100% of CMS IPPS rate,39306.65,100,MS DRG,31445.32,case rate,100% of CMS IPPS rate,10225.67,664418.3,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44507.19,100,MS DRG,35605.75,case rate,100% of CMS IPPS rate,71211.5,160,MS DRG,56969.2,case rate,160% of CMS IPPS rate,57859.35,130,MS DRG,46287.48,case rate,130% of CMS IPPS rate,13325.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13991.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44507.19,100,MS DRG,35605.75,case rate,100% of CMS IPPS rate,13325.28,100,,,case rate,100% of CMS IPPS rate,44507.19,100,MS DRG,35605.75,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13325.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,590129.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44507.19,100,MS DRG,35605.75,case rate,100% of CMS IPPS rate,44507.19,100,MS DRG,35605.75,case rate,100% of CMS IPPS rate,13325.28,590129.5,
AICD LEAD PROCEDURES,265,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47670.21,100,MS DRG,38136.17,case rate,100% of CMS IPPS rate,76272.34,160,MS DRG,61017.87,case rate,160% of CMS IPPS rate,61971.27,130,MS DRG,49577.02,case rate,130% of CMS IPPS rate,13600.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14280.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47670.21,100,MS DRG,38136.17,case rate,100% of CMS IPPS rate,13600.16,100,,,case rate,100% of CMS IPPS rate,47670.21,100,MS DRG,38136.17,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13600.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1009238.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47670.21,100,MS DRG,38136.17,case rate,100% of CMS IPPS rate,47670.21,100,MS DRG,38136.17,case rate,100% of CMS IPPS rate,13600.16,1009238,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79666.24,100,MS DRG,63732.99,case rate,100% of CMS IPPS rate,127465.98,160,MS DRG,101972.78,case rate,160% of CMS IPPS rate,103566.11,130,MS DRG,82852.89,case rate,130% of CMS IPPS rate,22840.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23982.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79666.24,100,MS DRG,63732.99,case rate,100% of CMS IPPS rate,22840.28,100,,,case rate,100% of CMS IPPS rate,79666.24,100,MS DRG,63732.99,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22840.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540357.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,79666.24,100,MS DRG,63732.99,case rate,100% of CMS IPPS rate,79666.24,100,MS DRG,63732.99,case rate,100% of CMS IPPS rate,22840.28,540357.5,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63551.42,100,MS DRG,50841.14,case rate,100% of CMS IPPS rate,101682.27,160,MS DRG,81345.82,case rate,160% of CMS IPPS rate,82616.85,130,MS DRG,66093.48,case rate,130% of CMS IPPS rate,17936.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18833.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63551.42,100,MS DRG,50841.14,case rate,100% of CMS IPPS rate,17936.95,100,,,case rate,100% of CMS IPPS rate,63551.42,100,MS DRG,50841.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17936.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268409.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,63551.42,100,MS DRG,50841.14,case rate,100% of CMS IPPS rate,63551.42,100,MS DRG,50841.14,case rate,100% of CMS IPPS rate,17936.95,268409.2,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86846.45,100,MS DRG,69477.16,case rate,100% of CMS IPPS rate,138954.32,160,MS DRG,111163.46,case rate,160% of CMS IPPS rate,112900.39,130,MS DRG,90320.31,case rate,130% of CMS IPPS rate,25420.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26691.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86846.45,100,MS DRG,69477.16,case rate,100% of CMS IPPS rate,25420.63,100,,,case rate,100% of CMS IPPS rate,86846.45,100,MS DRG,69477.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25420.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393264.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,86846.45,100,MS DRG,69477.16,case rate,100% of CMS IPPS rate,86846.45,100,MS DRG,69477.16,case rate,100% of CMS IPPS rate,25420.63,393264.6,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55038.03,100,MS DRG,44030.42,case rate,100% of CMS IPPS rate,88060.85,160,MS DRG,70448.68,case rate,160% of CMS IPPS rate,71549.44,130,MS DRG,57239.55,case rate,130% of CMS IPPS rate,15862.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16656.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55038.03,100,MS DRG,44030.42,case rate,100% of CMS IPPS rate,15862.92,100,,,case rate,100% of CMS IPPS rate,55038.03,100,MS DRG,44030.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15862.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326247.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,55038.03,100,MS DRG,44030.42,case rate,100% of CMS IPPS rate,55038.03,100,MS DRG,44030.42,case rate,100% of CMS IPPS rate,15862.92,326247.2,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65636.12,100,MS DRG,52508.9,case rate,100% of CMS IPPS rate,105017.79,160,MS DRG,84014.23,case rate,160% of CMS IPPS rate,85326.96,130,MS DRG,68261.57,case rate,130% of CMS IPPS rate,19569.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20548.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65636.12,100,MS DRG,52508.9,case rate,100% of CMS IPPS rate,19569.87,100,,,case rate,100% of CMS IPPS rate,65636.12,100,MS DRG,52508.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19569.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,325814.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,65636.12,100,MS DRG,52508.9,case rate,100% of CMS IPPS rate,65636.12,100,MS DRG,52508.9,case rate,100% of CMS IPPS rate,19569.87,325815,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46751.15,100,MS DRG,37400.92,case rate,100% of CMS IPPS rate,74801.84,160,MS DRG,59841.47,case rate,160% of CMS IPPS rate,60776.5,130,MS DRG,48621.2,case rate,130% of CMS IPPS rate,13131.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13788.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46751.15,100,MS DRG,37400.92,case rate,100% of CMS IPPS rate,13131.98,100,,,case rate,100% of CMS IPPS rate,46751.15,100,MS DRG,37400.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13131.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258134.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46751.15,100,MS DRG,37400.92,case rate,100% of CMS IPPS rate,46751.15,100,MS DRG,37400.92,case rate,100% of CMS IPPS rate,13131.98,258134.2,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34756.18,100,MS DRG,27804.94,case rate,100% of CMS IPPS rate,55609.89,160,MS DRG,44487.91,case rate,160% of CMS IPPS rate,45183.03,130,MS DRG,36146.42,case rate,130% of CMS IPPS rate,9539.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10016.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34756.18,100,MS DRG,27804.94,case rate,100% of CMS IPPS rate,9539.79,100,,,case rate,100% of CMS IPPS rate,34756.18,100,MS DRG,27804.94,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9539.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1010906.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34756.18,100,MS DRG,27804.94,case rate,100% of CMS IPPS rate,34756.18,100,MS DRG,27804.94,case rate,100% of CMS IPPS rate,9539.79,1010906,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51951.68,100,MS DRG,41561.34,case rate,100% of CMS IPPS rate,83122.69,160,MS DRG,66498.15,case rate,160% of CMS IPPS rate,67537.18,130,MS DRG,54029.74,case rate,130% of CMS IPPS rate,14908.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15653.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51951.68,100,MS DRG,41561.34,case rate,100% of CMS IPPS rate,14908.25,100,,,case rate,100% of CMS IPPS rate,51951.68,100,MS DRG,41561.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14908.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,985949.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,51951.68,100,MS DRG,41561.34,case rate,100% of CMS IPPS rate,51951.68,100,MS DRG,41561.34,case rate,100% of CMS IPPS rate,14908.25,985949.2,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44209.87,100,MS DRG,35367.9,case rate,100% of CMS IPPS rate,70735.79,160,MS DRG,56588.63,case rate,160% of CMS IPPS rate,57472.83,130,MS DRG,45978.26,case rate,130% of CMS IPPS rate,11899,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12493.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44209.87,100,MS DRG,35367.9,case rate,100% of CMS IPPS rate,11899,100,,,case rate,100% of CMS IPPS rate,44209.87,100,MS DRG,35367.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11899,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2344154.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44209.87,100,MS DRG,35367.9,case rate,100% of CMS IPPS rate,44209.87,100,MS DRG,35367.9,case rate,100% of CMS IPPS rate,11899,2344155,
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC,275,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88983.06,100,MS DRG,71186.45,case rate,100% of CMS IPPS rate,142372.9,160,MS DRG,113898.32,case rate,160% of CMS IPPS rate,115677.98,130,MS DRG,92542.38,case rate,130% of CMS IPPS rate,26943.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28290.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88983.06,100,MS DRG,71186.45,case rate,100% of CMS IPPS rate,26943.36,100,,,case rate,100% of CMS IPPS rate,88983.06,100,MS DRG,71186.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26943.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,915900.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,88983.06,100,MS DRG,71186.45,case rate,100% of CMS IPPS rate,88983.06,100,MS DRG,71186.45,case rate,100% of CMS IPPS rate,26943.36,915900.5,
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR,276,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79242.69,100,MS DRG,63394.15,case rate,100% of CMS IPPS rate,126788.3,160,MS DRG,101430.64,case rate,160% of CMS IPPS rate,103015.5,130,MS DRG,82412.4,case rate,130% of CMS IPPS rate,23616.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24797.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79242.69,100,MS DRG,63394.15,case rate,100% of CMS IPPS rate,23616.52,100,,,case rate,100% of CMS IPPS rate,79242.69,100,MS DRG,63394.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23616.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2060719.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,79242.69,100,MS DRG,63394.15,case rate,100% of CMS IPPS rate,79242.69,100,MS DRG,63394.15,case rate,100% of CMS IPPS rate,23616.52,2060720,
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC,277,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62397.57,100,MS DRG,49918.06,case rate,100% of CMS IPPS rate,99836.11,160,MS DRG,79868.89,case rate,160% of CMS IPPS rate,81116.84,130,MS DRG,64893.47,case rate,130% of CMS IPPS rate,17735.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18622.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,62397.57,100,MS DRG,49918.06,case rate,100% of CMS IPPS rate,17735.65,100,,,case rate,100% of CMS IPPS rate,62397.57,100,MS DRG,49918.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17735.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,847691.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,62397.57,100,MS DRG,49918.06,case rate,100% of CMS IPPS rate,62397.57,100,MS DRG,49918.06,case rate,100% of CMS IPPS rate,17735.65,847691.6,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC,278,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58598.64,100,MS DRG,46878.91,case rate,100% of CMS IPPS rate,93757.82,160,MS DRG,75006.26,case rate,160% of CMS IPPS rate,76178.23,130,MS DRG,60942.58,case rate,130% of CMS IPPS rate,19075.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20029.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58598.64,100,MS DRG,46878.91,case rate,100% of CMS IPPS rate,19075.38,100,,,case rate,100% of CMS IPPS rate,58598.64,100,MS DRG,46878.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19075.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1101167.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,58598.64,100,MS DRG,46878.91,case rate,100% of CMS IPPS rate,58598.64,100,MS DRG,46878.91,case rate,100% of CMS IPPS rate,19075.38,1101167,
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC,279,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43735.59,100,MS DRG,34988.47,case rate,100% of CMS IPPS rate,69976.94,160,MS DRG,55981.55,case rate,160% of CMS IPPS rate,56856.27,130,MS DRG,45485.02,case rate,130% of CMS IPPS rate,12216.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12827.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43735.59,100,MS DRG,34988.47,case rate,100% of CMS IPPS rate,12216.97,100,,,case rate,100% of CMS IPPS rate,43735.59,100,MS DRG,34988.47,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12216.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1352099.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43735.59,100,MS DRG,34988.47,case rate,100% of CMS IPPS rate,43735.59,100,MS DRG,34988.47,case rate,100% of CMS IPPS rate,12216.97,1352100,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,39508.08,160,MS DRG,31606.46,case rate,160% of CMS IPPS rate,32100.32,130,MS DRG,25680.26,case rate,130% of CMS IPPS rate,6257.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6570.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,6257.94,100,,,case rate,100% of CMS IPPS rate,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6257.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503662.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,6257.94,503662.9,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16746.63,100,MS DRG,13397.3,case rate,100% of CMS IPPS rate,26794.61,160,MS DRG,21435.69,case rate,160% of CMS IPPS rate,21770.62,130,MS DRG,17416.5,case rate,130% of CMS IPPS rate,3514.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3690.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16746.63,100,MS DRG,13397.3,case rate,100% of CMS IPPS rate,3514.42,100,,,case rate,100% of CMS IPPS rate,16746.63,100,MS DRG,13397.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3514.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,733907.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16746.63,100,MS DRG,13397.3,case rate,100% of CMS IPPS rate,16746.63,100,MS DRG,13397.3,case rate,100% of CMS IPPS rate,3514.42,733907.1,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14447.21,100,MS DRG,11557.77,case rate,100% of CMS IPPS rate,23115.54,160,MS DRG,18492.43,case rate,160% of CMS IPPS rate,18781.37,130,MS DRG,15025.1,case rate,130% of CMS IPPS rate,2764.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2902.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14447.21,100,MS DRG,11557.77,case rate,100% of CMS IPPS rate,2764.49,100,,,case rate,100% of CMS IPPS rate,14447.21,100,MS DRG,11557.77,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2764.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,632252.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14447.21,100,MS DRG,11557.77,case rate,100% of CMS IPPS rate,14447.21,100,MS DRG,11557.77,case rate,100% of CMS IPPS rate,2764.49,632252.5,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29233.58,100,MS DRG,23386.86,case rate,100% of CMS IPPS rate,46773.73,160,MS DRG,37418.98,case rate,160% of CMS IPPS rate,38003.65,130,MS DRG,30402.92,case rate,130% of CMS IPPS rate,7455.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7827.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29233.58,100,MS DRG,23386.86,case rate,100% of CMS IPPS rate,7455.08,100,,,case rate,100% of CMS IPPS rate,29233.58,100,MS DRG,23386.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7455.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,875909.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29233.58,100,MS DRG,23386.86,case rate,100% of CMS IPPS rate,29233.58,100,MS DRG,23386.86,case rate,100% of CMS IPPS rate,7455.08,875909.4,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14702.06,100,MS DRG,11761.65,case rate,100% of CMS IPPS rate,23523.3,160,MS DRG,18818.64,case rate,160% of CMS IPPS rate,19112.68,130,MS DRG,15290.14,case rate,130% of CMS IPPS rate,2825.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2966.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14702.06,100,MS DRG,11761.65,case rate,100% of CMS IPPS rate,2825.11,100,,,case rate,100% of CMS IPPS rate,14702.06,100,MS DRG,11761.65,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2825.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492900.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14702.06,100,MS DRG,11761.65,case rate,100% of CMS IPPS rate,14702.06,100,MS DRG,11761.65,case rate,100% of CMS IPPS rate,2825.11,492900.5,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11740.77,100,MS DRG,9392.62,case rate,100% of CMS IPPS rate,18785.23,160,MS DRG,15028.18,case rate,160% of CMS IPPS rate,15263,130,MS DRG,12210.4,case rate,130% of CMS IPPS rate,2140.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2247.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11740.77,100,MS DRG,9392.62,case rate,100% of CMS IPPS rate,2140.37,100,,,case rate,100% of CMS IPPS rate,11740.77,100,MS DRG,9392.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2140.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390790.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11740.77,100,MS DRG,9392.62,case rate,100% of CMS IPPS rate,11740.77,100,MS DRG,9392.62,case rate,100% of CMS IPPS rate,2140.37,390790.7,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31406.74,100,MS DRG,25125.39,case rate,100% of CMS IPPS rate,50250.78,160,MS DRG,40200.62,case rate,160% of CMS IPPS rate,40828.76,130,MS DRG,32663.01,case rate,130% of CMS IPPS rate,8438.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8860.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31406.74,100,MS DRG,25125.39,case rate,100% of CMS IPPS rate,8438.34,100,,,case rate,100% of CMS IPPS rate,31406.74,100,MS DRG,25125.39,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8438.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,479450.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31406.74,100,MS DRG,25125.39,case rate,100% of CMS IPPS rate,31406.74,100,MS DRG,25125.39,case rate,100% of CMS IPPS rate,8438.34,479450.7,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18735.77,100,MS DRG,14988.62,case rate,100% of CMS IPPS rate,29977.23,160,MS DRG,23981.78,case rate,160% of CMS IPPS rate,24356.5,130,MS DRG,19485.2,case rate,130% of CMS IPPS rate,4154.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4362.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18735.77,100,MS DRG,14988.62,case rate,100% of CMS IPPS rate,4154.55,100,,,case rate,100% of CMS IPPS rate,18735.77,100,MS DRG,14988.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4154.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,835214.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18735.77,100,MS DRG,14988.62,case rate,100% of CMS IPPS rate,18735.77,100,MS DRG,14988.62,case rate,100% of CMS IPPS rate,4154.55,835214.7,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36567.17,100,MS DRG,29253.74,case rate,100% of CMS IPPS rate,58507.47,160,MS DRG,46805.98,case rate,160% of CMS IPPS rate,47537.32,130,MS DRG,38029.86,case rate,130% of CMS IPPS rate,10414.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10934.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36567.17,100,MS DRG,29253.74,case rate,100% of CMS IPPS rate,10414.01,100,,,case rate,100% of CMS IPPS rate,36567.17,100,MS DRG,29253.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10414.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418851.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36567.17,100,MS DRG,29253.74,case rate,100% of CMS IPPS rate,36567.17,100,MS DRG,29253.74,case rate,100% of CMS IPPS rate,10414.01,418851.6,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23408.93,100,MS DRG,18727.14,case rate,100% of CMS IPPS rate,37454.29,160,MS DRG,29963.43,case rate,160% of CMS IPPS rate,30431.61,130,MS DRG,24345.29,case rate,130% of CMS IPPS rate,6011.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6311.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23408.93,100,MS DRG,18727.14,case rate,100% of CMS IPPS rate,6011.26,100,,,case rate,100% of CMS IPPS rate,23408.93,100,MS DRG,18727.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6011.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381135.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23408.93,100,MS DRG,18727.14,case rate,100% of CMS IPPS rate,23408.93,100,MS DRG,18727.14,case rate,100% of CMS IPPS rate,6011.26,381135.6,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18777.05,100,MS DRG,15021.64,case rate,100% of CMS IPPS rate,30043.28,160,MS DRG,24034.62,case rate,160% of CMS IPPS rate,24410.17,130,MS DRG,19528.14,case rate,130% of CMS IPPS rate,3732.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3919.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18777.05,100,MS DRG,15021.64,case rate,100% of CMS IPPS rate,3732.5,100,,,case rate,100% of CMS IPPS rate,18777.05,100,MS DRG,15021.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3732.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403564.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18777.05,100,MS DRG,15021.64,case rate,100% of CMS IPPS rate,18777.05,100,MS DRG,15021.64,case rate,100% of CMS IPPS rate,3732.5,403564.3,
HEART FAILURE AND SHOCK WITH MCC,291,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21122.49,100,MS DRG,16897.99,case rate,100% of CMS IPPS rate,33795.98,160,MS DRG,27036.78,case rate,160% of CMS IPPS rate,27459.24,130,MS DRG,21967.39,case rate,130% of CMS IPPS rate,4974.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5223.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21122.49,100,MS DRG,16897.99,case rate,100% of CMS IPPS rate,4974.63,100,,,case rate,100% of CMS IPPS rate,21122.49,100,MS DRG,16897.99,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4974.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,334023.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21122.49,100,MS DRG,16897.99,case rate,100% of CMS IPPS rate,21122.49,100,MS DRG,16897.99,case rate,100% of CMS IPPS rate,4974.63,334023.8,
HEART FAILURE AND SHOCK WITH CC,292,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16080.05,100,MS DRG,12864.04,case rate,100% of CMS IPPS rate,25728.08,160,MS DRG,20582.46,case rate,160% of CMS IPPS rate,20904.07,130,MS DRG,16723.26,case rate,130% of CMS IPPS rate,3283.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3447.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16080.05,100,MS DRG,12864.04,case rate,100% of CMS IPPS rate,3283.38,100,,,case rate,100% of CMS IPPS rate,16080.05,100,MS DRG,12864.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3283.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271812.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16080.05,100,MS DRG,12864.04,case rate,100% of CMS IPPS rate,16080.05,100,MS DRG,12864.04,case rate,100% of CMS IPPS rate,3283.38,271812.6,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12599.65,100,MS DRG,10079.72,case rate,100% of CMS IPPS rate,20159.44,160,MS DRG,16127.55,case rate,160% of CMS IPPS rate,16379.55,130,MS DRG,13103.64,case rate,130% of CMS IPPS rate,2091.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2196.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12599.65,100,MS DRG,10079.72,case rate,100% of CMS IPPS rate,2091.95,100,,,case rate,100% of CMS IPPS rate,12599.65,100,MS DRG,10079.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2091.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272004.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12599.65,100,MS DRG,10079.72,case rate,100% of CMS IPPS rate,12599.65,100,MS DRG,10079.72,case rate,100% of CMS IPPS rate,2091.95,272004.7,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18878.51,100,MS DRG,15102.81,case rate,100% of CMS IPPS rate,30205.62,160,MS DRG,24164.5,case rate,160% of CMS IPPS rate,24542.06,130,MS DRG,19633.65,case rate,130% of CMS IPPS rate,4681.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4915.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18878.51,100,MS DRG,15102.81,case rate,100% of CMS IPPS rate,4681.82,100,,,case rate,100% of CMS IPPS rate,18878.51,100,MS DRG,15102.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4681.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372130.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18878.51,100,MS DRG,15102.81,case rate,100% of CMS IPPS rate,18878.51,100,MS DRG,15102.81,case rate,100% of CMS IPPS rate,4681.82,372130.5,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15379.25,100,MS DRG,12303.4,case rate,100% of CMS IPPS rate,24606.8,160,MS DRG,19685.44,case rate,160% of CMS IPPS rate,19993.03,130,MS DRG,15994.42,case rate,130% of CMS IPPS rate,3011.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3161.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15379.25,100,MS DRG,12303.4,case rate,100% of CMS IPPS rate,3011.16,100,,,case rate,100% of CMS IPPS rate,15379.25,100,MS DRG,12303.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3011.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455262.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15379.25,100,MS DRG,12303.4,case rate,100% of CMS IPPS rate,15379.25,100,MS DRG,12303.4,case rate,100% of CMS IPPS rate,3011.16,455262.1,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24889.57,100,MS DRG,19911.66,case rate,100% of CMS IPPS rate,39823.31,160,MS DRG,31858.65,case rate,160% of CMS IPPS rate,32356.44,130,MS DRG,25885.15,case rate,130% of CMS IPPS rate,6246.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6558.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24889.57,100,MS DRG,19911.66,case rate,100% of CMS IPPS rate,6246.5,100,,,case rate,100% of CMS IPPS rate,24889.57,100,MS DRG,19911.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6246.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,801071.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24889.57,100,MS DRG,19911.66,case rate,100% of CMS IPPS rate,24889.57,100,MS DRG,19911.66,case rate,100% of CMS IPPS rate,6246.5,801072,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14571.09,100,MS DRG,11656.87,case rate,100% of CMS IPPS rate,23313.74,160,MS DRG,18650.99,case rate,160% of CMS IPPS rate,18942.42,130,MS DRG,15153.94,case rate,130% of CMS IPPS rate,2685.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2819.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14571.09,100,MS DRG,11656.87,case rate,100% of CMS IPPS rate,2685.57,100,,,case rate,100% of CMS IPPS rate,14571.09,100,MS DRG,11656.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2685.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,582548.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14571.09,100,MS DRG,11656.87,case rate,100% of CMS IPPS rate,14571.09,100,MS DRG,11656.87,case rate,100% of CMS IPPS rate,2685.57,582548.2,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11162.67,100,MS DRG,8930.14,case rate,100% of CMS IPPS rate,17860.27,160,MS DRG,14288.22,case rate,160% of CMS IPPS rate,14511.47,130,MS DRG,11609.18,case rate,130% of CMS IPPS rate,1684.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,1768.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,11162.67,100,MS DRG,8930.14,case rate,100% of CMS IPPS rate,1684.01,100,,,case rate,100% of CMS IPPS rate,11162.67,100,MS DRG,8930.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1684.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,351603.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11162.67,100,MS DRG,8930.14,case rate,100% of CMS IPPS rate,11162.67,100,MS DRG,8930.14,case rate,100% of CMS IPPS rate,1684.01,351603.5,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24571.02,100,MS DRG,19656.82,case rate,100% of CMS IPPS rate,39313.63,160,MS DRG,31450.9,case rate,160% of CMS IPPS rate,31942.33,130,MS DRG,25553.86,case rate,130% of CMS IPPS rate,6167.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6475.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24571.02,100,MS DRG,19656.82,case rate,100% of CMS IPPS rate,6167.2,100,,,case rate,100% of CMS IPPS rate,24571.02,100,MS DRG,19656.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6167.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,468328.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24571.02,100,MS DRG,19656.82,case rate,100% of CMS IPPS rate,24571.02,100,MS DRG,19656.82,case rate,100% of CMS IPPS rate,6167.2,468328.9,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18563.51,100,MS DRG,14850.81,case rate,100% of CMS IPPS rate,29701.62,160,MS DRG,23761.3,case rate,160% of CMS IPPS rate,24132.56,130,MS DRG,19306.05,case rate,130% of CMS IPPS rate,4081.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4285.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18563.51,100,MS DRG,14850.81,case rate,100% of CMS IPPS rate,4081.73,100,,,case rate,100% of CMS IPPS rate,18563.51,100,MS DRG,14850.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4081.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,409970,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18563.51,100,MS DRG,14850.81,case rate,100% of CMS IPPS rate,18563.51,100,MS DRG,14850.81,case rate,100% of CMS IPPS rate,4081.73,409970,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14349.29,100,MS DRG,11479.43,case rate,100% of CMS IPPS rate,22958.86,160,MS DRG,18367.09,case rate,160% of CMS IPPS rate,18654.08,130,MS DRG,14923.26,case rate,130% of CMS IPPS rate,2719.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2855.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14349.29,100,MS DRG,11479.43,case rate,100% of CMS IPPS rate,2719.88,100,,,case rate,100% of CMS IPPS rate,14349.29,100,MS DRG,11479.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2719.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440306.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14349.29,100,MS DRG,11479.43,case rate,100% of CMS IPPS rate,14349.29,100,MS DRG,11479.43,case rate,100% of CMS IPPS rate,2719.88,440306.2,
ATHEROSCLEROSIS WITH MCC,302,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19201.77,100,MS DRG,15361.42,case rate,100% of CMS IPPS rate,30722.83,160,MS DRG,24578.26,case rate,160% of CMS IPPS rate,24962.3,130,MS DRG,19969.84,case rate,130% of CMS IPPS rate,4435.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4656.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19201.77,100,MS DRG,15361.42,case rate,100% of CMS IPPS rate,4435.15,100,,,case rate,100% of CMS IPPS rate,19201.77,100,MS DRG,15361.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4435.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459695.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19201.77,100,MS DRG,15361.42,case rate,100% of CMS IPPS rate,19201.77,100,MS DRG,15361.42,case rate,100% of CMS IPPS rate,4435.15,459695,
ATHEROSCLEROSIS WITHOUT MCC,303,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13739.33,100,MS DRG,10991.46,case rate,100% of CMS IPPS rate,21982.93,160,MS DRG,17586.34,case rate,160% of CMS IPPS rate,17861.13,130,MS DRG,14288.9,case rate,130% of CMS IPPS rate,2563.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2691.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13739.33,100,MS DRG,10991.46,case rate,100% of CMS IPPS rate,2563.57,100,,,case rate,100% of CMS IPPS rate,13739.33,100,MS DRG,10991.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2563.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436316.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13739.33,100,MS DRG,10991.46,case rate,100% of CMS IPPS rate,13739.33,100,MS DRG,10991.46,case rate,100% of CMS IPPS rate,2563.57,436316.9,
HYPERTENSION WITH MCC,304,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19530.94,100,MS DRG,15624.75,case rate,100% of CMS IPPS rate,31249.5,160,MS DRG,24999.6,case rate,160% of CMS IPPS rate,25390.22,130,MS DRG,20312.18,case rate,130% of CMS IPPS rate,4479,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4702.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19530.94,100,MS DRG,15624.75,case rate,100% of CMS IPPS rate,4479,100,,,case rate,100% of CMS IPPS rate,19530.94,100,MS DRG,15624.75,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4479,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390897.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19530.94,100,MS DRG,15624.75,case rate,100% of CMS IPPS rate,19530.94,100,MS DRG,15624.75,case rate,100% of CMS IPPS rate,4479,390897.7,
HYPERTENSION WITHOUT MCC,305,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14864.86,100,MS DRG,11891.89,case rate,100% of CMS IPPS rate,23783.78,160,MS DRG,19027.02,case rate,160% of CMS IPPS rate,19324.32,130,MS DRG,15459.46,case rate,130% of CMS IPPS rate,2862.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3005.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14864.86,100,MS DRG,11891.89,case rate,100% of CMS IPPS rate,2862.09,100,,,case rate,100% of CMS IPPS rate,14864.86,100,MS DRG,11891.89,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2862.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460774.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14864.86,100,MS DRG,11891.89,case rate,100% of CMS IPPS rate,14864.86,100,MS DRG,11891.89,case rate,100% of CMS IPPS rate,2862.09,460774.4,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24106.19,100,MS DRG,19284.95,case rate,100% of CMS IPPS rate,38569.9,160,MS DRG,30855.92,case rate,160% of CMS IPPS rate,31338.05,130,MS DRG,25070.44,case rate,130% of CMS IPPS rate,5708.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5994.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24106.19,100,MS DRG,19284.95,case rate,100% of CMS IPPS rate,5708.93,100,,,case rate,100% of CMS IPPS rate,24106.19,100,MS DRG,19284.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5708.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,276531.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24106.19,100,MS DRG,19284.95,case rate,100% of CMS IPPS rate,24106.19,100,MS DRG,19284.95,case rate,100% of CMS IPPS rate,5708.93,276531.8,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17095.86,100,MS DRG,13676.69,case rate,100% of CMS IPPS rate,27353.38,160,MS DRG,21882.7,case rate,160% of CMS IPPS rate,22224.62,130,MS DRG,17779.7,case rate,130% of CMS IPPS rate,3531.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3708.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17095.86,100,MS DRG,13676.69,case rate,100% of CMS IPPS rate,3531.96,100,,,case rate,100% of CMS IPPS rate,17095.86,100,MS DRG,13676.69,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3531.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,558491.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17095.86,100,MS DRG,13676.69,case rate,100% of CMS IPPS rate,17095.86,100,MS DRG,13676.69,case rate,100% of CMS IPPS rate,3531.96,558491.6,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20158.6,100,MS DRG,16126.88,case rate,100% of CMS IPPS rate,32253.76,160,MS DRG,25803.01,case rate,160% of CMS IPPS rate,26206.18,130,MS DRG,20964.94,case rate,130% of CMS IPPS rate,4597.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4827.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20158.6,100,MS DRG,16126.88,case rate,100% of CMS IPPS rate,4597.57,100,,,case rate,100% of CMS IPPS rate,20158.6,100,MS DRG,16126.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4597.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390933.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20158.6,100,MS DRG,16126.88,case rate,100% of CMS IPPS rate,20158.6,100,MS DRG,16126.88,case rate,100% of CMS IPPS rate,4597.57,390933,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,23617.66,160,MS DRG,18894.13,case rate,160% of CMS IPPS rate,19189.35,130,MS DRG,15351.48,case rate,130% of CMS IPPS rate,2818.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2959.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,2818.63,100,,,case rate,100% of CMS IPPS rate,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2818.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372265.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,14761.04,100,MS DRG,11808.83,case rate,100% of CMS IPPS rate,2818.63,372265.1,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12499.38,100,MS DRG,9999.5,case rate,100% of CMS IPPS rate,19999.01,160,MS DRG,15999.21,case rate,160% of CMS IPPS rate,16249.19,130,MS DRG,12999.35,case rate,130% of CMS IPPS rate,2133.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2239.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12499.38,100,MS DRG,9999.5,case rate,100% of CMS IPPS rate,2133.13,100,,,case rate,100% of CMS IPPS rate,12499.38,100,MS DRG,9999.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2133.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,339069.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12499.38,100,MS DRG,9999.5,case rate,100% of CMS IPPS rate,12499.38,100,MS DRG,9999.5,case rate,100% of CMS IPPS rate,2133.13,339069.4,
ANGINA PECTORIS,311,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14211.25,100,MS DRG,11369,case rate,100% of CMS IPPS rate,22738,160,MS DRG,18190.4,case rate,160% of CMS IPPS rate,18474.63,130,MS DRG,14779.7,case rate,130% of CMS IPPS rate,2662.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2795.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14211.25,100,MS DRG,11369,case rate,100% of CMS IPPS rate,2662.31,100,,,case rate,100% of CMS IPPS rate,14211.25,100,MS DRG,11369,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2662.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368387.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14211.25,100,MS DRG,11369,case rate,100% of CMS IPPS rate,14211.25,100,MS DRG,11369,case rate,100% of CMS IPPS rate,2662.31,368387.7,
SYNCOPE AND COLLAPSE,312,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16162.63,100,MS DRG,12930.1,case rate,100% of CMS IPPS rate,25860.21,160,MS DRG,20688.17,case rate,160% of CMS IPPS rate,21011.42,130,MS DRG,16809.14,case rate,130% of CMS IPPS rate,3321.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3487.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16162.63,100,MS DRG,12930.1,case rate,100% of CMS IPPS rate,3321.88,100,,,case rate,100% of CMS IPPS rate,16162.63,100,MS DRG,12930.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3321.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,514003.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16162.63,100,MS DRG,12930.1,case rate,100% of CMS IPPS rate,16162.63,100,MS DRG,12930.1,case rate,100% of CMS IPPS rate,3321.88,514003.5,
CHEST PAIN,313,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14512.1,100,MS DRG,11609.68,case rate,100% of CMS IPPS rate,23219.36,160,MS DRG,18575.49,case rate,160% of CMS IPPS rate,18865.73,130,MS DRG,15092.58,case rate,130% of CMS IPPS rate,2719.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2855.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14512.1,100,MS DRG,11609.68,case rate,100% of CMS IPPS rate,2719.88,100,,,case rate,100% of CMS IPPS rate,14512.1,100,MS DRG,11609.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2719.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,476152.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14512.1,100,MS DRG,11609.68,case rate,100% of CMS IPPS rate,14512.1,100,MS DRG,11609.68,case rate,100% of CMS IPPS rate,2719.88,476152.3,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30674.1,100,MS DRG,24539.28,case rate,100% of CMS IPPS rate,49078.56,160,MS DRG,39262.85,case rate,160% of CMS IPPS rate,39876.33,130,MS DRG,31901.06,case rate,130% of CMS IPPS rate,8210.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8620.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30674.1,100,MS DRG,24539.28,case rate,100% of CMS IPPS rate,8210.35,100,,,case rate,100% of CMS IPPS rate,30674.1,100,MS DRG,24539.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8210.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381045.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30674.1,100,MS DRG,24539.28,case rate,100% of CMS IPPS rate,30674.1,100,MS DRG,24539.28,case rate,100% of CMS IPPS rate,8210.35,381045.9,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17387.26,100,MS DRG,13909.81,case rate,100% of CMS IPPS rate,27819.62,160,MS DRG,22255.7,case rate,160% of CMS IPPS rate,22603.44,130,MS DRG,18082.75,case rate,130% of CMS IPPS rate,3668.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3852.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17387.26,100,MS DRG,13909.81,case rate,100% of CMS IPPS rate,3668.83,100,,,case rate,100% of CMS IPPS rate,17387.26,100,MS DRG,13909.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3668.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411963.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17387.26,100,MS DRG,13909.81,case rate,100% of CMS IPPS rate,17387.26,100,MS DRG,13909.81,case rate,100% of CMS IPPS rate,3668.83,411963.1,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14147.54,100,MS DRG,11318.03,case rate,100% of CMS IPPS rate,22636.06,160,MS DRG,18108.85,case rate,160% of CMS IPPS rate,18391.8,130,MS DRG,14713.44,case rate,130% of CMS IPPS rate,2602.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2732.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14147.54,100,MS DRG,11318.03,case rate,100% of CMS IPPS rate,2602.83,100,,,case rate,100% of CMS IPPS rate,14147.54,100,MS DRG,11318.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2602.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,499347.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14147.54,100,MS DRG,11318.03,case rate,100% of CMS IPPS rate,14147.54,100,MS DRG,11318.03,case rate,100% of CMS IPPS rate,2602.83,499347.6,
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION,317,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23586.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24765.27,100,,,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,23586.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23586.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1874186.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23586.02,1874187,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57436.55,100,MS DRG,45949.24,case rate,100% of CMS IPPS rate,91898.48,160,MS DRG,73518.78,case rate,160% of CMS IPPS rate,74667.52,130,MS DRG,59734.02,case rate,130% of CMS IPPS rate,16747.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17585.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57436.55,100,MS DRG,45949.24,case rate,100% of CMS IPPS rate,16747.81,100,,,case rate,100% of CMS IPPS rate,57436.55,100,MS DRG,45949.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16747.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,670716.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,57436.55,100,MS DRG,45949.24,case rate,100% of CMS IPPS rate,57436.55,100,MS DRG,45949.24,case rate,100% of CMS IPPS rate,16747.81,670716.4,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32237.33,100,MS DRG,25789.86,case rate,100% of CMS IPPS rate,51579.73,160,MS DRG,41263.78,case rate,160% of CMS IPPS rate,41908.53,130,MS DRG,33526.82,case rate,130% of CMS IPPS rate,8825.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9266.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32237.33,100,MS DRG,25789.86,case rate,100% of CMS IPPS rate,8825.31,100,,,case rate,100% of CMS IPPS rate,32237.33,100,MS DRG,25789.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8825.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1148333.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32237.33,100,MS DRG,25789.86,case rate,100% of CMS IPPS rate,32237.33,100,MS DRG,25789.86,case rate,100% of CMS IPPS rate,8825.31,1148333,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES,321,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39890.64,100,MS DRG,31912.51,case rate,100% of CMS IPPS rate,63825.02,160,MS DRG,51060.02,case rate,160% of CMS IPPS rate,51857.83,130,MS DRG,41486.26,case rate,130% of CMS IPPS rate,10853.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11396.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39890.64,100,MS DRG,31912.51,case rate,100% of CMS IPPS rate,10853.6,100,,,case rate,100% of CMS IPPS rate,39890.64,100,MS DRG,31912.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10853.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1297239.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39890.64,100,MS DRG,31912.51,case rate,100% of CMS IPPS rate,39890.64,100,MS DRG,31912.51,case rate,100% of CMS IPPS rate,10853.6,1297239,
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC,322,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27487.47,100,MS DRG,21989.98,case rate,100% of CMS IPPS rate,43979.95,160,MS DRG,35183.96,case rate,160% of CMS IPPS rate,35733.71,130,MS DRG,28586.97,case rate,130% of CMS IPPS rate,6897.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7242.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27487.47,100,MS DRG,21989.98,case rate,100% of CMS IPPS rate,6897.68,100,,,case rate,100% of CMS IPPS rate,27487.47,100,MS DRG,21989.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6897.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1806785.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27487.47,100,MS DRG,21989.98,case rate,100% of CMS IPPS rate,27487.47,100,MS DRG,21989.98,case rate,100% of CMS IPPS rate,6897.68,1806785,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC,323,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54818.59,100,MS DRG,43854.87,case rate,100% of CMS IPPS rate,87709.74,160,MS DRG,70167.79,case rate,160% of CMS IPPS rate,71264.17,130,MS DRG,57011.34,case rate,130% of CMS IPPS rate,16239.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17051.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54818.59,100,MS DRG,43854.87,case rate,100% of CMS IPPS rate,16239.22,100,,,case rate,100% of CMS IPPS rate,54818.59,100,MS DRG,43854.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16239.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1886615.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,54818.59,100,MS DRG,43854.87,case rate,100% of CMS IPPS rate,54818.59,100,MS DRG,43854.87,case rate,100% of CMS IPPS rate,16239.22,1886615,
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC,324,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40998.48,100,MS DRG,32798.78,case rate,100% of CMS IPPS rate,65597.57,160,MS DRG,52478.06,case rate,160% of CMS IPPS rate,53298.02,130,MS DRG,42638.42,case rate,130% of CMS IPPS rate,12181.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12790.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40998.48,100,MS DRG,32798.78,case rate,100% of CMS IPPS rate,12181.51,100,,,case rate,100% of CMS IPPS rate,40998.48,100,MS DRG,32798.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12181.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2112884.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40998.48,100,MS DRG,32798.78,case rate,100% of CMS IPPS rate,40998.48,100,MS DRG,32798.78,case rate,100% of CMS IPPS rate,12181.51,2112885,
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE,325,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37172.41,100,MS DRG,29737.93,case rate,100% of CMS IPPS rate,59475.86,160,MS DRG,47580.69,case rate,160% of CMS IPPS rate,48324.13,130,MS DRG,38659.3,case rate,130% of CMS IPPS rate,10911.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11457.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37172.41,100,MS DRG,29737.93,case rate,100% of CMS IPPS rate,10911.93,100,,,case rate,100% of CMS IPPS rate,37172.41,100,MS DRG,29737.93,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10911.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1243750.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37172.41,100,MS DRG,29737.93,case rate,100% of CMS IPPS rate,37172.41,100,MS DRG,29737.93,case rate,100% of CMS IPPS rate,10911.93,1243750,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65896.85,100,MS DRG,52717.48,case rate,100% of CMS IPPS rate,105434.96,160,MS DRG,84347.97,case rate,160% of CMS IPPS rate,85665.91,130,MS DRG,68532.73,case rate,130% of CMS IPPS rate,19363.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20332.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,65896.85,100,MS DRG,52717.48,case rate,100% of CMS IPPS rate,19363.99,100,,,case rate,100% of CMS IPPS rate,65896.85,100,MS DRG,52717.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19363.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,657564.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,65896.85,100,MS DRG,52717.48,case rate,100% of CMS IPPS rate,65896.85,100,MS DRG,52717.48,case rate,100% of CMS IPPS rate,19363.99,657564.7,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35439.29,100,MS DRG,28351.43,case rate,100% of CMS IPPS rate,56702.86,160,MS DRG,45362.29,case rate,160% of CMS IPPS rate,46071.08,130,MS DRG,36856.86,case rate,130% of CMS IPPS rate,9257.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9720.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35439.29,100,MS DRG,28351.43,case rate,100% of CMS IPPS rate,9257.28,100,,,case rate,100% of CMS IPPS rate,35439.29,100,MS DRG,28351.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9257.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,853397.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35439.29,100,MS DRG,28351.43,case rate,100% of CMS IPPS rate,35439.29,100,MS DRG,28351.43,case rate,100% of CMS IPPS rate,9257.28,853397.2,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24819.96,100,MS DRG,19855.97,case rate,100% of CMS IPPS rate,39711.94,160,MS DRG,31769.55,case rate,160% of CMS IPPS rate,32265.95,130,MS DRG,25812.76,case rate,130% of CMS IPPS rate,6075.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6379.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24819.96,100,MS DRG,19855.97,case rate,100% of CMS IPPS rate,6075.31,100,,,case rate,100% of CMS IPPS rate,24819.96,100,MS DRG,19855.97,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6075.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1466419.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24819.96,100,MS DRG,19855.97,case rate,100% of CMS IPPS rate,24819.96,100,MS DRG,19855.97,case rate,100% of CMS IPPS rate,6075.31,1466419,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59264.05,100,MS DRG,47411.24,case rate,100% of CMS IPPS rate,94822.48,160,MS DRG,75857.98,case rate,160% of CMS IPPS rate,77043.27,130,MS DRG,61634.62,case rate,130% of CMS IPPS rate,17506.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18382.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59264.05,100,MS DRG,47411.24,case rate,100% of CMS IPPS rate,17506.89,100,,,case rate,100% of CMS IPPS rate,59264.05,100,MS DRG,47411.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17506.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,528424.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59264.05,100,MS DRG,47411.24,case rate,100% of CMS IPPS rate,59264.05,100,MS DRG,47411.24,case rate,100% of CMS IPPS rate,17506.89,528424.3,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33961,100,MS DRG,27168.8,case rate,100% of CMS IPPS rate,54337.6,160,MS DRG,43470.08,case rate,160% of CMS IPPS rate,44149.3,130,MS DRG,35319.44,case rate,130% of CMS IPPS rate,9011.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9462.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33961,100,MS DRG,27168.8,case rate,100% of CMS IPPS rate,9011.75,100,,,case rate,100% of CMS IPPS rate,33961,100,MS DRG,27168.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9011.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,602344.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33961,100,MS DRG,27168.8,case rate,100% of CMS IPPS rate,33961,100,MS DRG,27168.8,case rate,100% of CMS IPPS rate,9011.75,602344.8,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25701.27,100,MS DRG,20561.02,case rate,100% of CMS IPPS rate,41122.03,160,MS DRG,32897.62,case rate,160% of CMS IPPS rate,33411.65,130,MS DRG,26729.32,case rate,130% of CMS IPPS rate,6294.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6609.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25701.27,100,MS DRG,20561.02,case rate,100% of CMS IPPS rate,6294.54,100,,,case rate,100% of CMS IPPS rate,25701.27,100,MS DRG,20561.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6294.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,937033.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25701.27,100,MS DRG,20561.02,case rate,100% of CMS IPPS rate,25701.27,100,MS DRG,20561.02,case rate,100% of CMS IPPS rate,6294.54,937033.1,
RECTAL RESECTION WITH MCC,332,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49088.33,100,MS DRG,39270.66,case rate,100% of CMS IPPS rate,78541.33,160,MS DRG,62833.06,case rate,160% of CMS IPPS rate,63814.83,130,MS DRG,51051.86,case rate,130% of CMS IPPS rate,13224.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13885.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49088.33,100,MS DRG,39270.66,case rate,100% of CMS IPPS rate,13224.63,100,,,case rate,100% of CMS IPPS rate,49088.33,100,MS DRG,39270.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13224.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,649324.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49088.33,100,MS DRG,39270.66,case rate,100% of CMS IPPS rate,49088.33,100,MS DRG,39270.66,case rate,100% of CMS IPPS rate,13224.63,649324.8,
RECTAL RESECTION WITH CC,333,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30508.93,100,MS DRG,24407.14,case rate,100% of CMS IPPS rate,48814.29,160,MS DRG,39051.43,case rate,160% of CMS IPPS rate,39661.61,130,MS DRG,31729.29,case rate,130% of CMS IPPS rate,8102.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8507.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30508.93,100,MS DRG,24407.14,case rate,100% of CMS IPPS rate,8102.83,100,,,case rate,100% of CMS IPPS rate,30508.93,100,MS DRG,24407.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8102.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,850258.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30508.93,100,MS DRG,24407.14,case rate,100% of CMS IPPS rate,30508.93,100,MS DRG,24407.14,case rate,100% of CMS IPPS rate,8102.83,850258.9,
RECTAL RESECTION WITHOUT CC/MCC,334,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24911.98,100,MS DRG,19929.58,case rate,100% of CMS IPPS rate,39859.17,160,MS DRG,31887.34,case rate,160% of CMS IPPS rate,32385.57,130,MS DRG,25908.46,case rate,130% of CMS IPPS rate,6323.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6639.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24911.98,100,MS DRG,19929.58,case rate,100% of CMS IPPS rate,6323.51,100,,,case rate,100% of CMS IPPS rate,24911.98,100,MS DRG,19929.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6323.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1173974.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24911.98,100,MS DRG,19929.58,case rate,100% of CMS IPPS rate,24911.98,100,MS DRG,19929.58,case rate,100% of CMS IPPS rate,6323.51,1173974,
PERITONEAL ADHESIOLYSIS WITH MCC,335,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48152.74,100,MS DRG,38522.19,case rate,100% of CMS IPPS rate,77044.38,160,MS DRG,61635.5,case rate,160% of CMS IPPS rate,62598.56,130,MS DRG,50078.85,case rate,130% of CMS IPPS rate,13814.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14505.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48152.74,100,MS DRG,38522.19,case rate,100% of CMS IPPS rate,13814.43,100,,,case rate,100% of CMS IPPS rate,48152.74,100,MS DRG,38522.19,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13814.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490568,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48152.74,100,MS DRG,38522.19,case rate,100% of CMS IPPS rate,48152.74,100,MS DRG,38522.19,case rate,100% of CMS IPPS rate,13814.43,490568,
PERITONEAL ADHESIOLYSIS WITH CC,336,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30813.32,100,MS DRG,24650.66,case rate,100% of CMS IPPS rate,49301.31,160,MS DRG,39441.05,case rate,160% of CMS IPPS rate,40057.32,130,MS DRG,32045.86,case rate,130% of CMS IPPS rate,8053.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8455.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30813.32,100,MS DRG,24650.66,case rate,100% of CMS IPPS rate,8053.27,100,,,case rate,100% of CMS IPPS rate,30813.32,100,MS DRG,24650.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8053.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,539952.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30813.32,100,MS DRG,24650.66,case rate,100% of CMS IPPS rate,30813.32,100,MS DRG,24650.66,case rate,100% of CMS IPPS rate,8053.27,539952.8,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23629.55,100,MS DRG,18903.64,case rate,100% of CMS IPPS rate,37807.28,160,MS DRG,30245.82,case rate,160% of CMS IPPS rate,30718.42,130,MS DRG,24574.74,case rate,130% of CMS IPPS rate,5852.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6145.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23629.55,100,MS DRG,18903.64,case rate,100% of CMS IPPS rate,5852.66,100,,,case rate,100% of CMS IPPS rate,23629.55,100,MS DRG,18903.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5852.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,690053.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23629.55,100,MS DRG,18903.64,case rate,100% of CMS IPPS rate,23629.55,100,MS DRG,18903.64,case rate,100% of CMS IPPS rate,5852.66,690053,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38306.19,100,MS DRG,30644.95,case rate,100% of CMS IPPS rate,61289.9,160,MS DRG,49031.92,case rate,160% of CMS IPPS rate,49798.05,130,MS DRG,39838.44,case rate,130% of CMS IPPS rate,10272.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10786.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38306.19,100,MS DRG,30644.95,case rate,100% of CMS IPPS rate,10272.94,100,,,case rate,100% of CMS IPPS rate,38306.19,100,MS DRG,30644.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10272.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,551696.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38306.19,100,MS DRG,30644.95,case rate,100% of CMS IPPS rate,38306.19,100,MS DRG,30644.95,case rate,100% of CMS IPPS rate,10272.94,551696.2,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24151.01,100,MS DRG,19320.81,case rate,100% of CMS IPPS rate,38641.62,160,MS DRG,30913.3,case rate,160% of CMS IPPS rate,31396.31,130,MS DRG,25117.05,case rate,130% of CMS IPPS rate,5675.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5959.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24151.01,100,MS DRG,19320.81,case rate,100% of CMS IPPS rate,5675.76,100,,,case rate,100% of CMS IPPS rate,24151.01,100,MS DRG,19320.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5675.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,642347.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24151.01,100,MS DRG,19320.81,case rate,100% of CMS IPPS rate,24151.01,100,MS DRG,19320.81,case rate,100% of CMS IPPS rate,5675.76,642347.7,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21168.5,100,MS DRG,16934.8,case rate,100% of CMS IPPS rate,33869.6,160,MS DRG,27095.68,case rate,160% of CMS IPPS rate,27519.05,130,MS DRG,22015.24,case rate,130% of CMS IPPS rate,4747.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4985.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21168.5,100,MS DRG,16934.8,case rate,100% of CMS IPPS rate,4747.78,100,,,case rate,100% of CMS IPPS rate,21168.5,100,MS DRG,16934.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4747.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,546206.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21168.5,100,MS DRG,16934.8,case rate,100% of CMS IPPS rate,21168.5,100,MS DRG,16934.8,case rate,100% of CMS IPPS rate,4747.78,546206.5,
ANAL AND STOMAL PROCEDURES WITH MCC,347,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36049.23,100,MS DRG,28839.38,case rate,100% of CMS IPPS rate,57678.77,160,MS DRG,46143.02,case rate,160% of CMS IPPS rate,46864,130,MS DRG,37491.2,case rate,130% of CMS IPPS rate,9023.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9474.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36049.23,100,MS DRG,28839.38,case rate,100% of CMS IPPS rate,9023.57,100,,,case rate,100% of CMS IPPS rate,36049.23,100,MS DRG,28839.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9023.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389401.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36049.23,100,MS DRG,28839.38,case rate,100% of CMS IPPS rate,36049.23,100,MS DRG,28839.38,case rate,100% of CMS IPPS rate,9023.57,389401.4,
ANAL AND STOMAL PROCEDURES WITH CC,348,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21328.95,100,MS DRG,17063.16,case rate,100% of CMS IPPS rate,34126.32,160,MS DRG,27301.06,case rate,160% of CMS IPPS rate,27727.64,130,MS DRG,22182.11,case rate,130% of CMS IPPS rate,4799.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5039.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21328.95,100,MS DRG,17063.16,case rate,100% of CMS IPPS rate,4799.63,100,,,case rate,100% of CMS IPPS rate,21328.95,100,MS DRG,17063.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4799.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,590986.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21328.95,100,MS DRG,17063.16,case rate,100% of CMS IPPS rate,21328.95,100,MS DRG,17063.16,case rate,100% of CMS IPPS rate,4799.63,590986.3,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17487.54,100,MS DRG,13990.03,case rate,100% of CMS IPPS rate,27980.06,160,MS DRG,22384.05,case rate,160% of CMS IPPS rate,22733.8,130,MS DRG,18187.04,case rate,130% of CMS IPPS rate,3358.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3526.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17487.54,100,MS DRG,13990.03,case rate,100% of CMS IPPS rate,3358.48,100,,,case rate,100% of CMS IPPS rate,17487.54,100,MS DRG,13990.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3358.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,816014.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17487.54,100,MS DRG,13990.03,case rate,100% of CMS IPPS rate,17487.54,100,MS DRG,13990.03,case rate,100% of CMS IPPS rate,3358.48,816014.1,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34290.17,100,MS DRG,27432.14,case rate,100% of CMS IPPS rate,54864.27,160,MS DRG,43891.42,case rate,160% of CMS IPPS rate,44577.22,130,MS DRG,35661.78,case rate,130% of CMS IPPS rate,9221.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9682.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34290.17,100,MS DRG,27432.14,case rate,100% of CMS IPPS rate,9221.44,100,,,case rate,100% of CMS IPPS rate,34290.17,100,MS DRG,27432.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9221.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,590466.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34290.17,100,MS DRG,27432.14,case rate,100% of CMS IPPS rate,34290.17,100,MS DRG,27432.14,case rate,100% of CMS IPPS rate,9221.44,590466.5,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23148.19,100,MS DRG,18518.55,case rate,100% of CMS IPPS rate,37037.1,160,MS DRG,29629.68,case rate,160% of CMS IPPS rate,30092.65,130,MS DRG,24074.12,case rate,130% of CMS IPPS rate,5736,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6022.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23148.19,100,MS DRG,18518.55,case rate,100% of CMS IPPS rate,5736,100,,,case rate,100% of CMS IPPS rate,23148.19,100,MS DRG,18518.55,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5736,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1127757.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23148.19,100,MS DRG,18518.55,case rate,100% of CMS IPPS rate,23148.19,100,MS DRG,18518.55,case rate,100% of CMS IPPS rate,5736,1127757,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19059.03,100,MS DRG,15247.22,case rate,100% of CMS IPPS rate,30494.45,160,MS DRG,24395.56,case rate,160% of CMS IPPS rate,24776.74,130,MS DRG,19821.39,case rate,130% of CMS IPPS rate,4203.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4413.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19059.03,100,MS DRG,15247.22,case rate,100% of CMS IPPS rate,4203.73,100,,,case rate,100% of CMS IPPS rate,19059.03,100,MS DRG,15247.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4203.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1195495.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19059.03,100,MS DRG,15247.22,case rate,100% of CMS IPPS rate,19059.03,100,MS DRG,15247.22,case rate,100% of CMS IPPS rate,4203.73,1195495,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40475.83,100,MS DRG,32380.66,case rate,100% of CMS IPPS rate,64761.33,160,MS DRG,51809.06,case rate,160% of CMS IPPS rate,52618.58,130,MS DRG,42094.86,case rate,130% of CMS IPPS rate,11182.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11741.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40475.83,100,MS DRG,32380.66,case rate,100% of CMS IPPS rate,11182.24,100,,,case rate,100% of CMS IPPS rate,40475.83,100,MS DRG,32380.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11182.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,592417.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40475.83,100,MS DRG,32380.66,case rate,100% of CMS IPPS rate,40475.83,100,MS DRG,32380.66,case rate,100% of CMS IPPS rate,11182.24,592417,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26241.61,100,MS DRG,20993.29,case rate,100% of CMS IPPS rate,41986.58,160,MS DRG,33589.26,case rate,160% of CMS IPPS rate,34114.09,130,MS DRG,27291.27,case rate,130% of CMS IPPS rate,6485.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6809.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26241.61,100,MS DRG,20993.29,case rate,100% of CMS IPPS rate,6485.55,100,,,case rate,100% of CMS IPPS rate,26241.61,100,MS DRG,20993.29,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6485.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,779626.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26241.61,100,MS DRG,20993.29,case rate,100% of CMS IPPS rate,26241.61,100,MS DRG,20993.29,case rate,100% of CMS IPPS rate,6485.55,779626.1,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22050.99,100,MS DRG,17640.79,case rate,100% of CMS IPPS rate,35281.58,160,MS DRG,28225.26,case rate,160% of CMS IPPS rate,28666.29,130,MS DRG,22933.03,case rate,130% of CMS IPPS rate,5082.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5337.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22050.99,100,MS DRG,17640.79,case rate,100% of CMS IPPS rate,5082.9,100,,,case rate,100% of CMS IPPS rate,22050.99,100,MS DRG,17640.79,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5082.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1045229.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22050.99,100,MS DRG,17640.79,case rate,100% of CMS IPPS rate,22050.99,100,MS DRG,17640.79,case rate,100% of CMS IPPS rate,5082.9,1045230,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56454.96,100,MS DRG,45163.97,case rate,100% of CMS IPPS rate,90327.94,160,MS DRG,72262.35,case rate,160% of CMS IPPS rate,73391.45,130,MS DRG,58713.16,case rate,130% of CMS IPPS rate,16263.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17076.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56454.96,100,MS DRG,45163.97,case rate,100% of CMS IPPS rate,16263.24,100,,,case rate,100% of CMS IPPS rate,56454.96,100,MS DRG,45163.97,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16263.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,582565.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,56454.96,100,MS DRG,45163.97,case rate,100% of CMS IPPS rate,56454.96,100,MS DRG,45163.97,case rate,100% of CMS IPPS rate,16263.24,582565.1,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31892.82,100,MS DRG,25514.26,case rate,100% of CMS IPPS rate,51028.51,160,MS DRG,40822.81,case rate,160% of CMS IPPS rate,41460.67,130,MS DRG,33168.54,case rate,130% of CMS IPPS rate,8585.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9015.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31892.82,100,MS DRG,25514.26,case rate,100% of CMS IPPS rate,8585.89,100,,,case rate,100% of CMS IPPS rate,31892.82,100,MS DRG,25514.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8585.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,548055.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31892.82,100,MS DRG,25514.26,case rate,100% of CMS IPPS rate,31892.82,100,MS DRG,25514.26,case rate,100% of CMS IPPS rate,8585.89,548055.1,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21089.46,100,MS DRG,16871.57,case rate,100% of CMS IPPS rate,33743.14,160,MS DRG,26994.51,case rate,160% of CMS IPPS rate,27416.3,130,MS DRG,21933.04,case rate,130% of CMS IPPS rate,5166.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5424.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21089.46,100,MS DRG,16871.57,case rate,100% of CMS IPPS rate,5166.4,100,,,case rate,100% of CMS IPPS rate,21089.46,100,MS DRG,16871.57,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5166.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,766505.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21089.46,100,MS DRG,16871.57,case rate,100% of CMS IPPS rate,21089.46,100,MS DRG,16871.57,case rate,100% of CMS IPPS rate,5166.4,766505.4,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25465.32,100,MS DRG,20372.26,case rate,100% of CMS IPPS rate,40744.51,160,MS DRG,32595.61,case rate,160% of CMS IPPS rate,33104.92,130,MS DRG,26483.94,case rate,130% of CMS IPPS rate,6366.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6685.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25465.32,100,MS DRG,20372.26,case rate,100% of CMS IPPS rate,6366.98,100,,,case rate,100% of CMS IPPS rate,25465.32,100,MS DRG,20372.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6366.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,523731.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25465.32,100,MS DRG,20372.26,case rate,100% of CMS IPPS rate,25465.32,100,MS DRG,20372.26,case rate,100% of CMS IPPS rate,6366.98,523731.5,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17635.01,100,MS DRG,14108.01,case rate,100% of CMS IPPS rate,28216.02,160,MS DRG,22572.82,case rate,160% of CMS IPPS rate,22925.51,130,MS DRG,18340.41,case rate,130% of CMS IPPS rate,3879.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4073.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17635.01,100,MS DRG,14108.01,case rate,100% of CMS IPPS rate,3879.66,100,,,case rate,100% of CMS IPPS rate,17635.01,100,MS DRG,14108.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3879.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438934.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17635.01,100,MS DRG,14108.01,case rate,100% of CMS IPPS rate,17635.01,100,MS DRG,14108.01,case rate,100% of CMS IPPS rate,3879.66,438934.1,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14749.24,100,MS DRG,11799.39,case rate,100% of CMS IPPS rate,23598.78,160,MS DRG,18879.02,case rate,160% of CMS IPPS rate,19174.01,130,MS DRG,15339.21,case rate,130% of CMS IPPS rate,2661.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2794.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14749.24,100,MS DRG,11799.39,case rate,100% of CMS IPPS rate,2661.17,100,,,case rate,100% of CMS IPPS rate,14749.24,100,MS DRG,11799.39,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2661.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,391871.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14749.24,100,MS DRG,11799.39,case rate,100% of CMS IPPS rate,14749.24,100,MS DRG,11799.39,case rate,100% of CMS IPPS rate,2661.17,391871.2,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26594.38,100,MS DRG,21275.5,case rate,100% of CMS IPPS rate,42551.01,160,MS DRG,34040.81,case rate,160% of CMS IPPS rate,34572.69,130,MS DRG,27658.15,case rate,130% of CMS IPPS rate,6664.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6997.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26594.38,100,MS DRG,21275.5,case rate,100% of CMS IPPS rate,6664.35,100,,,case rate,100% of CMS IPPS rate,26594.38,100,MS DRG,21275.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6664.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,304609.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26594.38,100,MS DRG,21275.5,case rate,100% of CMS IPPS rate,26594.38,100,MS DRG,21275.5,case rate,100% of CMS IPPS rate,6664.35,304609.3,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18272.11,100,MS DRG,14617.69,case rate,100% of CMS IPPS rate,29235.38,160,MS DRG,23388.3,case rate,160% of CMS IPPS rate,23753.74,130,MS DRG,19002.99,case rate,130% of CMS IPPS rate,3924.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4120.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18272.11,100,MS DRG,14617.69,case rate,100% of CMS IPPS rate,3924.27,100,,,case rate,100% of CMS IPPS rate,18272.11,100,MS DRG,14617.69,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3924.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300838.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18272.11,100,MS DRG,14617.69,case rate,100% of CMS IPPS rate,18272.11,100,MS DRG,14617.69,case rate,100% of CMS IPPS rate,3924.27,300838.9,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14428.35,100,MS DRG,11542.68,case rate,100% of CMS IPPS rate,23085.36,160,MS DRG,18468.29,case rate,160% of CMS IPPS rate,18756.86,130,MS DRG,15005.49,case rate,130% of CMS IPPS rate,2765.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2903.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14428.35,100,MS DRG,11542.68,case rate,100% of CMS IPPS rate,2765.63,100,,,case rate,100% of CMS IPPS rate,14428.35,100,MS DRG,11542.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2765.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231778.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14428.35,100,MS DRG,11542.68,case rate,100% of CMS IPPS rate,14428.35,100,MS DRG,11542.68,case rate,100% of CMS IPPS rate,2765.63,231778.5,
DIGESTIVE MALIGNANCY WITH MCC,374,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30738.99,100,MS DRG,24591.19,case rate,100% of CMS IPPS rate,49182.38,160,MS DRG,39345.9,case rate,160% of CMS IPPS rate,39960.69,130,MS DRG,31968.55,case rate,130% of CMS IPPS rate,8049.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8452.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30738.99,100,MS DRG,24591.19,case rate,100% of CMS IPPS rate,8049.84,100,,,case rate,100% of CMS IPPS rate,30738.99,100,MS DRG,24591.19,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8049.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406895.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30738.99,100,MS DRG,24591.19,case rate,100% of CMS IPPS rate,30738.99,100,MS DRG,24591.19,case rate,100% of CMS IPPS rate,8049.84,406895.7,
DIGESTIVE MALIGNANCY WITH CC,375,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20112.59,100,MS DRG,16090.07,case rate,100% of CMS IPPS rate,32180.14,160,MS DRG,25744.11,case rate,160% of CMS IPPS rate,26146.37,130,MS DRG,20917.1,case rate,130% of CMS IPPS rate,4684.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4918.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20112.59,100,MS DRG,16090.07,case rate,100% of CMS IPPS rate,4684.49,100,,,case rate,100% of CMS IPPS rate,20112.59,100,MS DRG,16090.07,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4684.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,373471.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20112.59,100,MS DRG,16090.07,case rate,100% of CMS IPPS rate,20112.59,100,MS DRG,16090.07,case rate,100% of CMS IPPS rate,4684.49,373471.3,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16491.79,100,MS DRG,13193.43,case rate,100% of CMS IPPS rate,26386.86,160,MS DRG,21109.49,case rate,160% of CMS IPPS rate,21439.33,130,MS DRG,17151.46,case rate,130% of CMS IPPS rate,3366.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3534.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16491.79,100,MS DRG,13193.43,case rate,100% of CMS IPPS rate,3366.49,100,,,case rate,100% of CMS IPPS rate,16491.79,100,MS DRG,13193.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3366.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501037.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16491.79,100,MS DRG,13193.43,case rate,100% of CMS IPPS rate,16491.79,100,MS DRG,13193.43,case rate,100% of CMS IPPS rate,3366.49,501037.2,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27096.96,100,MS DRG,21677.57,case rate,100% of CMS IPPS rate,43355.14,160,MS DRG,34684.11,case rate,160% of CMS IPPS rate,35226.05,130,MS DRG,28180.84,case rate,130% of CMS IPPS rate,6932,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7278.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27096.96,100,MS DRG,21677.57,case rate,100% of CMS IPPS rate,6932,100,,,case rate,100% of CMS IPPS rate,27096.96,100,MS DRG,21677.57,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6932,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452840.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27096.96,100,MS DRG,21677.57,case rate,100% of CMS IPPS rate,27096.96,100,MS DRG,21677.57,case rate,100% of CMS IPPS rate,6932,452840.5,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,28131.09,160,MS DRG,22504.87,case rate,160% of CMS IPPS rate,22856.51,130,MS DRG,18285.21,case rate,130% of CMS IPPS rate,3758.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3946.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,3758.8,100,,,case rate,100% of CMS IPPS rate,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3758.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452946.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,17581.93,100,MS DRG,14065.54,case rate,100% of CMS IPPS rate,3758.8,452946.7,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13445.56,100,MS DRG,10756.45,case rate,100% of CMS IPPS rate,21512.9,160,MS DRG,17210.32,case rate,160% of CMS IPPS rate,17479.23,130,MS DRG,13983.38,case rate,130% of CMS IPPS rate,2427.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2548.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13445.56,100,MS DRG,10756.45,case rate,100% of CMS IPPS rate,2427.46,100,,,case rate,100% of CMS IPPS rate,13445.56,100,MS DRG,10756.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2427.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428320.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13445.56,100,MS DRG,10756.45,case rate,100% of CMS IPPS rate,13445.56,100,MS DRG,10756.45,case rate,100% of CMS IPPS rate,2427.46,428321,
COMPLICATED PEPTIC ULCER WITH MCC,380,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28963.39,100,MS DRG,23170.71,case rate,100% of CMS IPPS rate,46341.42,160,MS DRG,37073.14,case rate,160% of CMS IPPS rate,37652.41,130,MS DRG,30121.93,case rate,130% of CMS IPPS rate,7336.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7703.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28963.39,100,MS DRG,23170.71,case rate,100% of CMS IPPS rate,7336.51,100,,,case rate,100% of CMS IPPS rate,28963.39,100,MS DRG,23170.71,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7336.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423875.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28963.39,100,MS DRG,23170.71,case rate,100% of CMS IPPS rate,28963.39,100,MS DRG,23170.71,case rate,100% of CMS IPPS rate,7336.51,423875.4,
COMPLICATED PEPTIC ULCER WITH CC,381,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18634.31,100,MS DRG,14907.45,case rate,100% of CMS IPPS rate,29814.9,160,MS DRG,23851.92,case rate,160% of CMS IPPS rate,24224.6,130,MS DRG,19379.68,case rate,130% of CMS IPPS rate,4152.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4359.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18634.31,100,MS DRG,14907.45,case rate,100% of CMS IPPS rate,4152.26,100,,,case rate,100% of CMS IPPS rate,18634.31,100,MS DRG,14907.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4152.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,391871.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18634.31,100,MS DRG,14907.45,case rate,100% of CMS IPPS rate,18634.31,100,MS DRG,14907.45,case rate,100% of CMS IPPS rate,4152.26,391871.2,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14907.33,100,MS DRG,11925.86,case rate,100% of CMS IPPS rate,23851.73,160,MS DRG,19081.38,case rate,160% of CMS IPPS rate,19379.53,130,MS DRG,15503.62,case rate,130% of CMS IPPS rate,2856.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2999.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14907.33,100,MS DRG,11925.86,case rate,100% of CMS IPPS rate,2856.75,100,,,case rate,100% of CMS IPPS rate,14907.33,100,MS DRG,11925.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2856.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,426505.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14907.33,100,MS DRG,11925.86,case rate,100% of CMS IPPS rate,14907.33,100,MS DRG,11925.86,case rate,100% of CMS IPPS rate,2856.75,426505.7,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22470.99,100,MS DRG,17976.79,case rate,100% of CMS IPPS rate,35953.58,160,MS DRG,28762.86,case rate,160% of CMS IPPS rate,29212.29,130,MS DRG,23369.83,case rate,130% of CMS IPPS rate,4819.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5060.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22470.99,100,MS DRG,17976.79,case rate,100% of CMS IPPS rate,4819.84,100,,,case rate,100% of CMS IPPS rate,22470.99,100,MS DRG,17976.79,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4819.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456320.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22470.99,100,MS DRG,17976.79,case rate,100% of CMS IPPS rate,22470.99,100,MS DRG,17976.79,case rate,100% of CMS IPPS rate,4819.84,456320.6,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16306.57,100,MS DRG,13045.26,case rate,100% of CMS IPPS rate,26090.51,160,MS DRG,20872.41,case rate,160% of CMS IPPS rate,21198.54,130,MS DRG,16958.83,case rate,130% of CMS IPPS rate,3315.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3481.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16306.57,100,MS DRG,13045.26,case rate,100% of CMS IPPS rate,3315.4,100,,,case rate,100% of CMS IPPS rate,16306.57,100,MS DRG,13045.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3315.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,441117.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16306.57,100,MS DRG,13045.26,case rate,100% of CMS IPPS rate,16306.57,100,MS DRG,13045.26,case rate,100% of CMS IPPS rate,3315.4,441117,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24461.31,100,MS DRG,19569.05,case rate,100% of CMS IPPS rate,39138.1,160,MS DRG,31310.48,case rate,160% of CMS IPPS rate,31799.7,130,MS DRG,25439.76,case rate,130% of CMS IPPS rate,6194.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6504.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24461.31,100,MS DRG,19569.05,case rate,100% of CMS IPPS rate,6194.65,100,,,case rate,100% of CMS IPPS rate,24461.31,100,MS DRG,19569.05,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6194.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297495.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24461.31,100,MS DRG,19569.05,case rate,100% of CMS IPPS rate,24461.31,100,MS DRG,19569.05,case rate,100% of CMS IPPS rate,6194.65,297495.8,
INFLAMMATORY BOWEL DISEASE WITH CC,386,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17437.99,100,MS DRG,13950.39,case rate,100% of CMS IPPS rate,27900.78,160,MS DRG,22320.62,case rate,160% of CMS IPPS rate,22669.39,130,MS DRG,18135.51,case rate,130% of CMS IPPS rate,3783.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3973.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17437.99,100,MS DRG,13950.39,case rate,100% of CMS IPPS rate,3783.97,100,,,case rate,100% of CMS IPPS rate,17437.99,100,MS DRG,13950.39,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3783.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316083.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17437.99,100,MS DRG,13950.39,case rate,100% of CMS IPPS rate,17437.99,100,MS DRG,13950.39,case rate,100% of CMS IPPS rate,3783.97,316083.5,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14046.08,100,MS DRG,11236.86,case rate,100% of CMS IPPS rate,22473.73,160,MS DRG,17978.98,case rate,160% of CMS IPPS rate,18259.9,130,MS DRG,14607.92,case rate,130% of CMS IPPS rate,2555.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2683.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14046.08,100,MS DRG,11236.86,case rate,100% of CMS IPPS rate,2555.56,100,,,case rate,100% of CMS IPPS rate,14046.08,100,MS DRG,11236.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2555.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324926.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14046.08,100,MS DRG,11236.86,case rate,100% of CMS IPPS rate,14046.08,100,MS DRG,11236.86,case rate,100% of CMS IPPS rate,2555.56,324926.5,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23123.42,100,MS DRG,18498.74,case rate,100% of CMS IPPS rate,36997.47,160,MS DRG,29597.98,case rate,160% of CMS IPPS rate,30060.45,130,MS DRG,24048.36,case rate,130% of CMS IPPS rate,5604.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5884.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23123.42,100,MS DRG,18498.74,case rate,100% of CMS IPPS rate,5604.08,100,,,case rate,100% of CMS IPPS rate,23123.42,100,MS DRG,18498.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5604.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358680.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23123.42,100,MS DRG,18498.74,case rate,100% of CMS IPPS rate,23123.42,100,MS DRG,18498.74,case rate,100% of CMS IPPS rate,5604.08,358680.6,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15370.98,100,MS DRG,12296.78,case rate,100% of CMS IPPS rate,24593.57,160,MS DRG,19674.86,case rate,160% of CMS IPPS rate,19982.27,130,MS DRG,15985.82,case rate,130% of CMS IPPS rate,3056.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3208.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15370.98,100,MS DRG,12296.78,case rate,100% of CMS IPPS rate,3056.15,100,,,case rate,100% of CMS IPPS rate,15370.98,100,MS DRG,12296.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3056.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,296536.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15370.98,100,MS DRG,12296.78,case rate,100% of CMS IPPS rate,15370.98,100,MS DRG,12296.78,case rate,100% of CMS IPPS rate,3056.15,296536.4,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12570.16,100,MS DRG,10056.13,case rate,100% of CMS IPPS rate,20112.26,160,MS DRG,16089.81,case rate,160% of CMS IPPS rate,16341.21,130,MS DRG,13072.97,case rate,130% of CMS IPPS rate,2086.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2190.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12570.16,100,MS DRG,10056.13,case rate,100% of CMS IPPS rate,2086.23,100,,,case rate,100% of CMS IPPS rate,12570.16,100,MS DRG,10056.13,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2086.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287388.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12570.16,100,MS DRG,10056.13,case rate,100% of CMS IPPS rate,12570.16,100,MS DRG,10056.13,case rate,100% of CMS IPPS rate,2086.23,287388.9,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21025.75,100,MS DRG,16820.6,case rate,100% of CMS IPPS rate,33641.2,160,MS DRG,26912.96,case rate,160% of CMS IPPS rate,27333.48,130,MS DRG,21866.78,case rate,130% of CMS IPPS rate,4897.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5142.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21025.75,100,MS DRG,16820.6,case rate,100% of CMS IPPS rate,4897.23,100,,,case rate,100% of CMS IPPS rate,21025.75,100,MS DRG,16820.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4897.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332331.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21025.75,100,MS DRG,16820.6,case rate,100% of CMS IPPS rate,21025.75,100,MS DRG,16820.6,case rate,100% of CMS IPPS rate,4897.23,332331.9,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15243.58,100,MS DRG,12194.86,case rate,100% of CMS IPPS rate,24389.73,160,MS DRG,19511.78,case rate,160% of CMS IPPS rate,19816.65,130,MS DRG,15853.32,case rate,130% of CMS IPPS rate,2974.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3123.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15243.58,100,MS DRG,12194.86,case rate,100% of CMS IPPS rate,2974.94,100,,,case rate,100% of CMS IPPS rate,15243.58,100,MS DRG,12194.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2974.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,354039.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15243.58,100,MS DRG,12194.86,case rate,100% of CMS IPPS rate,15243.58,100,MS DRG,12194.86,case rate,100% of CMS IPPS rate,2974.94,354039.4,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25083.05,100,MS DRG,20066.44,case rate,100% of CMS IPPS rate,40132.88,160,MS DRG,32106.3,case rate,160% of CMS IPPS rate,32607.97,130,MS DRG,26086.38,case rate,130% of CMS IPPS rate,6313.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6629.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25083.05,100,MS DRG,20066.44,case rate,100% of CMS IPPS rate,6313.6,100,,,case rate,100% of CMS IPPS rate,25083.05,100,MS DRG,20066.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6313.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355487.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25083.05,100,MS DRG,20066.44,case rate,100% of CMS IPPS rate,25083.05,100,MS DRG,20066.44,case rate,100% of CMS IPPS rate,6313.6,355487.7,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17028.59,100,MS DRG,13622.87,case rate,100% of CMS IPPS rate,27245.74,160,MS DRG,21796.59,case rate,160% of CMS IPPS rate,22137.17,130,MS DRG,17709.74,case rate,130% of CMS IPPS rate,3588.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3768.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17028.59,100,MS DRG,13622.87,case rate,100% of CMS IPPS rate,3588.76,100,,,case rate,100% of CMS IPPS rate,17028.59,100,MS DRG,13622.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3588.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381000.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17028.59,100,MS DRG,13622.87,case rate,100% of CMS IPPS rate,17028.59,100,MS DRG,13622.87,case rate,100% of CMS IPPS rate,3588.76,381000.4,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13614.28,100,MS DRG,10891.42,case rate,100% of CMS IPPS rate,21782.85,160,MS DRG,17426.28,case rate,160% of CMS IPPS rate,17698.56,130,MS DRG,14158.85,case rate,130% of CMS IPPS rate,2426.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2547.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13614.28,100,MS DRG,10891.42,case rate,100% of CMS IPPS rate,2426.31,100,,,case rate,100% of CMS IPPS rate,13614.28,100,MS DRG,10891.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2426.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405317.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13614.28,100,MS DRG,10891.42,case rate,100% of CMS IPPS rate,13614.28,100,MS DRG,10891.42,case rate,100% of CMS IPPS rate,2426.31,405317.7,
APPENDIX PROCEDURES WITH MCC,397,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32480.36,100,MS DRG,25984.29,case rate,100% of CMS IPPS rate,51968.58,160,MS DRG,41574.86,case rate,160% of CMS IPPS rate,42224.47,130,MS DRG,33779.58,case rate,130% of CMS IPPS rate,9446.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9919.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32480.36,100,MS DRG,25984.29,case rate,100% of CMS IPPS rate,9446.76,100,,,case rate,100% of CMS IPPS rate,32480.36,100,MS DRG,25984.29,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9446.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1099880.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32480.36,100,MS DRG,25984.29,case rate,100% of CMS IPPS rate,32480.36,100,MS DRG,25984.29,case rate,100% of CMS IPPS rate,9446.76,1099881,
APPENDIX PROCEDURES WITH CC,398,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23828.94,100,MS DRG,19063.15,case rate,100% of CMS IPPS rate,38126.3,160,MS DRG,30501.04,case rate,160% of CMS IPPS rate,30977.62,130,MS DRG,24782.1,case rate,130% of CMS IPPS rate,5769.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6057.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23828.94,100,MS DRG,19063.15,case rate,100% of CMS IPPS rate,5769.17,100,,,case rate,100% of CMS IPPS rate,23828.94,100,MS DRG,19063.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5769.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1635557.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23828.94,100,MS DRG,19063.15,case rate,100% of CMS IPPS rate,23828.94,100,MS DRG,19063.15,case rate,100% of CMS IPPS rate,5769.17,1635558,
APPENDIX PROCEDURES WITHOUT CC/MCC,399,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,30571.82,160,MS DRG,24457.46,case rate,160% of CMS IPPS rate,24839.61,130,MS DRG,19871.69,case rate,130% of CMS IPPS rate,4284.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4498.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,4284.55,100,,,case rate,100% of CMS IPPS rate,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4284.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,955792.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,4284.55,955792.6,
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL,402,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14915.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15661.24,100,,,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,14915.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14915.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,943156.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14915.5,943156.1,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70925.14,100,MS DRG,56740.11,case rate,100% of CMS IPPS rate,113480.22,160,MS DRG,90784.18,case rate,160% of CMS IPPS rate,92202.68,130,MS DRG,73762.14,case rate,130% of CMS IPPS rate,20697.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21732.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,70925.14,100,MS DRG,56740.11,case rate,100% of CMS IPPS rate,20697.24,100,,,case rate,100% of CMS IPPS rate,70925.14,100,MS DRG,56740.11,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20697.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,653153.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,70925.14,100,MS DRG,56740.11,case rate,100% of CMS IPPS rate,70925.14,100,MS DRG,56740.11,case rate,100% of CMS IPPS rate,20697.24,653153.6,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40040.49,100,MS DRG,32032.39,case rate,100% of CMS IPPS rate,64064.78,160,MS DRG,51251.82,case rate,160% of CMS IPPS rate,52052.64,130,MS DRG,41642.11,case rate,130% of CMS IPPS rate,10707.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11242.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40040.49,100,MS DRG,32032.39,case rate,100% of CMS IPPS rate,10707.19,100,,,case rate,100% of CMS IPPS rate,40040.49,100,MS DRG,32032.39,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10707.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,819025.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40040.49,100,MS DRG,32032.39,case rate,100% of CMS IPPS rate,40040.49,100,MS DRG,32032.39,case rate,100% of CMS IPPS rate,10707.19,819025.5,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31352.49,100,MS DRG,25081.99,case rate,100% of CMS IPPS rate,50163.98,160,MS DRG,40131.18,case rate,160% of CMS IPPS rate,40758.24,130,MS DRG,32606.59,case rate,130% of CMS IPPS rate,8142.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8549.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31352.49,100,MS DRG,25081.99,case rate,100% of CMS IPPS rate,8142.87,100,,,case rate,100% of CMS IPPS rate,31352.49,100,MS DRG,25081.99,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8142.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1119796.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31352.49,100,MS DRG,25081.99,case rate,100% of CMS IPPS rate,31352.49,100,MS DRG,25081.99,case rate,100% of CMS IPPS rate,8142.87,1119797,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49889.4,100,MS DRG,39911.52,case rate,100% of CMS IPPS rate,79823.04,160,MS DRG,63858.43,case rate,160% of CMS IPPS rate,64856.22,130,MS DRG,51884.98,case rate,130% of CMS IPPS rate,13348.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14016.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49889.4,100,MS DRG,39911.52,case rate,100% of CMS IPPS rate,13348.92,100,,,case rate,100% of CMS IPPS rate,49889.4,100,MS DRG,39911.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13348.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,801914.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49889.4,100,MS DRG,39911.52,case rate,100% of CMS IPPS rate,49889.4,100,MS DRG,39911.52,case rate,100% of CMS IPPS rate,13348.92,801914.2,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29067.21,100,MS DRG,23253.77,case rate,100% of CMS IPPS rate,46507.54,160,MS DRG,37206.03,case rate,160% of CMS IPPS rate,37787.37,130,MS DRG,30229.9,case rate,130% of CMS IPPS rate,7993.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8392.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29067.21,100,MS DRG,23253.77,case rate,100% of CMS IPPS rate,7993.03,100,,,case rate,100% of CMS IPPS rate,29067.21,100,MS DRG,23253.77,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7993.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550001.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29067.21,100,MS DRG,23253.77,case rate,100% of CMS IPPS rate,29067.21,100,MS DRG,23253.77,case rate,100% of CMS IPPS rate,7993.03,550001.7,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24441.25,100,MS DRG,19553,case rate,100% of CMS IPPS rate,39106,160,MS DRG,31284.8,case rate,160% of CMS IPPS rate,31773.63,130,MS DRG,25418.9,case rate,130% of CMS IPPS rate,5913.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6209.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24441.25,100,MS DRG,19553,case rate,100% of CMS IPPS rate,5913.66,100,,,case rate,100% of CMS IPPS rate,24441.25,100,MS DRG,19553,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5913.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,793795.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24441.25,100,MS DRG,19553,case rate,100% of CMS IPPS rate,24441.25,100,MS DRG,19553,case rate,100% of CMS IPPS rate,5913.66,793795.3,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41845.56,100,MS DRG,33476.45,case rate,100% of CMS IPPS rate,66952.9,160,MS DRG,53562.32,case rate,160% of CMS IPPS rate,54399.23,130,MS DRG,43519.38,case rate,130% of CMS IPPS rate,10345,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10862.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41845.56,100,MS DRG,33476.45,case rate,100% of CMS IPPS rate,10345,100,,,case rate,100% of CMS IPPS rate,41845.56,100,MS DRG,33476.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10345,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600257.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41845.56,100,MS DRG,33476.45,case rate,100% of CMS IPPS rate,41845.56,100,MS DRG,33476.45,case rate,100% of CMS IPPS rate,10345,600257.3,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30350.84,100,MS DRG,24280.67,case rate,100% of CMS IPPS rate,48561.34,160,MS DRG,38849.07,case rate,160% of CMS IPPS rate,39456.09,130,MS DRG,31564.87,case rate,130% of CMS IPPS rate,8126.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8533.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30350.84,100,MS DRG,24280.67,case rate,100% of CMS IPPS rate,8126.85,100,,,case rate,100% of CMS IPPS rate,30350.84,100,MS DRG,24280.67,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8126.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,660821.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30350.84,100,MS DRG,24280.67,case rate,100% of CMS IPPS rate,30350.84,100,MS DRG,24280.67,case rate,100% of CMS IPPS rate,8126.85,660821.6,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23785.28,100,MS DRG,19028.22,case rate,100% of CMS IPPS rate,38056.45,160,MS DRG,30445.16,case rate,160% of CMS IPPS rate,30920.86,130,MS DRG,24736.69,case rate,130% of CMS IPPS rate,6338.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6655.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23785.28,100,MS DRG,19028.22,case rate,100% of CMS IPPS rate,6338.38,100,,,case rate,100% of CMS IPPS rate,23785.28,100,MS DRG,19028.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6338.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,832477.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23785.28,100,MS DRG,19028.22,case rate,100% of CMS IPPS rate,23785.28,100,MS DRG,19028.22,case rate,100% of CMS IPPS rate,6338.38,832477.9,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47565.2,100,MS DRG,38052.16,case rate,100% of CMS IPPS rate,76104.32,160,MS DRG,60883.46,case rate,160% of CMS IPPS rate,61834.76,130,MS DRG,49467.81,case rate,130% of CMS IPPS rate,13358.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14026.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47565.2,100,MS DRG,38052.16,case rate,100% of CMS IPPS rate,13358.45,100,,,case rate,100% of CMS IPPS rate,47565.2,100,MS DRG,38052.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13358.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569441.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47565.2,100,MS DRG,38052.16,case rate,100% of CMS IPPS rate,47565.2,100,MS DRG,38052.16,case rate,100% of CMS IPPS rate,13358.45,569441.4,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29285.48,100,MS DRG,23428.38,case rate,100% of CMS IPPS rate,46856.77,160,MS DRG,37485.42,case rate,160% of CMS IPPS rate,38071.12,130,MS DRG,30456.9,case rate,130% of CMS IPPS rate,7541.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7918.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29285.48,100,MS DRG,23428.38,case rate,100% of CMS IPPS rate,7541.62,100,,,case rate,100% of CMS IPPS rate,29285.48,100,MS DRG,23428.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7541.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,784342.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29285.48,100,MS DRG,23428.38,case rate,100% of CMS IPPS rate,29285.48,100,MS DRG,23428.38,case rate,100% of CMS IPPS rate,7541.62,784342.7,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21774.91,100,MS DRG,17419.93,case rate,100% of CMS IPPS rate,34839.86,160,MS DRG,27871.89,case rate,160% of CMS IPPS rate,28307.38,130,MS DRG,22645.9,case rate,130% of CMS IPPS rate,5223.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5485.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21774.91,100,MS DRG,17419.93,case rate,100% of CMS IPPS rate,5223.97,100,,,case rate,100% of CMS IPPS rate,21774.91,100,MS DRG,17419.93,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5223.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,620331.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21774.91,100,MS DRG,17419.93,case rate,100% of CMS IPPS rate,21774.91,100,MS DRG,17419.93,case rate,100% of CMS IPPS rate,5223.97,620331.7,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33320.38,100,MS DRG,26656.3,case rate,100% of CMS IPPS rate,53312.61,160,MS DRG,42650.09,case rate,160% of CMS IPPS rate,43316.49,130,MS DRG,34653.19,case rate,130% of CMS IPPS rate,9060.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9513.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33320.38,100,MS DRG,26656.3,case rate,100% of CMS IPPS rate,9060.55,100,,,case rate,100% of CMS IPPS rate,33320.38,100,MS DRG,26656.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9060.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,731451.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33320.38,100,MS DRG,26656.3,case rate,100% of CMS IPPS rate,33320.38,100,MS DRG,26656.3,case rate,100% of CMS IPPS rate,9060.55,731451.4,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25261.2,100,MS DRG,20208.96,case rate,100% of CMS IPPS rate,40417.92,160,MS DRG,32334.34,case rate,160% of CMS IPPS rate,32839.56,130,MS DRG,26271.65,case rate,130% of CMS IPPS rate,6322.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6638.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25261.2,100,MS DRG,20208.96,case rate,100% of CMS IPPS rate,6322.75,100,,,case rate,100% of CMS IPPS rate,25261.2,100,MS DRG,20208.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6322.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,851263.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25261.2,100,MS DRG,20208.96,case rate,100% of CMS IPPS rate,25261.2,100,MS DRG,20208.96,case rate,100% of CMS IPPS rate,6322.75,851263.3,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21468.16,100,MS DRG,17174.53,case rate,100% of CMS IPPS rate,34349.06,160,MS DRG,27479.25,case rate,160% of CMS IPPS rate,27908.61,130,MS DRG,22326.89,case rate,130% of CMS IPPS rate,5023.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5274.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21468.16,100,MS DRG,17174.53,case rate,100% of CMS IPPS rate,5023.43,100,,,case rate,100% of CMS IPPS rate,21468.16,100,MS DRG,17174.53,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5023.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,934201.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21468.16,100,MS DRG,17174.53,case rate,100% of CMS IPPS rate,21468.16,100,MS DRG,17174.53,case rate,100% of CMS IPPS rate,5023.43,934201.8,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43737.95,100,MS DRG,34990.36,case rate,100% of CMS IPPS rate,69980.72,160,MS DRG,55984.58,case rate,160% of CMS IPPS rate,56859.34,130,MS DRG,45487.47,case rate,130% of CMS IPPS rate,13456.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14129.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43737.95,100,MS DRG,34990.36,case rate,100% of CMS IPPS rate,13456.43,100,,,case rate,100% of CMS IPPS rate,43737.95,100,MS DRG,34990.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13456.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,525365.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43737.95,100,MS DRG,34990.36,case rate,100% of CMS IPPS rate,43737.95,100,MS DRG,34990.36,case rate,100% of CMS IPPS rate,13456.43,525365.4,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26144.88,100,MS DRG,20915.9,case rate,100% of CMS IPPS rate,41831.81,160,MS DRG,33465.45,case rate,160% of CMS IPPS rate,33988.34,130,MS DRG,27190.67,case rate,130% of CMS IPPS rate,6243.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6555.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26144.88,100,MS DRG,20915.9,case rate,100% of CMS IPPS rate,6243.45,100,,,case rate,100% of CMS IPPS rate,26144.88,100,MS DRG,20915.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6243.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569587.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26144.88,100,MS DRG,20915.9,case rate,100% of CMS IPPS rate,26144.88,100,MS DRG,20915.9,case rate,100% of CMS IPPS rate,6243.45,569587.9,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22622.01,100,MS DRG,18097.61,case rate,100% of CMS IPPS rate,36195.22,160,MS DRG,28956.18,case rate,160% of CMS IPPS rate,29408.61,130,MS DRG,23526.89,case rate,130% of CMS IPPS rate,5602.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5882.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22622.01,100,MS DRG,18097.61,case rate,100% of CMS IPPS rate,5602.18,100,,,case rate,100% of CMS IPPS rate,22622.01,100,MS DRG,18097.61,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5602.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,727880.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22622.01,100,MS DRG,18097.61,case rate,100% of CMS IPPS rate,22622.01,100,MS DRG,18097.61,case rate,100% of CMS IPPS rate,5602.18,727880.3,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52115.68,100,MS DRG,41692.54,case rate,100% of CMS IPPS rate,83385.09,160,MS DRG,66708.07,case rate,160% of CMS IPPS rate,67750.38,130,MS DRG,54200.3,case rate,130% of CMS IPPS rate,15507.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16282.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52115.68,100,MS DRG,41692.54,case rate,100% of CMS IPPS rate,15507.21,100,,,case rate,100% of CMS IPPS rate,52115.68,100,MS DRG,41692.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15507.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,789896.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52115.68,100,MS DRG,41692.54,case rate,100% of CMS IPPS rate,52115.68,100,MS DRG,41692.54,case rate,100% of CMS IPPS rate,15507.21,789896.4,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,49799.65,160,MS DRG,39839.72,case rate,160% of CMS IPPS rate,40462.21,130,MS DRG,32369.77,case rate,130% of CMS IPPS rate,8705.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9140.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,8705.22,100,,,case rate,100% of CMS IPPS rate,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8705.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516628.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,8705.22,516628.3,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24874.23,100,MS DRG,19899.38,case rate,100% of CMS IPPS rate,39798.77,160,MS DRG,31839.02,case rate,160% of CMS IPPS rate,32336.5,130,MS DRG,25869.2,case rate,130% of CMS IPPS rate,5893.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6188.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24874.23,100,MS DRG,19899.38,case rate,100% of CMS IPPS rate,5893.46,100,,,case rate,100% of CMS IPPS rate,24874.23,100,MS DRG,19899.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5893.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,776276.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24874.23,100,MS DRG,19899.38,case rate,100% of CMS IPPS rate,24874.23,100,MS DRG,19899.38,case rate,100% of CMS IPPS rate,5893.46,776276.9,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,426,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39938.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41934.91,100,,,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,39938.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39938.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,591661.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39938.09,591661.6,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC,427,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27079.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28433.39,100,,,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,27079.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27079.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,638536.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27079.47,638537,
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC,428,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20984.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22033.9,100,,,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,20984.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20984.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,833518.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20984.71,833518.6,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC,429,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31799.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33388.92,100,,,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,31799.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31799.04,100,,,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,31799.04,33388.92,
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC,430,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20856.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21899.4,100,,,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,20856.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20856.61,100,,,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,20856.61,21899.4,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28579.96,100,MS DRG,22863.97,case rate,100% of CMS IPPS rate,45727.94,160,MS DRG,36582.35,case rate,160% of CMS IPPS rate,37153.95,130,MS DRG,29723.16,case rate,130% of CMS IPPS rate,7469.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7842.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28579.96,100,MS DRG,22863.97,case rate,100% of CMS IPPS rate,7469.19,100,,,case rate,100% of CMS IPPS rate,28579.96,100,MS DRG,22863.97,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7469.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452401.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28579.96,100,MS DRG,22863.97,case rate,100% of CMS IPPS rate,28579.96,100,MS DRG,22863.97,case rate,100% of CMS IPPS rate,7469.19,452401.6,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18138.79,100,MS DRG,14511.03,case rate,100% of CMS IPPS rate,29022.06,160,MS DRG,23217.65,case rate,160% of CMS IPPS rate,23580.43,130,MS DRG,18864.34,case rate,130% of CMS IPPS rate,4078.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4282.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18138.79,100,MS DRG,14511.03,case rate,100% of CMS IPPS rate,4078.68,100,,,case rate,100% of CMS IPPS rate,18138.79,100,MS DRG,14511.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4078.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,348415.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18138.79,100,MS DRG,14511.03,case rate,100% of CMS IPPS rate,18138.79,100,MS DRG,14511.03,case rate,100% of CMS IPPS rate,4078.68,348415.6,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13873.84,100,MS DRG,11099.07,case rate,100% of CMS IPPS rate,22198.14,160,MS DRG,17758.51,case rate,160% of CMS IPPS rate,18035.99,130,MS DRG,14428.79,case rate,130% of CMS IPPS rate,2655.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2788.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13873.84,100,MS DRG,11099.07,case rate,100% of CMS IPPS rate,2655.45,100,,,case rate,100% of CMS IPPS rate,13873.84,100,MS DRG,11099.07,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2655.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350967.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13873.84,100,MS DRG,11099.07,case rate,100% of CMS IPPS rate,13873.84,100,MS DRG,11099.07,case rate,100% of CMS IPPS rate,2655.45,350967.7,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26738.3,100,MS DRG,21390.64,case rate,100% of CMS IPPS rate,42781.28,160,MS DRG,34225.02,case rate,160% of CMS IPPS rate,34759.79,130,MS DRG,27807.83,case rate,130% of CMS IPPS rate,6956.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7304.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26738.3,100,MS DRG,21390.64,case rate,100% of CMS IPPS rate,6956.4,100,,,case rate,100% of CMS IPPS rate,26738.3,100,MS DRG,21390.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6956.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,429401.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26738.3,100,MS DRG,21390.64,case rate,100% of CMS IPPS rate,26738.3,100,MS DRG,21390.64,case rate,100% of CMS IPPS rate,6956.4,429401.5,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18961.1,100,MS DRG,15168.88,case rate,100% of CMS IPPS rate,30337.76,160,MS DRG,24270.21,case rate,160% of CMS IPPS rate,24649.43,130,MS DRG,19719.54,case rate,130% of CMS IPPS rate,4299.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4514.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18961.1,100,MS DRG,15168.88,case rate,100% of CMS IPPS rate,4299.42,100,,,case rate,100% of CMS IPPS rate,18961.1,100,MS DRG,15168.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4299.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,403581.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18961.1,100,MS DRG,15168.88,case rate,100% of CMS IPPS rate,18961.1,100,MS DRG,15168.88,case rate,100% of CMS IPPS rate,4299.42,403581.5,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15780.39,100,MS DRG,12624.31,case rate,100% of CMS IPPS rate,25248.62,160,MS DRG,20198.9,case rate,160% of CMS IPPS rate,20514.51,130,MS DRG,16411.61,case rate,130% of CMS IPPS rate,2993.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3143.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15780.39,100,MS DRG,12624.31,case rate,100% of CMS IPPS rate,2993.62,100,,,case rate,100% of CMS IPPS rate,15780.39,100,MS DRG,12624.31,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2993.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,458292.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15780.39,100,MS DRG,12624.31,case rate,100% of CMS IPPS rate,15780.39,100,MS DRG,12624.31,case rate,100% of CMS IPPS rate,2993.62,458292.5,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25663.52,100,MS DRG,20530.82,case rate,100% of CMS IPPS rate,41061.63,160,MS DRG,32849.3,case rate,160% of CMS IPPS rate,33362.58,130,MS DRG,26690.06,case rate,130% of CMS IPPS rate,6342.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6660.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25663.52,100,MS DRG,20530.82,case rate,100% of CMS IPPS rate,6342.96,100,,,case rate,100% of CMS IPPS rate,25663.52,100,MS DRG,20530.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6342.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364024.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25663.52,100,MS DRG,20530.82,case rate,100% of CMS IPPS rate,25663.52,100,MS DRG,20530.82,case rate,100% of CMS IPPS rate,6342.96,364024.5,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16064.71,100,MS DRG,12851.77,case rate,100% of CMS IPPS rate,25703.54,160,MS DRG,20562.83,case rate,160% of CMS IPPS rate,20884.12,130,MS DRG,16707.3,case rate,130% of CMS IPPS rate,3279.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3443.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16064.71,100,MS DRG,12851.77,case rate,100% of CMS IPPS rate,3279.56,100,,,case rate,100% of CMS IPPS rate,16064.71,100,MS DRG,12851.77,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3279.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,317394.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16064.71,100,MS DRG,12851.77,case rate,100% of CMS IPPS rate,16064.71,100,MS DRG,12851.77,case rate,100% of CMS IPPS rate,3279.56,317394.8,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13237.92,100,MS DRG,10590.34,case rate,100% of CMS IPPS rate,21180.67,160,MS DRG,16944.54,case rate,160% of CMS IPPS rate,17209.3,130,MS DRG,13767.44,case rate,130% of CMS IPPS rate,2345.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2462.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13237.92,100,MS DRG,10590.34,case rate,100% of CMS IPPS rate,2345.11,100,,,case rate,100% of CMS IPPS rate,13237.92,100,MS DRG,10590.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2345.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300109.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13237.92,100,MS DRG,10590.34,case rate,100% of CMS IPPS rate,13237.92,100,MS DRG,10590.34,case rate,100% of CMS IPPS rate,2345.11,300109.5,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27544.11,100,MS DRG,22035.29,case rate,100% of CMS IPPS rate,44070.58,160,MS DRG,35256.46,case rate,160% of CMS IPPS rate,35807.34,130,MS DRG,28645.87,case rate,130% of CMS IPPS rate,7207.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7567.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27544.11,100,MS DRG,22035.29,case rate,100% of CMS IPPS rate,7207.26,100,,,case rate,100% of CMS IPPS rate,27544.11,100,MS DRG,22035.29,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7207.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388608.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27544.11,100,MS DRG,22035.29,case rate,100% of CMS IPPS rate,27544.11,100,MS DRG,22035.29,case rate,100% of CMS IPPS rate,7207.26,388608.4,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17200.85,100,MS DRG,13760.68,case rate,100% of CMS IPPS rate,27521.36,160,MS DRG,22017.09,case rate,160% of CMS IPPS rate,22361.11,130,MS DRG,17888.89,case rate,130% of CMS IPPS rate,3683.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3867.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17200.85,100,MS DRG,13760.68,case rate,100% of CMS IPPS rate,3683.7,100,,,case rate,100% of CMS IPPS rate,17200.85,100,MS DRG,13760.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3683.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380811.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17200.85,100,MS DRG,13760.68,case rate,100% of CMS IPPS rate,17200.85,100,MS DRG,13760.68,case rate,100% of CMS IPPS rate,3683.7,380811.7,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14407.09,100,MS DRG,11525.67,case rate,100% of CMS IPPS rate,23051.34,160,MS DRG,18441.07,case rate,160% of CMS IPPS rate,18729.22,130,MS DRG,14983.38,case rate,130% of CMS IPPS rate,2679.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2813.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14407.09,100,MS DRG,11525.67,case rate,100% of CMS IPPS rate,2679.09,100,,,case rate,100% of CMS IPPS rate,14407.09,100,MS DRG,11525.67,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2679.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352438.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14407.09,100,MS DRG,11525.67,case rate,100% of CMS IPPS rate,14407.09,100,MS DRG,11525.67,case rate,100% of CMS IPPS rate,2679.09,352438.6,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25243.51,100,MS DRG,20194.81,case rate,100% of CMS IPPS rate,40389.62,160,MS DRG,32311.7,case rate,160% of CMS IPPS rate,32816.56,130,MS DRG,26253.25,case rate,130% of CMS IPPS rate,6421.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6742.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25243.51,100,MS DRG,20194.81,case rate,100% of CMS IPPS rate,6421.88,100,,,case rate,100% of CMS IPPS rate,25243.51,100,MS DRG,20194.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6421.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425163.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25243.51,100,MS DRG,20194.81,case rate,100% of CMS IPPS rate,25243.51,100,MS DRG,20194.81,case rate,100% of CMS IPPS rate,6421.88,425163.9,
DISORDERS OF THE BILIARY TRACT WITH CC,445,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18797.12,100,MS DRG,15037.7,case rate,100% of CMS IPPS rate,30075.39,160,MS DRG,24060.31,case rate,160% of CMS IPPS rate,24436.26,130,MS DRG,19549.01,case rate,130% of CMS IPPS rate,4134.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4341.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18797.12,100,MS DRG,15037.7,case rate,100% of CMS IPPS rate,4134.72,100,,,case rate,100% of CMS IPPS rate,18797.12,100,MS DRG,15037.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4134.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459632.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18797.12,100,MS DRG,15037.7,case rate,100% of CMS IPPS rate,18797.12,100,MS DRG,15037.7,case rate,100% of CMS IPPS rate,4134.72,459632.2,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15431.16,100,MS DRG,12344.93,case rate,100% of CMS IPPS rate,24689.86,160,MS DRG,19751.89,case rate,160% of CMS IPPS rate,20060.51,130,MS DRG,16048.41,case rate,130% of CMS IPPS rate,3039.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3191.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15431.16,100,MS DRG,12344.93,case rate,100% of CMS IPPS rate,3039.75,100,,,case rate,100% of CMS IPPS rate,15431.16,100,MS DRG,12344.93,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3039.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,554166.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15431.16,100,MS DRG,12344.93,case rate,100% of CMS IPPS rate,15431.16,100,MS DRG,12344.93,case rate,100% of CMS IPPS rate,3039.75,554166.4,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,447,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25562.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26840.12,100,,,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,25562.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25562.07,100,,,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,25562.07,26840.12,
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,448,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15568.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16346.99,100,,,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,15568.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15568.59,100,,,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,15568.59,16346.99,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE,450,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19635.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20616.78,100,,,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,19635.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19635.07,100,,,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,19635.07,20616.78,
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,451,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11765.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12353.81,100,,,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,11765.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11765.56,100,,,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,11765.56,12353.81,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105424.68,100,MS DRG,84339.74,case rate,100% of CMS IPPS rate,168679.49,160,MS DRG,134943.59,case rate,160% of CMS IPPS rate,137052.08,130,MS DRG,109641.66,case rate,130% of CMS IPPS rate,32289.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33903.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,105424.68,100,MS DRG,84339.74,case rate,100% of CMS IPPS rate,32289.33,100,,,case rate,100% of CMS IPPS rate,105424.68,100,MS DRG,84339.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32289.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1013542.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,105424.68,100,MS DRG,84339.74,case rate,100% of CMS IPPS rate,105424.68,100,MS DRG,84339.74,case rate,100% of CMS IPPS rate,32289.33,1013543,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77651.14,100,MS DRG,62120.91,case rate,100% of CMS IPPS rate,124241.82,160,MS DRG,99393.46,case rate,160% of CMS IPPS rate,100946.48,130,MS DRG,80757.18,case rate,130% of CMS IPPS rate,21881.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22975.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77651.14,100,MS DRG,62120.91,case rate,100% of CMS IPPS rate,21881.81,100,,,case rate,100% of CMS IPPS rate,77651.14,100,MS DRG,62120.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21881.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2071026.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,77651.14,100,MS DRG,62120.91,case rate,100% of CMS IPPS rate,77651.14,100,MS DRG,62120.91,case rate,100% of CMS IPPS rate,21881.81,2071026,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59431.58,100,MS DRG,47545.26,case rate,100% of CMS IPPS rate,95090.53,160,MS DRG,76072.42,case rate,160% of CMS IPPS rate,77261.05,130,MS DRG,61808.84,case rate,130% of CMS IPPS rate,16462.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17285.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59431.58,100,MS DRG,47545.26,case rate,100% of CMS IPPS rate,16462.63,100,,,case rate,100% of CMS IPPS rate,59431.58,100,MS DRG,47545.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16462.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2350314.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59431.58,100,MS DRG,47545.26,case rate,100% of CMS IPPS rate,59431.58,100,MS DRG,47545.26,case rate,100% of CMS IPPS rate,16462.63,2350315,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC,461,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86419.37,100,MS DRG,69135.5,case rate,100% of CMS IPPS rate,138270.99,160,MS DRG,110616.79,case rate,160% of CMS IPPS rate,112345.18,130,MS DRG,89876.14,case rate,130% of CMS IPPS rate,22840.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23982.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,86419.37,100,MS DRG,69135.5,case rate,100% of CMS IPPS rate,22840.28,100,,,case rate,100% of CMS IPPS rate,86419.37,100,MS DRG,69135.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22840.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1028675.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,86419.37,100,MS DRG,69135.5,case rate,100% of CMS IPPS rate,86419.37,100,MS DRG,69135.5,case rate,100% of CMS IPPS rate,22840.28,1028675,
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC,462,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39555.59,100,MS DRG,31644.47,case rate,100% of CMS IPPS rate,63288.94,160,MS DRG,50631.15,case rate,160% of CMS IPPS rate,51422.27,130,MS DRG,41137.82,case rate,130% of CMS IPPS rate,10918.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11464.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39555.59,100,MS DRG,31644.47,case rate,100% of CMS IPPS rate,10918.41,100,,,case rate,100% of CMS IPPS rate,39555.59,100,MS DRG,31644.47,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10918.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1326031.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39555.59,100,MS DRG,31644.47,case rate,100% of CMS IPPS rate,39555.59,100,MS DRG,31644.47,case rate,100% of CMS IPPS rate,10918.41,1326032,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72795.12,100,MS DRG,58236.1,case rate,100% of CMS IPPS rate,116472.19,160,MS DRG,93177.75,case rate,160% of CMS IPPS rate,94633.66,130,MS DRG,75706.93,case rate,130% of CMS IPPS rate,20591.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21621.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72795.12,100,MS DRG,58236.1,case rate,100% of CMS IPPS rate,20591.64,100,,,case rate,100% of CMS IPPS rate,72795.12,100,MS DRG,58236.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20591.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676539.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,72795.12,100,MS DRG,58236.1,case rate,100% of CMS IPPS rate,72795.12,100,MS DRG,58236.1,case rate,100% of CMS IPPS rate,20591.64,676539.3,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41385.45,100,MS DRG,33108.36,case rate,100% of CMS IPPS rate,66216.72,160,MS DRG,52973.38,case rate,160% of CMS IPPS rate,53801.09,130,MS DRG,43040.87,case rate,130% of CMS IPPS rate,11241.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11803.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41385.45,100,MS DRG,33108.36,case rate,100% of CMS IPPS rate,11241.71,100,,,case rate,100% of CMS IPPS rate,41385.45,100,MS DRG,33108.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11241.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,659290.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41385.45,100,MS DRG,33108.36,case rate,100% of CMS IPPS rate,41385.45,100,MS DRG,33108.36,case rate,100% of CMS IPPS rate,11241.71,659290.5,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28046.7,100,MS DRG,22437.36,case rate,100% of CMS IPPS rate,44874.72,160,MS DRG,35899.78,case rate,160% of CMS IPPS rate,36460.71,130,MS DRG,29168.57,case rate,130% of CMS IPPS rate,6618.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6949.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28046.7,100,MS DRG,22437.36,case rate,100% of CMS IPPS rate,6618.99,100,,,case rate,100% of CMS IPPS rate,28046.7,100,MS DRG,22437.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6618.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1033164.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28046.7,100,MS DRG,22437.36,case rate,100% of CMS IPPS rate,28046.7,100,MS DRG,22437.36,case rate,100% of CMS IPPS rate,6618.99,1033164,
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,466,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67166.31,100,MS DRG,53733.05,case rate,100% of CMS IPPS rate,107466.1,160,MS DRG,85972.88,case rate,160% of CMS IPPS rate,87316.2,130,MS DRG,69852.96,case rate,130% of CMS IPPS rate,19423.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20394.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,67166.31,100,MS DRG,53733.05,case rate,100% of CMS IPPS rate,19423.47,100,,,case rate,100% of CMS IPPS rate,67166.31,100,MS DRG,53733.05,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19423.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,971033.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,67166.31,100,MS DRG,53733.05,case rate,100% of CMS IPPS rate,67166.31,100,MS DRG,53733.05,case rate,100% of CMS IPPS rate,19423.47,971033.7,
REVISION OF HIP OR KNEE REPLACEMENT WITH CC,467,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47106.27,100,MS DRG,37685.02,case rate,100% of CMS IPPS rate,75370.03,160,MS DRG,60296.02,case rate,160% of CMS IPPS rate,61238.15,130,MS DRG,48990.52,case rate,130% of CMS IPPS rate,13058.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13711.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,47106.27,100,MS DRG,37685.02,case rate,100% of CMS IPPS rate,13058.78,100,,,case rate,100% of CMS IPPS rate,47106.27,100,MS DRG,37685.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13058.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1742971.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,47106.27,100,MS DRG,37685.02,case rate,100% of CMS IPPS rate,47106.27,100,MS DRG,37685.02,case rate,100% of CMS IPPS rate,13058.78,1742972,
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,468,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37470.9,100,MS DRG,29976.72,case rate,100% of CMS IPPS rate,59953.44,160,MS DRG,47962.75,case rate,160% of CMS IPPS rate,48712.17,130,MS DRG,38969.74,case rate,130% of CMS IPPS rate,10001.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10501.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37470.9,100,MS DRG,29976.72,case rate,100% of CMS IPPS rate,10001.49,100,,,case rate,100% of CMS IPPS rate,37470.9,100,MS DRG,29976.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10001.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2032687.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37470.9,100,MS DRG,29976.72,case rate,100% of CMS IPPS rate,37470.9,100,MS DRG,29976.72,case rate,100% of CMS IPPS rate,10001.49,2032688,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,469,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45259.9,100,MS DRG,36207.92,case rate,100% of CMS IPPS rate,72415.84,160,MS DRG,57932.67,case rate,160% of CMS IPPS rate,58837.87,130,MS DRG,47070.3,case rate,130% of CMS IPPS rate,12462.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13085.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45259.9,100,MS DRG,36207.92,case rate,100% of CMS IPPS rate,12462.11,100,,,case rate,100% of CMS IPPS rate,45259.9,100,MS DRG,36207.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12462.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2068911.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45259.9,100,MS DRG,36207.92,case rate,100% of CMS IPPS rate,45259.9,100,MS DRG,36207.92,case rate,100% of CMS IPPS rate,12462.11,2068912,
MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,470,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28175.3,100,MS DRG,22540.24,case rate,100% of CMS IPPS rate,45080.48,160,MS DRG,36064.38,case rate,160% of CMS IPPS rate,36627.89,130,MS DRG,29302.31,case rate,130% of CMS IPPS rate,7188.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7548,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28175.3,100,MS DRG,22540.24,case rate,100% of CMS IPPS rate,7188.58,100,,,case rate,100% of CMS IPPS rate,28175.3,100,MS DRG,22540.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7188.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1492280.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28175.3,100,MS DRG,22540.24,case rate,100% of CMS IPPS rate,28175.3,100,MS DRG,22540.24,case rate,100% of CMS IPPS rate,7188.58,1492280,
CERVICAL SPINAL FUSION WITH MCC,471,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64009.19,100,MS DRG,51207.35,case rate,100% of CMS IPPS rate,102414.7,160,MS DRG,81931.76,case rate,160% of CMS IPPS rate,83211.95,130,MS DRG,66569.56,case rate,130% of CMS IPPS rate,18518.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19444.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64009.19,100,MS DRG,51207.35,case rate,100% of CMS IPPS rate,18518.75,100,,,case rate,100% of CMS IPPS rate,64009.19,100,MS DRG,51207.35,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18518.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,897256.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,64009.19,100,MS DRG,51207.35,case rate,100% of CMS IPPS rate,64009.19,100,MS DRG,51207.35,case rate,100% of CMS IPPS rate,18518.75,897256.8,
CERVICAL SPINAL FUSION WITH CC,472,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40842.74,100,MS DRG,32674.19,case rate,100% of CMS IPPS rate,65348.38,160,MS DRG,52278.7,case rate,160% of CMS IPPS rate,53095.56,130,MS DRG,42476.45,case rate,130% of CMS IPPS rate,11045.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11598.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40842.74,100,MS DRG,32674.19,case rate,100% of CMS IPPS rate,11045.75,100,,,case rate,100% of CMS IPPS rate,40842.74,100,MS DRG,32674.19,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11045.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1914497.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40842.74,100,MS DRG,32674.19,case rate,100% of CMS IPPS rate,40842.74,100,MS DRG,32674.19,case rate,100% of CMS IPPS rate,11045.75,1914498,
CERVICAL SPINAL FUSION WITHOUT CC/MCC,473,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35005.12,100,MS DRG,28004.1,case rate,100% of CMS IPPS rate,56008.19,160,MS DRG,44806.55,case rate,160% of CMS IPPS rate,45506.66,130,MS DRG,36405.33,case rate,130% of CMS IPPS rate,9025.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9477.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35005.12,100,MS DRG,28004.1,case rate,100% of CMS IPPS rate,9025.85,100,,,case rate,100% of CMS IPPS rate,35005.12,100,MS DRG,28004.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9025.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1667325.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35005.12,100,MS DRG,28004.1,case rate,100% of CMS IPPS rate,35005.12,100,MS DRG,28004.1,case rate,100% of CMS IPPS rate,9025.85,1667325,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56739.29,100,MS DRG,45391.43,case rate,100% of CMS IPPS rate,90782.86,160,MS DRG,72626.29,case rate,160% of CMS IPPS rate,73761.08,130,MS DRG,59008.86,case rate,130% of CMS IPPS rate,17098.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17953.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,56739.29,100,MS DRG,45391.43,case rate,100% of CMS IPPS rate,17098.19,100,,,case rate,100% of CMS IPPS rate,56739.29,100,MS DRG,45391.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17098.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,525262.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,56739.29,100,MS DRG,45391.43,case rate,100% of CMS IPPS rate,56739.29,100,MS DRG,45391.43,case rate,100% of CMS IPPS rate,17098.19,525262.7,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31278.16,100,MS DRG,25022.53,case rate,100% of CMS IPPS rate,50045.06,160,MS DRG,40036.05,case rate,160% of CMS IPPS rate,40661.61,130,MS DRG,32529.29,case rate,130% of CMS IPPS rate,8224.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8636.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31278.16,100,MS DRG,25022.53,case rate,100% of CMS IPPS rate,8224.84,100,,,case rate,100% of CMS IPPS rate,31278.16,100,MS DRG,25022.53,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8224.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366337.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31278.16,100,MS DRG,25022.53,case rate,100% of CMS IPPS rate,31278.16,100,MS DRG,25022.53,case rate,100% of CMS IPPS rate,8224.84,366337.5,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19860.1,100,MS DRG,15888.08,case rate,100% of CMS IPPS rate,31776.16,160,MS DRG,25420.93,case rate,160% of CMS IPPS rate,25818.13,130,MS DRG,20654.5,case rate,130% of CMS IPPS rate,4434.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4656.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19860.1,100,MS DRG,15888.08,case rate,100% of CMS IPPS rate,4434.39,100,,,case rate,100% of CMS IPPS rate,19860.1,100,MS DRG,15888.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4434.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,553568.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19860.1,100,MS DRG,15888.08,case rate,100% of CMS IPPS rate,19860.1,100,MS DRG,15888.08,case rate,100% of CMS IPPS rate,4434.39,553568.9,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45722.39,100,MS DRG,36577.91,case rate,100% of CMS IPPS rate,73155.82,160,MS DRG,58524.66,case rate,160% of CMS IPPS rate,59439.11,130,MS DRG,47551.29,case rate,130% of CMS IPPS rate,13111.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13766.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45722.39,100,MS DRG,36577.91,case rate,100% of CMS IPPS rate,13111.39,100,,,case rate,100% of CMS IPPS rate,45722.39,100,MS DRG,36577.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13111.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465754.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45722.39,100,MS DRG,36577.91,case rate,100% of CMS IPPS rate,45722.39,100,MS DRG,36577.91,case rate,100% of CMS IPPS rate,13111.39,465754.5,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34097.86,100,MS DRG,27278.29,case rate,100% of CMS IPPS rate,54556.58,160,MS DRG,43645.26,case rate,160% of CMS IPPS rate,44327.22,130,MS DRG,35461.78,case rate,130% of CMS IPPS rate,8916.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9361.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34097.86,100,MS DRG,27278.29,case rate,100% of CMS IPPS rate,8916.05,100,,,case rate,100% of CMS IPPS rate,34097.86,100,MS DRG,27278.29,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8916.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,625016.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34097.86,100,MS DRG,27278.29,case rate,100% of CMS IPPS rate,34097.86,100,MS DRG,27278.29,case rate,100% of CMS IPPS rate,8916.05,625016.6,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27966.48,100,MS DRG,22373.18,case rate,100% of CMS IPPS rate,44746.37,160,MS DRG,35797.1,case rate,160% of CMS IPPS rate,36356.42,130,MS DRG,29085.14,case rate,130% of CMS IPPS rate,6770.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7108.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27966.48,100,MS DRG,22373.18,case rate,100% of CMS IPPS rate,6770.34,100,,,case rate,100% of CMS IPPS rate,27966.48,100,MS DRG,22373.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6770.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,721838.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27966.48,100,MS DRG,22373.18,case rate,100% of CMS IPPS rate,27966.48,100,MS DRG,22373.18,case rate,100% of CMS IPPS rate,6770.34,721838.6,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40766.07,100,MS DRG,32612.86,case rate,100% of CMS IPPS rate,65225.71,160,MS DRG,52180.57,case rate,160% of CMS IPPS rate,52995.89,130,MS DRG,42396.71,case rate,130% of CMS IPPS rate,11212.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11773.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40766.07,100,MS DRG,32612.86,case rate,100% of CMS IPPS rate,11212.74,100,,,case rate,100% of CMS IPPS rate,40766.07,100,MS DRG,32612.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11212.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,528582.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40766.07,100,MS DRG,32612.86,case rate,100% of CMS IPPS rate,40766.07,100,MS DRG,32612.86,case rate,100% of CMS IPPS rate,11212.74,528582.2,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30454.65,100,MS DRG,24363.72,case rate,100% of CMS IPPS rate,48727.44,160,MS DRG,38981.95,case rate,160% of CMS IPPS rate,39591.05,130,MS DRG,31672.84,case rate,130% of CMS IPPS rate,7910.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8306.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30454.65,100,MS DRG,24363.72,case rate,100% of CMS IPPS rate,7910.68,100,,,case rate,100% of CMS IPPS rate,30454.65,100,MS DRG,24363.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7910.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,787574.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30454.65,100,MS DRG,24363.72,case rate,100% of CMS IPPS rate,30454.65,100,MS DRG,24363.72,case rate,100% of CMS IPPS rate,7910.68,787574.6,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24714.96,100,MS DRG,19771.97,case rate,100% of CMS IPPS rate,39543.94,160,MS DRG,31635.15,case rate,160% of CMS IPPS rate,32129.45,130,MS DRG,25703.56,case rate,130% of CMS IPPS rate,6048.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6350.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24714.96,100,MS DRG,19771.97,case rate,100% of CMS IPPS rate,6048.25,100,,,case rate,100% of CMS IPPS rate,24714.96,100,MS DRG,19771.97,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6048.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1042492.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24714.96,100,MS DRG,19771.97,case rate,100% of CMS IPPS rate,24714.96,100,MS DRG,19771.97,case rate,100% of CMS IPPS rate,6048.25,1042493,
MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,483,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35283.56,100,MS DRG,28226.85,case rate,100% of CMS IPPS rate,56453.7,160,MS DRG,45162.96,case rate,160% of CMS IPPS rate,45868.63,130,MS DRG,36694.9,case rate,130% of CMS IPPS rate,9715.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10200.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35283.56,100,MS DRG,28226.85,case rate,100% of CMS IPPS rate,9715.17,100,,,case rate,100% of CMS IPPS rate,35283.56,100,MS DRG,28226.85,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9715.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1686414.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35283.56,100,MS DRG,28226.85,case rate,100% of CMS IPPS rate,35283.56,100,MS DRG,28226.85,case rate,100% of CMS IPPS rate,9715.17,1686415,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,485,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44837.52,100,MS DRG,35870.02,case rate,100% of CMS IPPS rate,71740.03,160,MS DRG,57392.02,case rate,160% of CMS IPPS rate,58288.78,130,MS DRG,46631.02,case rate,130% of CMS IPPS rate,12273.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12887.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44837.52,100,MS DRG,35870.02,case rate,100% of CMS IPPS rate,12273.77,100,,,case rate,100% of CMS IPPS rate,44837.52,100,MS DRG,35870.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12273.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521548.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44837.52,100,MS DRG,35870.02,case rate,100% of CMS IPPS rate,44837.52,100,MS DRG,35870.02,case rate,100% of CMS IPPS rate,12273.77,521548.7,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,486,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29668.92,100,MS DRG,23735.14,case rate,100% of CMS IPPS rate,47470.27,160,MS DRG,37976.22,case rate,160% of CMS IPPS rate,38569.6,130,MS DRG,30855.68,case rate,130% of CMS IPPS rate,8086.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8490.34,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29668.92,100,MS DRG,23735.14,case rate,100% of CMS IPPS rate,8086.06,100,,,case rate,100% of CMS IPPS rate,29668.92,100,MS DRG,23735.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8086.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,421745.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29668.92,100,MS DRG,23735.14,case rate,100% of CMS IPPS rate,29668.92,100,MS DRG,23735.14,case rate,100% of CMS IPPS rate,8086.06,421745.4,
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,487,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24201.75,100,MS DRG,19361.4,case rate,100% of CMS IPPS rate,38722.8,160,MS DRG,30978.24,case rate,160% of CMS IPPS rate,31462.28,130,MS DRG,25169.82,case rate,130% of CMS IPPS rate,6024.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6325.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24201.75,100,MS DRG,19361.4,case rate,100% of CMS IPPS rate,6024.61,100,,,case rate,100% of CMS IPPS rate,24201.75,100,MS DRG,19361.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6024.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,601702.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24201.75,100,MS DRG,19361.4,case rate,100% of CMS IPPS rate,24201.75,100,MS DRG,19361.4,case rate,100% of CMS IPPS rate,6024.61,601702.6,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,488,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30828.65,100,MS DRG,24662.92,case rate,100% of CMS IPPS rate,49325.84,160,MS DRG,39460.67,case rate,160% of CMS IPPS rate,40077.25,130,MS DRG,32061.8,case rate,130% of CMS IPPS rate,7493.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7867.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30828.65,100,MS DRG,24662.92,case rate,100% of CMS IPPS rate,7493.21,100,,,case rate,100% of CMS IPPS rate,30828.65,100,MS DRG,24662.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7493.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1024579.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30828.65,100,MS DRG,24662.92,case rate,100% of CMS IPPS rate,30828.65,100,MS DRG,24662.92,case rate,100% of CMS IPPS rate,7493.21,1024580,
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,489,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20577.42,100,MS DRG,16461.94,case rate,100% of CMS IPPS rate,32923.87,160,MS DRG,26339.1,case rate,160% of CMS IPPS rate,26750.65,130,MS DRG,21400.52,case rate,130% of CMS IPPS rate,4721.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4957.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20577.42,100,MS DRG,16461.94,case rate,100% of CMS IPPS rate,4721.47,100,,,case rate,100% of CMS IPPS rate,20577.42,100,MS DRG,16461.94,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4721.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1168337.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20577.42,100,MS DRG,16461.94,case rate,100% of CMS IPPS rate,20577.42,100,MS DRG,16461.94,case rate,100% of CMS IPPS rate,4721.47,1168338,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46820.76,100,MS DRG,37456.61,case rate,100% of CMS IPPS rate,74913.22,160,MS DRG,59930.58,case rate,160% of CMS IPPS rate,60866.99,130,MS DRG,48693.59,case rate,130% of CMS IPPS rate,13539.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14216.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46820.76,100,MS DRG,37456.61,case rate,100% of CMS IPPS rate,13539.16,100,,,case rate,100% of CMS IPPS rate,46820.76,100,MS DRG,37456.61,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13539.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490737.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46820.76,100,MS DRG,37456.61,case rate,100% of CMS IPPS rate,46820.76,100,MS DRG,37456.61,case rate,100% of CMS IPPS rate,13539.16,490737.8,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34310.22,100,MS DRG,27448.18,case rate,100% of CMS IPPS rate,54896.35,160,MS DRG,43917.08,case rate,160% of CMS IPPS rate,44603.29,130,MS DRG,35682.63,case rate,130% of CMS IPPS rate,9153.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9611.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34310.22,100,MS DRG,27448.18,case rate,100% of CMS IPPS rate,9153.96,100,,,case rate,100% of CMS IPPS rate,34310.22,100,MS DRG,27448.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9153.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,801937.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34310.22,100,MS DRG,27448.18,case rate,100% of CMS IPPS rate,34310.22,100,MS DRG,27448.18,case rate,100% of CMS IPPS rate,9153.96,801937.9,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28027.82,100,MS DRG,22422.26,case rate,100% of CMS IPPS rate,44844.51,160,MS DRG,35875.61,case rate,160% of CMS IPPS rate,36436.17,130,MS DRG,29148.94,case rate,130% of CMS IPPS rate,7188.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7547.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28027.82,100,MS DRG,22422.26,case rate,100% of CMS IPPS rate,7188.2,100,,,case rate,100% of CMS IPPS rate,28027.82,100,MS DRG,22422.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7188.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1110781.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28027.82,100,MS DRG,22422.26,case rate,100% of CMS IPPS rate,28027.82,100,MS DRG,22422.26,case rate,100% of CMS IPPS rate,7188.2,1110782,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48225.9,100,MS DRG,38580.72,case rate,100% of CMS IPPS rate,77161.44,160,MS DRG,61729.15,case rate,160% of CMS IPPS rate,62693.67,130,MS DRG,50154.94,case rate,130% of CMS IPPS rate,13422.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14093.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48225.9,100,MS DRG,38580.72,case rate,100% of CMS IPPS rate,13422.5,100,,,case rate,100% of CMS IPPS rate,48225.9,100,MS DRG,38580.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13422.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,545422.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48225.9,100,MS DRG,38580.72,case rate,100% of CMS IPPS rate,48225.9,100,MS DRG,38580.72,case rate,100% of CMS IPPS rate,13422.5,545422.7,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29423.52,100,MS DRG,23538.82,case rate,100% of CMS IPPS rate,47077.63,160,MS DRG,37662.1,case rate,160% of CMS IPPS rate,38250.58,130,MS DRG,30600.46,case rate,130% of CMS IPPS rate,7522.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7898.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29423.52,100,MS DRG,23538.82,case rate,100% of CMS IPPS rate,7522.18,100,,,case rate,100% of CMS IPPS rate,29423.52,100,MS DRG,23538.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7522.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1009000.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29423.52,100,MS DRG,23538.82,case rate,100% of CMS IPPS rate,29423.52,100,MS DRG,23538.82,case rate,100% of CMS IPPS rate,7522.18,1009000,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22815.49,100,MS DRG,18252.39,case rate,100% of CMS IPPS rate,36504.78,160,MS DRG,29203.82,case rate,160% of CMS IPPS rate,29660.14,130,MS DRG,23728.11,case rate,130% of CMS IPPS rate,5118.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5374.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22815.49,100,MS DRG,18252.39,case rate,100% of CMS IPPS rate,5118.74,100,,,case rate,100% of CMS IPPS rate,22815.49,100,MS DRG,18252.39,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5118.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,983279.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22815.49,100,MS DRG,18252.39,case rate,100% of CMS IPPS rate,22815.49,100,MS DRG,18252.39,case rate,100% of CMS IPPS rate,5118.74,983279.7,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36779.53,100,MS DRG,29423.62,case rate,100% of CMS IPPS rate,58847.25,160,MS DRG,47077.8,case rate,160% of CMS IPPS rate,47813.39,130,MS DRG,38250.71,case rate,130% of CMS IPPS rate,9626.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10107.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36779.53,100,MS DRG,29423.62,case rate,100% of CMS IPPS rate,9626.33,100,,,case rate,100% of CMS IPPS rate,36779.53,100,MS DRG,29423.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9626.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,497076.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36779.53,100,MS DRG,29423.62,case rate,100% of CMS IPPS rate,36779.53,100,MS DRG,29423.62,case rate,100% of CMS IPPS rate,9626.33,497076.8,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21192.08,100,MS DRG,16953.66,case rate,100% of CMS IPPS rate,33907.33,160,MS DRG,27125.86,case rate,160% of CMS IPPS rate,27549.7,130,MS DRG,22039.76,case rate,130% of CMS IPPS rate,4188.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4398.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21192.08,100,MS DRG,16953.66,case rate,100% of CMS IPPS rate,4188.86,100,,,case rate,100% of CMS IPPS rate,21192.08,100,MS DRG,16953.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4188.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,996059.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21192.08,100,MS DRG,16953.66,case rate,100% of CMS IPPS rate,21192.08,100,MS DRG,16953.66,case rate,100% of CMS IPPS rate,4188.86,996059.3,
SOFT TISSUE PROCEDURES WITH MCC,500,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44233.48,100,MS DRG,35386.78,case rate,100% of CMS IPPS rate,70773.57,160,MS DRG,56618.86,case rate,160% of CMS IPPS rate,57503.52,130,MS DRG,46002.82,case rate,130% of CMS IPPS rate,12080.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12684.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44233.48,100,MS DRG,35386.78,case rate,100% of CMS IPPS rate,12080.86,100,,,case rate,100% of CMS IPPS rate,44233.48,100,MS DRG,35386.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12080.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423214.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44233.48,100,MS DRG,35386.78,case rate,100% of CMS IPPS rate,44233.48,100,MS DRG,35386.78,case rate,100% of CMS IPPS rate,12080.86,423214.1,
SOFT TISSUE PROCEDURES WITH CC,501,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26452.8,100,MS DRG,21162.24,case rate,100% of CMS IPPS rate,42324.48,160,MS DRG,33859.58,case rate,160% of CMS IPPS rate,34388.64,130,MS DRG,27510.91,case rate,130% of CMS IPPS rate,6804.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7144.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26452.8,100,MS DRG,21162.24,case rate,100% of CMS IPPS rate,6804.28,100,,,case rate,100% of CMS IPPS rate,26452.8,100,MS DRG,21162.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6804.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,654235.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26452.8,100,MS DRG,21162.24,case rate,100% of CMS IPPS rate,26452.8,100,MS DRG,21162.24,case rate,100% of CMS IPPS rate,6804.28,654235.7,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22288.13,100,MS DRG,17830.5,case rate,100% of CMS IPPS rate,35661.01,160,MS DRG,28528.81,case rate,160% of CMS IPPS rate,28974.57,130,MS DRG,23179.66,case rate,130% of CMS IPPS rate,5326.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5593.24,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22288.13,100,MS DRG,17830.5,case rate,100% of CMS IPPS rate,5326.91,100,,,case rate,100% of CMS IPPS rate,22288.13,100,MS DRG,17830.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5326.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,969132,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22288.13,100,MS DRG,17830.5,case rate,100% of CMS IPPS rate,22288.13,100,MS DRG,17830.5,case rate,100% of CMS IPPS rate,5326.91,969132,
FOOT PROCEDURES WITH MCC,503,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37616,100,MS DRG,30092.8,case rate,100% of CMS IPPS rate,60185.6,160,MS DRG,48148.48,case rate,160% of CMS IPPS rate,48900.8,130,MS DRG,39120.64,case rate,130% of CMS IPPS rate,10090.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10594.82,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37616,100,MS DRG,30092.8,case rate,100% of CMS IPPS rate,10090.32,100,,,case rate,100% of CMS IPPS rate,37616,100,MS DRG,30092.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10090.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,471299.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37616,100,MS DRG,30092.8,case rate,100% of CMS IPPS rate,37616,100,MS DRG,30092.8,case rate,100% of CMS IPPS rate,10090.32,471299.8,
FOOT PROCEDURES WITH CC,504,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26351.34,100,MS DRG,21081.07,case rate,100% of CMS IPPS rate,42162.14,160,MS DRG,33729.71,case rate,160% of CMS IPPS rate,34256.74,130,MS DRG,27405.39,case rate,130% of CMS IPPS rate,6691.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7025.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26351.34,100,MS DRG,21081.07,case rate,100% of CMS IPPS rate,6691.04,100,,,case rate,100% of CMS IPPS rate,26351.34,100,MS DRG,21081.07,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6691.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,587459.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26351.34,100,MS DRG,21081.07,case rate,100% of CMS IPPS rate,26351.34,100,MS DRG,21081.07,case rate,100% of CMS IPPS rate,6691.04,587459.9,
FOOT PROCEDURES WITHOUT CC/MCC,505,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26098.85,100,MS DRG,20879.08,case rate,100% of CMS IPPS rate,41758.16,160,MS DRG,33406.53,case rate,160% of CMS IPPS rate,33928.51,130,MS DRG,27142.81,case rate,130% of CMS IPPS rate,6691.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7025.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26098.85,100,MS DRG,20879.08,case rate,100% of CMS IPPS rate,6691.04,100,,,case rate,100% of CMS IPPS rate,26098.85,100,MS DRG,20879.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6691.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1114486.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26098.85,100,MS DRG,20879.08,case rate,100% of CMS IPPS rate,26098.85,100,MS DRG,20879.08,case rate,100% of CMS IPPS rate,6691.04,1114487,
MAJOR THUMB OR JOINT PROCEDURES,506,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23230.78,100,MS DRG,18584.62,case rate,100% of CMS IPPS rate,37169.25,160,MS DRG,29735.4,case rate,160% of CMS IPPS rate,30200.01,130,MS DRG,24160.01,case rate,130% of CMS IPPS rate,5715.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6001.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23230.78,100,MS DRG,18584.62,case rate,100% of CMS IPPS rate,5715.41,100,,,case rate,100% of CMS IPPS rate,23230.78,100,MS DRG,18584.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5715.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,505146.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23230.78,100,MS DRG,18584.62,case rate,100% of CMS IPPS rate,23230.78,100,MS DRG,18584.62,case rate,100% of CMS IPPS rate,5715.41,505146.4,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,49799.65,160,MS DRG,39839.72,case rate,160% of CMS IPPS rate,40462.21,130,MS DRG,32369.77,case rate,130% of CMS IPPS rate,7389.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7758.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,7389.5,100,,,case rate,100% of CMS IPPS rate,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7389.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480139.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,31124.78,100,MS DRG,24899.82,case rate,100% of CMS IPPS rate,7389.5,480139.6,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22893.35,100,MS DRG,18314.68,case rate,100% of CMS IPPS rate,36629.36,160,MS DRG,29303.49,case rate,160% of CMS IPPS rate,29761.36,130,MS DRG,23809.09,case rate,130% of CMS IPPS rate,4733.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4969.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22893.35,100,MS DRG,18314.68,case rate,100% of CMS IPPS rate,4733.29,100,,,case rate,100% of CMS IPPS rate,22893.35,100,MS DRG,18314.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4733.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,790747.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22893.35,100,MS DRG,18314.68,case rate,100% of CMS IPPS rate,22893.35,100,MS DRG,18314.68,case rate,100% of CMS IPPS rate,4733.29,790747.2,
ARTHROSCOPY,509,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22092.27,100,MS DRG,17673.82,case rate,100% of CMS IPPS rate,35347.63,160,MS DRG,28278.1,case rate,160% of CMS IPPS rate,28719.95,130,MS DRG,22975.96,case rate,130% of CMS IPPS rate,6697.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7032.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22092.27,100,MS DRG,17673.82,case rate,100% of CMS IPPS rate,6697.52,100,,,case rate,100% of CMS IPPS rate,22092.27,100,MS DRG,17673.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6697.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520162.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22092.27,100,MS DRG,17673.82,case rate,100% of CMS IPPS rate,22092.27,100,MS DRG,17673.82,case rate,100% of CMS IPPS rate,6697.52,520162.3,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38072.59,100,MS DRG,30458.07,case rate,100% of CMS IPPS rate,60916.14,160,MS DRG,48732.91,case rate,160% of CMS IPPS rate,49494.37,130,MS DRG,39595.5,case rate,130% of CMS IPPS rate,10896.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11441.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38072.59,100,MS DRG,30458.07,case rate,100% of CMS IPPS rate,10896.68,100,,,case rate,100% of CMS IPPS rate,38072.59,100,MS DRG,30458.07,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10896.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,679809.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38072.59,100,MS DRG,30458.07,case rate,100% of CMS IPPS rate,38072.59,100,MS DRG,30458.07,case rate,100% of CMS IPPS rate,10896.68,679809.2,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29497.85,100,MS DRG,23598.28,case rate,100% of CMS IPPS rate,47196.56,160,MS DRG,37757.25,case rate,160% of CMS IPPS rate,38347.21,130,MS DRG,30677.77,case rate,130% of CMS IPPS rate,7477.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7851.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29497.85,100,MS DRG,23598.28,case rate,100% of CMS IPPS rate,7477.19,100,,,case rate,100% of CMS IPPS rate,29497.85,100,MS DRG,23598.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7477.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968232.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29497.85,100,MS DRG,23598.28,case rate,100% of CMS IPPS rate,29497.85,100,MS DRG,23598.28,case rate,100% of CMS IPPS rate,7477.19,968232.4,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25014.62,100,MS DRG,20011.7,case rate,100% of CMS IPPS rate,40023.39,160,MS DRG,32018.71,case rate,160% of CMS IPPS rate,32519.01,130,MS DRG,26015.21,case rate,130% of CMS IPPS rate,6129.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6436.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25014.62,100,MS DRG,20011.7,case rate,100% of CMS IPPS rate,6129.83,100,,,case rate,100% of CMS IPPS rate,25014.62,100,MS DRG,20011.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6129.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1364561.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25014.62,100,MS DRG,20011.7,case rate,100% of CMS IPPS rate,25014.62,100,MS DRG,20011.7,case rate,100% of CMS IPPS rate,6129.83,1364562,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,40159.31,160,MS DRG,32127.45,case rate,160% of CMS IPPS rate,32629.44,130,MS DRG,26103.55,case rate,130% of CMS IPPS rate,5740.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6027.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,5740.19,100,,,case rate,100% of CMS IPPS rate,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5740.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,687511.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,5740.19,687511.9,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18262.66,100,MS DRG,14610.13,case rate,100% of CMS IPPS rate,29220.26,160,MS DRG,23376.21,case rate,160% of CMS IPPS rate,23741.46,130,MS DRG,18993.17,case rate,130% of CMS IPPS rate,3887.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4081.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18262.66,100,MS DRG,14610.13,case rate,100% of CMS IPPS rate,3887.29,100,,,case rate,100% of CMS IPPS rate,18262.66,100,MS DRG,14610.13,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3887.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,736610.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18262.66,100,MS DRG,14610.13,case rate,100% of CMS IPPS rate,18262.66,100,MS DRG,14610.13,case rate,100% of CMS IPPS rate,3887.29,736610.8,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43274.3,100,MS DRG,34619.44,case rate,100% of CMS IPPS rate,69238.88,160,MS DRG,55391.1,case rate,160% of CMS IPPS rate,56256.59,130,MS DRG,45005.27,case rate,130% of CMS IPPS rate,11789.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12379.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43274.3,100,MS DRG,34619.44,case rate,100% of CMS IPPS rate,11789.96,100,,,case rate,100% of CMS IPPS rate,43274.3,100,MS DRG,34619.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11789.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,772588.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43274.3,100,MS DRG,34619.44,case rate,100% of CMS IPPS rate,43274.3,100,MS DRG,34619.44,case rate,100% of CMS IPPS rate,11789.96,772588.5,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30052.34,100,MS DRG,24041.87,case rate,100% of CMS IPPS rate,48083.74,160,MS DRG,38466.99,case rate,160% of CMS IPPS rate,39068.04,130,MS DRG,31254.43,case rate,130% of CMS IPPS rate,7669.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8053.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30052.34,100,MS DRG,24041.87,case rate,100% of CMS IPPS rate,7669.73,100,,,case rate,100% of CMS IPPS rate,30052.34,100,MS DRG,24041.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7669.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,880303.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30052.34,100,MS DRG,24041.87,case rate,100% of CMS IPPS rate,30052.34,100,MS DRG,24041.87,case rate,100% of CMS IPPS rate,7669.73,880303.8,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23605.95,100,MS DRG,18884.76,case rate,100% of CMS IPPS rate,37769.52,160,MS DRG,30215.62,case rate,160% of CMS IPPS rate,30687.74,130,MS DRG,24550.19,case rate,130% of CMS IPPS rate,5691.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5975.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23605.95,100,MS DRG,18884.76,case rate,100% of CMS IPPS rate,5691.01,100,,,case rate,100% of CMS IPPS rate,23605.95,100,MS DRG,18884.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5691.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1336382.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23605.95,100,MS DRG,18884.76,case rate,100% of CMS IPPS rate,23605.95,100,MS DRG,18884.76,case rate,100% of CMS IPPS rate,5691.01,1336383,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49058.83,100,MS DRG,39247.06,case rate,100% of CMS IPPS rate,78494.13,160,MS DRG,62795.3,case rate,160% of CMS IPPS rate,63776.48,130,MS DRG,51021.18,case rate,130% of CMS IPPS rate,13664.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14347.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49058.83,100,MS DRG,39247.06,case rate,100% of CMS IPPS rate,13664.22,100,,,case rate,100% of CMS IPPS rate,49058.83,100,MS DRG,39247.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13664.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2352602.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49058.83,100,MS DRG,39247.06,case rate,100% of CMS IPPS rate,49058.83,100,MS DRG,39247.06,case rate,100% of CMS IPPS rate,13664.22,2352602,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29200.54,100,MS DRG,23360.43,case rate,100% of CMS IPPS rate,46720.86,160,MS DRG,37376.69,case rate,160% of CMS IPPS rate,37960.7,130,MS DRG,30368.56,case rate,130% of CMS IPPS rate,7517.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7893.87,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29200.54,100,MS DRG,23360.43,case rate,100% of CMS IPPS rate,7517.99,100,,,case rate,100% of CMS IPPS rate,29200.54,100,MS DRG,23360.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7517.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,913734.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29200.54,100,MS DRG,23360.43,case rate,100% of CMS IPPS rate,29200.54,100,MS DRG,23360.43,case rate,100% of CMS IPPS rate,7517.99,913734.9,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22863.86,100,MS DRG,18291.09,case rate,100% of CMS IPPS rate,36582.18,160,MS DRG,29265.74,case rate,160% of CMS IPPS rate,29723.02,130,MS DRG,23778.42,case rate,130% of CMS IPPS rate,5464.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5737.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22863.86,100,MS DRG,18291.09,case rate,100% of CMS IPPS rate,5464.16,100,,,case rate,100% of CMS IPPS rate,22863.86,100,MS DRG,18291.09,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5464.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1181048.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22863.86,100,MS DRG,18291.09,case rate,100% of CMS IPPS rate,22863.86,100,MS DRG,18291.09,case rate,100% of CMS IPPS rate,5464.16,1181049,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41300.51,100,MS DRG,33040.41,case rate,100% of CMS IPPS rate,66080.82,160,MS DRG,52864.66,case rate,160% of CMS IPPS rate,53690.66,130,MS DRG,42952.53,case rate,130% of CMS IPPS rate,11112.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11668.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41300.51,100,MS DRG,33040.41,case rate,100% of CMS IPPS rate,11112.47,100,,,case rate,100% of CMS IPPS rate,41300.51,100,MS DRG,33040.41,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11112.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,668387.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41300.51,100,MS DRG,33040.41,case rate,100% of CMS IPPS rate,41300.51,100,MS DRG,33040.41,case rate,100% of CMS IPPS rate,11112.47,668387.5,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30894.71,100,MS DRG,24715.77,case rate,100% of CMS IPPS rate,49431.54,160,MS DRG,39545.23,case rate,160% of CMS IPPS rate,40163.12,130,MS DRG,32130.5,case rate,130% of CMS IPPS rate,8037.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8439.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30894.71,100,MS DRG,24715.77,case rate,100% of CMS IPPS rate,8037.26,100,,,case rate,100% of CMS IPPS rate,30894.71,100,MS DRG,24715.77,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8037.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,644215.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30894.71,100,MS DRG,24715.77,case rate,100% of CMS IPPS rate,30894.71,100,MS DRG,24715.77,case rate,100% of CMS IPPS rate,8037.26,644215.8,
FRACTURES OF FEMUR WITH MCC,533,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25222.27,100,MS DRG,20177.82,case rate,100% of CMS IPPS rate,40355.63,160,MS DRG,32284.5,case rate,160% of CMS IPPS rate,32788.95,130,MS DRG,26231.16,case rate,130% of CMS IPPS rate,5813.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6104.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25222.27,100,MS DRG,20177.82,case rate,100% of CMS IPPS rate,5813.77,100,,,case rate,100% of CMS IPPS rate,25222.27,100,MS DRG,20177.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5813.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401379.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25222.27,100,MS DRG,20177.82,case rate,100% of CMS IPPS rate,25222.27,100,MS DRG,20177.82,case rate,100% of CMS IPPS rate,5813.77,401379.8,
FRACTURES OF FEMUR WITHOUT MCC,534,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15531.45,100,MS DRG,12425.16,case rate,100% of CMS IPPS rate,24850.32,160,MS DRG,19880.26,case rate,160% of CMS IPPS rate,20190.89,130,MS DRG,16152.71,case rate,130% of CMS IPPS rate,3103.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3258.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15531.45,100,MS DRG,12425.16,case rate,100% of CMS IPPS rate,3103.42,100,,,case rate,100% of CMS IPPS rate,15531.45,100,MS DRG,12425.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3103.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,331534.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15531.45,100,MS DRG,12425.16,case rate,100% of CMS IPPS rate,15531.45,100,MS DRG,12425.16,case rate,100% of CMS IPPS rate,3103.42,331534.5,
FRACTURES OF HIP AND PELVIS WITH MCC,535,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21273.51,100,MS DRG,17018.81,case rate,100% of CMS IPPS rate,34037.62,160,MS DRG,27230.1,case rate,160% of CMS IPPS rate,27655.56,130,MS DRG,22124.45,case rate,130% of CMS IPPS rate,5070.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5323.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21273.51,100,MS DRG,17018.81,case rate,100% of CMS IPPS rate,5070.32,100,,,case rate,100% of CMS IPPS rate,21273.51,100,MS DRG,17018.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5070.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,398769.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21273.51,100,MS DRG,17018.81,case rate,100% of CMS IPPS rate,21273.51,100,MS DRG,17018.81,case rate,100% of CMS IPPS rate,5070.32,398769.9,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15261.27,100,MS DRG,12209.02,case rate,100% of CMS IPPS rate,24418.03,160,MS DRG,19534.42,case rate,160% of CMS IPPS rate,19839.65,130,MS DRG,15871.72,case rate,130% of CMS IPPS rate,3091.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3246.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15261.27,100,MS DRG,12209.02,case rate,100% of CMS IPPS rate,3091.6,100,,,case rate,100% of CMS IPPS rate,15261.27,100,MS DRG,12209.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3091.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289581.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15261.27,100,MS DRG,12209.02,case rate,100% of CMS IPPS rate,15261.27,100,MS DRG,12209.02,case rate,100% of CMS IPPS rate,3091.6,289581.3,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17383.73,100,MS DRG,13906.98,case rate,100% of CMS IPPS rate,27813.97,160,MS DRG,22251.18,case rate,160% of CMS IPPS rate,22598.85,130,MS DRG,18079.08,case rate,130% of CMS IPPS rate,3503.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3678.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17383.73,100,MS DRG,13906.98,case rate,100% of CMS IPPS rate,3503.74,100,,,case rate,100% of CMS IPPS rate,17383.73,100,MS DRG,13906.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3503.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,386612.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17383.73,100,MS DRG,13906.98,case rate,100% of CMS IPPS rate,17383.73,100,MS DRG,13906.98,case rate,100% of CMS IPPS rate,3503.74,386612.6,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14341.03,100,MS DRG,11472.82,case rate,100% of CMS IPPS rate,22945.65,160,MS DRG,18356.52,case rate,160% of CMS IPPS rate,18643.34,130,MS DRG,14914.67,case rate,130% of CMS IPPS rate,2560.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2688.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14341.03,100,MS DRG,11472.82,case rate,100% of CMS IPPS rate,2560.13,100,,,case rate,100% of CMS IPPS rate,14341.03,100,MS DRG,11472.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2560.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419991.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14341.03,100,MS DRG,11472.82,case rate,100% of CMS IPPS rate,14341.03,100,MS DRG,11472.82,case rate,100% of CMS IPPS rate,2560.13,419991.6,
OSTEOMYELITIS WITH MCC,539,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29386.94,100,MS DRG,23509.55,case rate,100% of CMS IPPS rate,47019.1,160,MS DRG,37615.28,case rate,160% of CMS IPPS rate,38203.02,130,MS DRG,30562.42,case rate,130% of CMS IPPS rate,7710.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8096.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29386.94,100,MS DRG,23509.55,case rate,100% of CMS IPPS rate,7710.52,100,,,case rate,100% of CMS IPPS rate,29386.94,100,MS DRG,23509.55,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7710.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,291772.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29386.94,100,MS DRG,23509.55,case rate,100% of CMS IPPS rate,29386.94,100,MS DRG,23509.55,case rate,100% of CMS IPPS rate,7710.52,291772.3,
OSTEOMYELITIS WITH CC,540,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21291.19,100,MS DRG,17032.95,case rate,100% of CMS IPPS rate,34065.9,160,MS DRG,27252.72,case rate,160% of CMS IPPS rate,27678.55,130,MS DRG,22142.84,case rate,130% of CMS IPPS rate,4933.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5180.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21291.19,100,MS DRG,17032.95,case rate,100% of CMS IPPS rate,4933.83,100,,,case rate,100% of CMS IPPS rate,21291.19,100,MS DRG,17032.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4933.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,322406.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21291.19,100,MS DRG,17032.95,case rate,100% of CMS IPPS rate,21291.19,100,MS DRG,17032.95,case rate,100% of CMS IPPS rate,4933.83,322406.7,
OSTEOMYELITIS WITHOUT CC/MCC,541,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16096.56,100,MS DRG,12877.25,case rate,100% of CMS IPPS rate,25754.5,160,MS DRG,20603.6,case rate,160% of CMS IPPS rate,20925.53,130,MS DRG,16740.42,case rate,130% of CMS IPPS rate,3335.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3502.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16096.56,100,MS DRG,12877.25,case rate,100% of CMS IPPS rate,3335.61,100,,,case rate,100% of CMS IPPS rate,16096.56,100,MS DRG,12877.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3335.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,291722.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16096.56,100,MS DRG,12877.25,case rate,100% of CMS IPPS rate,16096.56,100,MS DRG,12877.25,case rate,100% of CMS IPPS rate,3335.61,291722.9,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27491.01,100,MS DRG,21992.81,case rate,100% of CMS IPPS rate,43985.62,160,MS DRG,35188.5,case rate,160% of CMS IPPS rate,35738.31,130,MS DRG,28590.65,case rate,130% of CMS IPPS rate,7110.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7466.33,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27491.01,100,MS DRG,21992.81,case rate,100% of CMS IPPS rate,7110.81,100,,,case rate,100% of CMS IPPS rate,27491.01,100,MS DRG,21992.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7110.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413641.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27491.01,100,MS DRG,21992.81,case rate,100% of CMS IPPS rate,27491.01,100,MS DRG,21992.81,case rate,100% of CMS IPPS rate,7110.81,413641.8,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18843.12,100,MS DRG,15074.5,case rate,100% of CMS IPPS rate,30148.99,160,MS DRG,24119.19,case rate,160% of CMS IPPS rate,24496.06,130,MS DRG,19596.85,case rate,130% of CMS IPPS rate,4044.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4246.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18843.12,100,MS DRG,15074.5,case rate,100% of CMS IPPS rate,4044.74,100,,,case rate,100% of CMS IPPS rate,18843.12,100,MS DRG,15074.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4044.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401358.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18843.12,100,MS DRG,15074.5,case rate,100% of CMS IPPS rate,18843.12,100,MS DRG,15074.5,case rate,100% of CMS IPPS rate,4044.74,401358.7,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15030.04,100,MS DRG,12024.03,case rate,100% of CMS IPPS rate,24048.06,160,MS DRG,19238.45,case rate,160% of CMS IPPS rate,19539.05,130,MS DRG,15631.24,case rate,130% of CMS IPPS rate,2881.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3025.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15030.04,100,MS DRG,12024.03,case rate,100% of CMS IPPS rate,2881.15,100,,,case rate,100% of CMS IPPS rate,15030.04,100,MS DRG,12024.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2881.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455723.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15030.04,100,MS DRG,12024.03,case rate,100% of CMS IPPS rate,15030.04,100,MS DRG,12024.03,case rate,100% of CMS IPPS rate,2881.15,455723.1,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35389.73,100,MS DRG,28311.78,case rate,100% of CMS IPPS rate,56623.57,160,MS DRG,45298.86,case rate,160% of CMS IPPS rate,46006.65,130,MS DRG,36805.32,case rate,130% of CMS IPPS rate,9633.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10115.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35389.73,100,MS DRG,28311.78,case rate,100% of CMS IPPS rate,9633.96,100,,,case rate,100% of CMS IPPS rate,35389.73,100,MS DRG,28311.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9633.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,465945.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35389.73,100,MS DRG,28311.78,case rate,100% of CMS IPPS rate,35389.73,100,MS DRG,28311.78,case rate,100% of CMS IPPS rate,9633.96,465946,
CONNECTIVE TISSUE DISORDERS WITH CC,546,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20124.39,100,MS DRG,16099.51,case rate,100% of CMS IPPS rate,32199.02,160,MS DRG,25759.22,case rate,160% of CMS IPPS rate,26161.71,130,MS DRG,20929.37,case rate,130% of CMS IPPS rate,4413.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4634.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20124.39,100,MS DRG,16099.51,case rate,100% of CMS IPPS rate,4413.8,100,,,case rate,100% of CMS IPPS rate,20124.39,100,MS DRG,16099.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4413.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376713.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20124.39,100,MS DRG,16099.51,case rate,100% of CMS IPPS rate,20124.39,100,MS DRG,16099.51,case rate,100% of CMS IPPS rate,4413.8,376713.8,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15688.35,100,MS DRG,12550.68,case rate,100% of CMS IPPS rate,25101.36,160,MS DRG,20081.09,case rate,160% of CMS IPPS rate,20394.86,130,MS DRG,16315.89,case rate,130% of CMS IPPS rate,2844.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2987.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15688.35,100,MS DRG,12550.68,case rate,100% of CMS IPPS rate,2844.93,100,,,case rate,100% of CMS IPPS rate,15688.35,100,MS DRG,12550.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2844.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393758.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15688.35,100,MS DRG,12550.68,case rate,100% of CMS IPPS rate,15688.35,100,MS DRG,12550.68,case rate,100% of CMS IPPS rate,2844.93,393759,
SEPTIC ARTHRITIS WITH MCC,548,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28978.74,100,MS DRG,23182.99,case rate,100% of CMS IPPS rate,46365.98,160,MS DRG,37092.78,case rate,160% of CMS IPPS rate,37672.36,130,MS DRG,30137.89,case rate,130% of CMS IPPS rate,7680.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8064.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28978.74,100,MS DRG,23182.99,case rate,100% of CMS IPPS rate,7680.78,100,,,case rate,100% of CMS IPPS rate,28978.74,100,MS DRG,23182.99,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7680.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,371203.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28978.74,100,MS DRG,23182.99,case rate,100% of CMS IPPS rate,28978.74,100,MS DRG,23182.99,case rate,100% of CMS IPPS rate,7680.78,371204,
SEPTIC ARTHRITIS WITH CC,549,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20205.78,100,MS DRG,16164.62,case rate,100% of CMS IPPS rate,32329.25,160,MS DRG,25863.4,case rate,160% of CMS IPPS rate,26267.51,130,MS DRG,21014.01,case rate,130% of CMS IPPS rate,4594.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4824.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20205.78,100,MS DRG,16164.62,case rate,100% of CMS IPPS rate,4594.52,100,,,case rate,100% of CMS IPPS rate,20205.78,100,MS DRG,16164.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4594.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293903.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20205.78,100,MS DRG,16164.62,case rate,100% of CMS IPPS rate,20205.78,100,MS DRG,16164.62,case rate,100% of CMS IPPS rate,4594.52,293903.4,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17106.47,100,MS DRG,13685.18,case rate,100% of CMS IPPS rate,27370.35,160,MS DRG,21896.28,case rate,160% of CMS IPPS rate,22238.41,130,MS DRG,17790.73,case rate,130% of CMS IPPS rate,3286.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3451.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17106.47,100,MS DRG,13685.18,case rate,100% of CMS IPPS rate,3286.81,100,,,case rate,100% of CMS IPPS rate,17106.47,100,MS DRG,13685.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3286.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307416.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17106.47,100,MS DRG,13685.18,case rate,100% of CMS IPPS rate,17106.47,100,MS DRG,13685.18,case rate,100% of CMS IPPS rate,3286.81,307416.2,
MEDICAL BACK PROBLEMS WITH MCC,551,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26054.03,100,MS DRG,20843.22,case rate,100% of CMS IPPS rate,41686.45,160,MS DRG,33349.16,case rate,160% of CMS IPPS rate,33870.24,130,MS DRG,27096.19,case rate,130% of CMS IPPS rate,6505.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6831.03,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26054.03,100,MS DRG,20843.22,case rate,100% of CMS IPPS rate,6505.75,100,,,case rate,100% of CMS IPPS rate,26054.03,100,MS DRG,20843.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6505.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,407208.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26054.03,100,MS DRG,20843.22,case rate,100% of CMS IPPS rate,26054.03,100,MS DRG,20843.22,case rate,100% of CMS IPPS rate,6505.75,407208.7,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17375.46,100,MS DRG,13900.37,case rate,100% of CMS IPPS rate,27800.74,160,MS DRG,22240.59,case rate,160% of CMS IPPS rate,22588.1,130,MS DRG,18070.48,case rate,130% of CMS IPPS rate,3674.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3858.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17375.46,100,MS DRG,13900.37,case rate,100% of CMS IPPS rate,3674.55,100,,,case rate,100% of CMS IPPS rate,17375.46,100,MS DRG,13900.37,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3674.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400772.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17375.46,100,MS DRG,13900.37,case rate,100% of CMS IPPS rate,17375.46,100,MS DRG,13900.37,case rate,100% of CMS IPPS rate,3674.55,400772.7,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21920.02,100,MS DRG,17536.02,case rate,100% of CMS IPPS rate,35072.03,160,MS DRG,28057.62,case rate,160% of CMS IPPS rate,28496.03,130,MS DRG,22796.82,case rate,130% of CMS IPPS rate,4979.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5228.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21920.02,100,MS DRG,17536.02,case rate,100% of CMS IPPS rate,4979.2,100,,,case rate,100% of CMS IPPS rate,21920.02,100,MS DRG,17536.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4979.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379182.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21920.02,100,MS DRG,17536.02,case rate,100% of CMS IPPS rate,21920.02,100,MS DRG,17536.02,case rate,100% of CMS IPPS rate,4979.2,379182.9,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15670.65,100,MS DRG,12536.52,case rate,100% of CMS IPPS rate,25073.04,160,MS DRG,20058.43,case rate,160% of CMS IPPS rate,20371.85,130,MS DRG,16297.48,case rate,130% of CMS IPPS rate,3181.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3341.05,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15670.65,100,MS DRG,12536.52,case rate,100% of CMS IPPS rate,3181.96,100,,,case rate,100% of CMS IPPS rate,15670.65,100,MS DRG,12536.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3181.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271428.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15670.65,100,MS DRG,12536.52,case rate,100% of CMS IPPS rate,15670.65,100,MS DRG,12536.52,case rate,100% of CMS IPPS rate,3181.96,271428.4,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22480.43,100,MS DRG,17984.34,case rate,100% of CMS IPPS rate,35968.69,160,MS DRG,28774.95,case rate,160% of CMS IPPS rate,29224.56,130,MS DRG,23379.65,case rate,130% of CMS IPPS rate,5133.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5390.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22480.43,100,MS DRG,17984.34,case rate,100% of CMS IPPS rate,5133.99,100,,,case rate,100% of CMS IPPS rate,22480.43,100,MS DRG,17984.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5133.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404268.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22480.43,100,MS DRG,17984.34,case rate,100% of CMS IPPS rate,22480.43,100,MS DRG,17984.34,case rate,100% of CMS IPPS rate,5133.99,404268.8,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15701.33,100,MS DRG,12561.06,case rate,100% of CMS IPPS rate,25122.13,160,MS DRG,20097.7,case rate,160% of CMS IPPS rate,20411.73,130,MS DRG,16329.38,case rate,130% of CMS IPPS rate,3112.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3268.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15701.33,100,MS DRG,12561.06,case rate,100% of CMS IPPS rate,3112.96,100,,,case rate,100% of CMS IPPS rate,15701.33,100,MS DRG,12561.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3112.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384461.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15701.33,100,MS DRG,12561.06,case rate,100% of CMS IPPS rate,15701.33,100,MS DRG,12561.06,case rate,100% of CMS IPPS rate,3112.96,384461.9,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24342.15,100,MS DRG,19473.72,case rate,100% of CMS IPPS rate,38947.44,160,MS DRG,31157.95,case rate,160% of CMS IPPS rate,31644.8,130,MS DRG,25315.84,case rate,130% of CMS IPPS rate,5908.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6203.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24342.15,100,MS DRG,19473.72,case rate,100% of CMS IPPS rate,5908.32,100,,,case rate,100% of CMS IPPS rate,24342.15,100,MS DRG,19473.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5908.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248188.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24342.15,100,MS DRG,19473.72,case rate,100% of CMS IPPS rate,24342.15,100,MS DRG,19473.72,case rate,100% of CMS IPPS rate,5908.32,248188.8,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16338.41,100,MS DRG,13070.73,case rate,100% of CMS IPPS rate,26141.46,160,MS DRG,20913.17,case rate,160% of CMS IPPS rate,21239.93,130,MS DRG,16991.94,case rate,130% of CMS IPPS rate,3293.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3457.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16338.41,100,MS DRG,13070.73,case rate,100% of CMS IPPS rate,3293.29,100,,,case rate,100% of CMS IPPS rate,16338.41,100,MS DRG,13070.73,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3293.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228735.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16338.41,100,MS DRG,13070.73,case rate,100% of CMS IPPS rate,16338.41,100,MS DRG,13070.73,case rate,100% of CMS IPPS rate,3293.29,228735.6,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27807.2,100,MS DRG,22245.76,case rate,100% of CMS IPPS rate,44491.52,160,MS DRG,35593.22,case rate,160% of CMS IPPS rate,36149.36,130,MS DRG,28919.49,case rate,130% of CMS IPPS rate,7077.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7431.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27807.2,100,MS DRG,22245.76,case rate,100% of CMS IPPS rate,7077.26,100,,,case rate,100% of CMS IPPS rate,27807.2,100,MS DRG,22245.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7077.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249060.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27807.2,100,MS DRG,22245.76,case rate,100% of CMS IPPS rate,27807.2,100,MS DRG,22245.76,case rate,100% of CMS IPPS rate,7077.26,249060.4,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19331.56,100,MS DRG,15465.25,case rate,100% of CMS IPPS rate,30930.5,160,MS DRG,24744.4,case rate,160% of CMS IPPS rate,25131.03,130,MS DRG,20104.82,case rate,130% of CMS IPPS rate,4341.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4558.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19331.56,100,MS DRG,15465.25,case rate,100% of CMS IPPS rate,4341.36,100,,,case rate,100% of CMS IPPS rate,19331.56,100,MS DRG,15465.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4341.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236084.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19331.56,100,MS DRG,15465.25,case rate,100% of CMS IPPS rate,19331.56,100,MS DRG,15465.25,case rate,100% of CMS IPPS rate,4341.36,236084.2,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15179.87,100,MS DRG,12143.9,case rate,100% of CMS IPPS rate,24287.79,160,MS DRG,19430.23,case rate,160% of CMS IPPS rate,19733.83,130,MS DRG,15787.06,case rate,130% of CMS IPPS rate,3117.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3273,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15179.87,100,MS DRG,12143.9,case rate,100% of CMS IPPS rate,3117.15,100,,,case rate,100% of CMS IPPS rate,15179.87,100,MS DRG,12143.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3117.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189050.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15179.87,100,MS DRG,12143.9,case rate,100% of CMS IPPS rate,15179.87,100,MS DRG,12143.9,case rate,100% of CMS IPPS rate,3117.15,189050.2,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23916.24,100,MS DRG,19132.99,case rate,100% of CMS IPPS rate,38265.98,160,MS DRG,30612.78,case rate,160% of CMS IPPS rate,31091.11,130,MS DRG,24872.89,case rate,130% of CMS IPPS rate,5579.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5858.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23916.24,100,MS DRG,19132.99,case rate,100% of CMS IPPS rate,5579.68,100,,,case rate,100% of CMS IPPS rate,23916.24,100,MS DRG,19132.99,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5579.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227458.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23916.24,100,MS DRG,19132.99,case rate,100% of CMS IPPS rate,23916.24,100,MS DRG,19132.99,case rate,100% of CMS IPPS rate,5579.68,227458.2,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16541.36,100,MS DRG,13233.09,case rate,100% of CMS IPPS rate,26466.18,160,MS DRG,21172.94,case rate,160% of CMS IPPS rate,21503.77,130,MS DRG,17203.02,case rate,130% of CMS IPPS rate,3407.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3578.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16541.36,100,MS DRG,13233.09,case rate,100% of CMS IPPS rate,3407.67,100,,,case rate,100% of CMS IPPS rate,16541.36,100,MS DRG,13233.09,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3407.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,399126.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16541.36,100,MS DRG,13233.09,case rate,100% of CMS IPPS rate,16541.36,100,MS DRG,13233.09,case rate,100% of CMS IPPS rate,3407.67,399126.1,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24402.32,100,MS DRG,19521.86,case rate,100% of CMS IPPS rate,39043.71,160,MS DRG,31234.97,case rate,160% of CMS IPPS rate,31723.02,130,MS DRG,25378.42,case rate,130% of CMS IPPS rate,5982.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6281.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24402.32,100,MS DRG,19521.86,case rate,100% of CMS IPPS rate,5982.67,100,,,case rate,100% of CMS IPPS rate,24402.32,100,MS DRG,19521.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5982.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,418912.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24402.32,100,MS DRG,19521.86,case rate,100% of CMS IPPS rate,24402.32,100,MS DRG,19521.86,case rate,100% of CMS IPPS rate,5982.67,418912.1,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17765.98,100,MS DRG,14212.78,case rate,100% of CMS IPPS rate,28425.57,160,MS DRG,22740.46,case rate,160% of CMS IPPS rate,23095.77,130,MS DRG,18476.62,case rate,130% of CMS IPPS rate,3887.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4082.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17765.98,100,MS DRG,14212.78,case rate,100% of CMS IPPS rate,3887.67,100,,,case rate,100% of CMS IPPS rate,17765.98,100,MS DRG,14212.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3887.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308100.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17765.98,100,MS DRG,14212.78,case rate,100% of CMS IPPS rate,17765.98,100,MS DRG,14212.78,case rate,100% of CMS IPPS rate,3887.67,308100.3,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14829.47,100,MS DRG,11863.58,case rate,100% of CMS IPPS rate,23727.15,160,MS DRG,18981.72,case rate,160% of CMS IPPS rate,19278.31,130,MS DRG,15422.65,case rate,130% of CMS IPPS rate,2852.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2994.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14829.47,100,MS DRG,11863.58,case rate,100% of CMS IPPS rate,2852.18,100,,,case rate,100% of CMS IPPS rate,14829.47,100,MS DRG,11863.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2852.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357614.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14829.47,100,MS DRG,11863.58,case rate,100% of CMS IPPS rate,14829.47,100,MS DRG,11863.58,case rate,100% of CMS IPPS rate,2852.18,357614.5,
SKIN DEBRIDEMENT WITH MCC,570,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40451.05,100,MS DRG,32360.84,case rate,100% of CMS IPPS rate,64721.68,160,MS DRG,51777.34,case rate,160% of CMS IPPS rate,52586.37,130,MS DRG,42069.1,case rate,130% of CMS IPPS rate,11476.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12050.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40451.05,100,MS DRG,32360.84,case rate,100% of CMS IPPS rate,11476.57,100,,,case rate,100% of CMS IPPS rate,40451.05,100,MS DRG,32360.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11476.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436734.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40451.05,100,MS DRG,32360.84,case rate,100% of CMS IPPS rate,40451.05,100,MS DRG,32360.84,case rate,100% of CMS IPPS rate,11476.57,436734.9,
SKIN DEBRIDEMENT WITH CC,571,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25936.04,100,MS DRG,20748.83,case rate,100% of CMS IPPS rate,41497.66,160,MS DRG,33198.13,case rate,160% of CMS IPPS rate,33716.85,130,MS DRG,26973.48,case rate,130% of CMS IPPS rate,6383.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6702.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25936.04,100,MS DRG,20748.83,case rate,100% of CMS IPPS rate,6383.37,100,,,case rate,100% of CMS IPPS rate,25936.04,100,MS DRG,20748.83,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6383.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450872.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25936.04,100,MS DRG,20748.83,case rate,100% of CMS IPPS rate,25936.04,100,MS DRG,20748.83,case rate,100% of CMS IPPS rate,6383.37,450873,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19420.04,100,MS DRG,15536.03,case rate,100% of CMS IPPS rate,31072.06,160,MS DRG,24857.65,case rate,160% of CMS IPPS rate,25246.05,130,MS DRG,20196.84,case rate,130% of CMS IPPS rate,4355.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4573.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19420.04,100,MS DRG,15536.03,case rate,100% of CMS IPPS rate,4355.47,100,,,case rate,100% of CMS IPPS rate,19420.04,100,MS DRG,15536.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4355.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624448.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19420.04,100,MS DRG,15536.03,case rate,100% of CMS IPPS rate,19420.04,100,MS DRG,15536.03,case rate,100% of CMS IPPS rate,4355.47,624448.6,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79335.88,100,MS DRG,63468.7,case rate,100% of CMS IPPS rate,126937.41,160,MS DRG,101549.93,case rate,160% of CMS IPPS rate,103136.64,130,MS DRG,82509.31,case rate,130% of CMS IPPS rate,23478.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24652.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,79335.88,100,MS DRG,63468.7,case rate,100% of CMS IPPS rate,23478.51,100,,,case rate,100% of CMS IPPS rate,79335.88,100,MS DRG,63468.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23478.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564992.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,79335.88,100,MS DRG,63468.7,case rate,100% of CMS IPPS rate,79335.88,100,MS DRG,63468.7,case rate,100% of CMS IPPS rate,23478.51,564992.9,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46156.54,100,MS DRG,36925.23,case rate,100% of CMS IPPS rate,73850.46,160,MS DRG,59080.37,case rate,160% of CMS IPPS rate,60003.5,130,MS DRG,48002.8,case rate,130% of CMS IPPS rate,13210.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13870.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46156.54,100,MS DRG,36925.23,case rate,100% of CMS IPPS rate,13210.14,100,,,case rate,100% of CMS IPPS rate,46156.54,100,MS DRG,36925.23,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13210.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315327.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46156.54,100,MS DRG,36925.23,case rate,100% of CMS IPPS rate,46156.54,100,MS DRG,36925.23,case rate,100% of CMS IPPS rate,13210.14,315327.5,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30113.7,100,MS DRG,24090.96,case rate,100% of CMS IPPS rate,48181.92,160,MS DRG,38545.54,case rate,160% of CMS IPPS rate,39147.81,130,MS DRG,31318.25,case rate,130% of CMS IPPS rate,7612.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7993.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30113.7,100,MS DRG,24090.96,case rate,100% of CMS IPPS rate,7612.54,100,,,case rate,100% of CMS IPPS rate,30113.7,100,MS DRG,24090.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7612.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574031.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30113.7,100,MS DRG,24090.96,case rate,100% of CMS IPPS rate,30113.7,100,MS DRG,24090.96,case rate,100% of CMS IPPS rate,7612.54,574031.6,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73023.99,100,MS DRG,58419.19,case rate,100% of CMS IPPS rate,116838.38,160,MS DRG,93470.7,case rate,160% of CMS IPPS rate,94931.19,130,MS DRG,75944.95,case rate,130% of CMS IPPS rate,20569.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21598.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,73023.99,100,MS DRG,58419.19,case rate,100% of CMS IPPS rate,20569.9,100,,,case rate,100% of CMS IPPS rate,73023.99,100,MS DRG,58419.19,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20569.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,618247.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,73023.99,100,MS DRG,58419.19,case rate,100% of CMS IPPS rate,73023.99,100,MS DRG,58419.19,case rate,100% of CMS IPPS rate,20569.9,618247.7,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37229.03,100,MS DRG,29783.22,case rate,100% of CMS IPPS rate,59566.45,160,MS DRG,47653.16,case rate,160% of CMS IPPS rate,48397.74,130,MS DRG,38718.19,case rate,130% of CMS IPPS rate,10152.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10659.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37229.03,100,MS DRG,29783.22,case rate,100% of CMS IPPS rate,10152.08,100,,,case rate,100% of CMS IPPS rate,37229.03,100,MS DRG,29783.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10152.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,901879.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37229.03,100,MS DRG,29783.22,case rate,100% of CMS IPPS rate,37229.03,100,MS DRG,29783.22,case rate,100% of CMS IPPS rate,10152.08,901880,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24975.7,100,MS DRG,19980.56,case rate,100% of CMS IPPS rate,39961.12,160,MS DRG,31968.9,case rate,160% of CMS IPPS rate,32468.41,130,MS DRG,25974.73,case rate,130% of CMS IPPS rate,6444.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6766.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24975.7,100,MS DRG,19980.56,case rate,100% of CMS IPPS rate,6444.75,100,,,case rate,100% of CMS IPPS rate,24975.7,100,MS DRG,19980.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6444.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,757766.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24975.7,100,MS DRG,19980.56,case rate,100% of CMS IPPS rate,24975.7,100,MS DRG,19980.56,case rate,100% of CMS IPPS rate,6444.75,757766,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45406.19,100,MS DRG,36324.95,case rate,100% of CMS IPPS rate,72649.9,160,MS DRG,58119.92,case rate,160% of CMS IPPS rate,59028.05,130,MS DRG,47222.44,case rate,130% of CMS IPPS rate,12426.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13047.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45406.19,100,MS DRG,36324.95,case rate,100% of CMS IPPS rate,12426.66,100,,,case rate,100% of CMS IPPS rate,45406.19,100,MS DRG,36324.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12426.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,499504.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45406.19,100,MS DRG,36324.95,case rate,100% of CMS IPPS rate,45406.19,100,MS DRG,36324.95,case rate,100% of CMS IPPS rate,12426.66,499504.4,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26581.39,100,MS DRG,21265.11,case rate,100% of CMS IPPS rate,42530.22,160,MS DRG,34024.18,case rate,160% of CMS IPPS rate,34555.81,130,MS DRG,27644.65,case rate,130% of CMS IPPS rate,6759.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7097.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26581.39,100,MS DRG,21265.11,case rate,100% of CMS IPPS rate,6759.67,100,,,case rate,100% of CMS IPPS rate,26581.39,100,MS DRG,21265.11,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6759.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,868990.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26581.39,100,MS DRG,21265.11,case rate,100% of CMS IPPS rate,26581.39,100,MS DRG,21265.11,case rate,100% of CMS IPPS rate,6759.67,868990.8,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21863.4,100,MS DRG,17490.72,case rate,100% of CMS IPPS rate,34981.44,160,MS DRG,27985.15,case rate,160% of CMS IPPS rate,28422.42,130,MS DRG,22737.94,case rate,130% of CMS IPPS rate,5487.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5761.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21863.4,100,MS DRG,17490.72,case rate,100% of CMS IPPS rate,5487.04,100,,,case rate,100% of CMS IPPS rate,21863.4,100,MS DRG,17490.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5487.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1380193.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21863.4,100,MS DRG,17490.72,case rate,100% of CMS IPPS rate,21863.4,100,MS DRG,17490.72,case rate,100% of CMS IPPS rate,5487.04,1380193,
MASTECTOMY FOR MALIGNANCY WITH CC/MCC,582,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26518.87,100,MS DRG,21215.1,case rate,100% of CMS IPPS rate,42430.19,160,MS DRG,33944.15,case rate,160% of CMS IPPS rate,34474.53,130,MS DRG,27579.62,case rate,130% of CMS IPPS rate,6676.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7010.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26518.87,100,MS DRG,21215.1,case rate,100% of CMS IPPS rate,6676.56,100,,,case rate,100% of CMS IPPS rate,26518.87,100,MS DRG,21215.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6676.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2051140.67,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26518.87,100,MS DRG,21215.1,case rate,100% of CMS IPPS rate,26518.87,100,MS DRG,21215.1,case rate,100% of CMS IPPS rate,6676.56,2051141,
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,583,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23930.39,100,MS DRG,19144.31,case rate,100% of CMS IPPS rate,38288.62,160,MS DRG,30630.9,case rate,160% of CMS IPPS rate,31109.51,130,MS DRG,24887.61,case rate,130% of CMS IPPS rate,6262.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6576.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23930.39,100,MS DRG,19144.31,case rate,100% of CMS IPPS rate,6262.89,100,,,case rate,100% of CMS IPPS rate,23930.39,100,MS DRG,19144.31,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6262.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1850910.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23930.39,100,MS DRG,19144.31,case rate,100% of CMS IPPS rate,23930.39,100,MS DRG,19144.31,case rate,100% of CMS IPPS rate,6262.89,1850910,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29082.56,100,MS DRG,23266.05,case rate,100% of CMS IPPS rate,46532.1,160,MS DRG,37225.68,case rate,160% of CMS IPPS rate,37807.33,130,MS DRG,30245.86,case rate,130% of CMS IPPS rate,7805.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8196.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29082.56,100,MS DRG,23266.05,case rate,100% of CMS IPPS rate,7805.84,100,,,case rate,100% of CMS IPPS rate,29082.56,100,MS DRG,23266.05,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7805.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1940146.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29082.56,100,MS DRG,23266.05,case rate,100% of CMS IPPS rate,29082.56,100,MS DRG,23266.05,case rate,100% of CMS IPPS rate,7805.84,1940147,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25842.84,100,MS DRG,20674.27,case rate,100% of CMS IPPS rate,41348.54,160,MS DRG,33078.83,case rate,160% of CMS IPPS rate,33595.69,130,MS DRG,26876.55,case rate,130% of CMS IPPS rate,7568.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7946.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25842.84,100,MS DRG,20674.27,case rate,100% of CMS IPPS rate,7568.31,100,,,case rate,100% of CMS IPPS rate,25842.84,100,MS DRG,20674.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7568.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1580969.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25842.84,100,MS DRG,20674.27,case rate,100% of CMS IPPS rate,25842.84,100,MS DRG,20674.27,case rate,100% of CMS IPPS rate,7568.31,1580970,
SKIN ULCERS WITH MCC,592,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30633.99,100,MS DRG,24507.19,case rate,100% of CMS IPPS rate,49014.38,160,MS DRG,39211.5,case rate,160% of CMS IPPS rate,39824.19,130,MS DRG,31859.35,case rate,130% of CMS IPPS rate,7839.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8231.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30633.99,100,MS DRG,24507.19,case rate,100% of CMS IPPS rate,7839.77,100,,,case rate,100% of CMS IPPS rate,30633.99,100,MS DRG,24507.19,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7839.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384187.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30633.99,100,MS DRG,24507.19,case rate,100% of CMS IPPS rate,30633.99,100,MS DRG,24507.19,case rate,100% of CMS IPPS rate,7839.77,384187.4,
SKIN ULCERS WITH CC,593,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20249.45,100,MS DRG,16199.56,case rate,100% of CMS IPPS rate,32399.12,160,MS DRG,25919.3,case rate,160% of CMS IPPS rate,26324.29,130,MS DRG,21059.43,case rate,130% of CMS IPPS rate,4661.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4894.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20249.45,100,MS DRG,16199.56,case rate,100% of CMS IPPS rate,4661.62,100,,,case rate,100% of CMS IPPS rate,20249.45,100,MS DRG,16199.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4661.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,339449.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20249.45,100,MS DRG,16199.56,case rate,100% of CMS IPPS rate,20249.45,100,MS DRG,16199.56,case rate,100% of CMS IPPS rate,4661.62,339449.8,
SKIN ULCERS WITHOUT CC/MCC,594,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15264.81,100,MS DRG,12211.85,case rate,100% of CMS IPPS rate,24423.7,160,MS DRG,19538.96,case rate,160% of CMS IPPS rate,19844.25,130,MS DRG,15875.4,case rate,130% of CMS IPPS rate,3235.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3397.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15264.81,100,MS DRG,12211.85,case rate,100% of CMS IPPS rate,3235.72,100,,,case rate,100% of CMS IPPS rate,15264.81,100,MS DRG,12211.85,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3235.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,322865.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15264.81,100,MS DRG,12211.85,case rate,100% of CMS IPPS rate,15264.81,100,MS DRG,12211.85,case rate,100% of CMS IPPS rate,3235.72,322865.2,
MAJOR SKIN DISORDERS WITH MCC,595,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31635.63,100,MS DRG,25308.5,case rate,100% of CMS IPPS rate,50617.01,160,MS DRG,40493.61,case rate,160% of CMS IPPS rate,41126.32,130,MS DRG,32901.06,case rate,130% of CMS IPPS rate,8063.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8467.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31635.63,100,MS DRG,25308.5,case rate,100% of CMS IPPS rate,8063.95,100,,,case rate,100% of CMS IPPS rate,31635.63,100,MS DRG,25308.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8063.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,434786.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31635.63,100,MS DRG,25308.5,case rate,100% of CMS IPPS rate,31635.63,100,MS DRG,25308.5,case rate,100% of CMS IPPS rate,8063.95,434786.1,
MAJOR SKIN DISORDERS WITHOUT MCC,596,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17879.23,100,MS DRG,14303.38,case rate,100% of CMS IPPS rate,28606.77,160,MS DRG,22885.42,case rate,160% of CMS IPPS rate,23243,130,MS DRG,18594.4,case rate,130% of CMS IPPS rate,4121.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4327.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17879.23,100,MS DRG,14303.38,case rate,100% of CMS IPPS rate,4121.76,100,,,case rate,100% of CMS IPPS rate,17879.23,100,MS DRG,14303.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4121.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301194.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17879.23,100,MS DRG,14303.38,case rate,100% of CMS IPPS rate,17879.23,100,MS DRG,14303.38,case rate,100% of CMS IPPS rate,4121.76,301194.2,
MALIGNANT BREAST DISORDERS WITH MCC,597,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24857.72,100,MS DRG,19886.18,case rate,100% of CMS IPPS rate,39772.35,160,MS DRG,31817.88,case rate,160% of CMS IPPS rate,32315.04,130,MS DRG,25852.03,case rate,130% of CMS IPPS rate,6697.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7032.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24857.72,100,MS DRG,19886.18,case rate,100% of CMS IPPS rate,6697.52,100,,,case rate,100% of CMS IPPS rate,24857.72,100,MS DRG,19886.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6697.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383728.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24857.72,100,MS DRG,19886.18,case rate,100% of CMS IPPS rate,24857.72,100,MS DRG,19886.18,case rate,100% of CMS IPPS rate,6697.52,383728.1,
MALIGNANT BREAST DISORDERS WITH CC,598,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20118.48,100,MS DRG,16094.78,case rate,100% of CMS IPPS rate,32189.57,160,MS DRG,25751.66,case rate,160% of CMS IPPS rate,26154.02,130,MS DRG,20923.22,case rate,130% of CMS IPPS rate,4044.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4246.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20118.48,100,MS DRG,16094.78,case rate,100% of CMS IPPS rate,4044.36,100,,,case rate,100% of CMS IPPS rate,20118.48,100,MS DRG,16094.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4044.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303140.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20118.48,100,MS DRG,16094.78,case rate,100% of CMS IPPS rate,20118.48,100,MS DRG,16094.78,case rate,100% of CMS IPPS rate,4044.36,303140.8,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13912.77,100,MS DRG,11130.22,case rate,100% of CMS IPPS rate,22260.43,160,MS DRG,17808.34,case rate,160% of CMS IPPS rate,18086.6,130,MS DRG,14469.28,case rate,130% of CMS IPPS rate,3259.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3422.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13912.77,100,MS DRG,11130.22,case rate,100% of CMS IPPS rate,3259.36,100,,,case rate,100% of CMS IPPS rate,13912.77,100,MS DRG,11130.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3259.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,489053.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13912.77,100,MS DRG,11130.22,case rate,100% of CMS IPPS rate,13912.77,100,MS DRG,11130.22,case rate,100% of CMS IPPS rate,3259.36,489053.1,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18073.9,100,MS DRG,14459.12,case rate,100% of CMS IPPS rate,28918.24,160,MS DRG,23134.59,case rate,160% of CMS IPPS rate,23496.07,130,MS DRG,18796.86,case rate,130% of CMS IPPS rate,3647.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3829.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18073.9,100,MS DRG,14459.12,case rate,100% of CMS IPPS rate,3647.09,100,,,case rate,100% of CMS IPPS rate,18073.9,100,MS DRG,14459.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3647.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242207.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18073.9,100,MS DRG,14459.12,case rate,100% of CMS IPPS rate,18073.9,100,MS DRG,14459.12,case rate,100% of CMS IPPS rate,3647.09,242207.6,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13449.11,100,MS DRG,10759.29,case rate,100% of CMS IPPS rate,21518.58,160,MS DRG,17214.86,case rate,160% of CMS IPPS rate,17483.84,130,MS DRG,13987.07,case rate,130% of CMS IPPS rate,2285.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2399.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13449.11,100,MS DRG,10759.29,case rate,100% of CMS IPPS rate,2285.63,100,,,case rate,100% of CMS IPPS rate,13449.11,100,MS DRG,10759.29,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2285.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272292.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13449.11,100,MS DRG,10759.29,case rate,100% of CMS IPPS rate,13449.11,100,MS DRG,10759.29,case rate,100% of CMS IPPS rate,2285.63,272292.8,
CELLULITIS WITH MCC,602,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23524.55,100,MS DRG,18819.64,case rate,100% of CMS IPPS rate,37639.28,160,MS DRG,30111.42,case rate,160% of CMS IPPS rate,30581.92,130,MS DRG,24465.54,case rate,130% of CMS IPPS rate,5601.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5881.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23524.55,100,MS DRG,18819.64,case rate,100% of CMS IPPS rate,5601.41,100,,,case rate,100% of CMS IPPS rate,23524.55,100,MS DRG,18819.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5601.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,263775,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23524.55,100,MS DRG,18819.64,case rate,100% of CMS IPPS rate,23524.55,100,MS DRG,18819.64,case rate,100% of CMS IPPS rate,5601.41,263775,
CELLULITIS WITHOUT MCC,603,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16412.75,100,MS DRG,13130.2,case rate,100% of CMS IPPS rate,26260.4,160,MS DRG,21008.32,case rate,160% of CMS IPPS rate,21336.58,130,MS DRG,17069.26,case rate,130% of CMS IPPS rate,3358.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3526,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16412.75,100,MS DRG,13130.2,case rate,100% of CMS IPPS rate,3358.1,100,,,case rate,100% of CMS IPPS rate,16412.75,100,MS DRG,13130.2,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3358.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,296691.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16412.75,100,MS DRG,13130.2,case rate,100% of CMS IPPS rate,16412.75,100,MS DRG,13130.2,case rate,100% of CMS IPPS rate,3358.1,296691.8,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23745.17,100,MS DRG,18996.14,case rate,100% of CMS IPPS rate,37992.27,160,MS DRG,30393.82,case rate,160% of CMS IPPS rate,30868.72,130,MS DRG,24694.98,case rate,130% of CMS IPPS rate,5664.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5947.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23745.17,100,MS DRG,18996.14,case rate,100% of CMS IPPS rate,5664.32,100,,,case rate,100% of CMS IPPS rate,23745.17,100,MS DRG,18996.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5664.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440251.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23745.17,100,MS DRG,18996.14,case rate,100% of CMS IPPS rate,23745.17,100,MS DRG,18996.14,case rate,100% of CMS IPPS rate,5664.32,440252,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16697.08,100,MS DRG,13357.66,case rate,100% of CMS IPPS rate,26715.33,160,MS DRG,21372.26,case rate,160% of CMS IPPS rate,21706.2,130,MS DRG,17364.96,case rate,130% of CMS IPPS rate,3521.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3697.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16697.08,100,MS DRG,13357.66,case rate,100% of CMS IPPS rate,3521.66,100,,,case rate,100% of CMS IPPS rate,16697.08,100,MS DRG,13357.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3521.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,561946.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16697.08,100,MS DRG,13357.66,case rate,100% of CMS IPPS rate,16697.08,100,MS DRG,13357.66,case rate,100% of CMS IPPS rate,3521.66,561946.2,
MINOR SKIN DISORDERS WITH MCC,606,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24684.28,100,MS DRG,19747.42,case rate,100% of CMS IPPS rate,39494.85,160,MS DRG,31595.88,case rate,160% of CMS IPPS rate,32089.56,130,MS DRG,25671.65,case rate,130% of CMS IPPS rate,6139.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6446.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24684.28,100,MS DRG,19747.42,case rate,100% of CMS IPPS rate,6139.37,100,,,case rate,100% of CMS IPPS rate,24684.28,100,MS DRG,19747.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6139.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,282701.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24684.28,100,MS DRG,19747.42,case rate,100% of CMS IPPS rate,24684.28,100,MS DRG,19747.42,case rate,100% of CMS IPPS rate,6139.37,282701.9,
MINOR SKIN DISORDERS WITHOUT MCC,607,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16516.56,100,MS DRG,13213.25,case rate,100% of CMS IPPS rate,26426.5,160,MS DRG,21141.2,case rate,160% of CMS IPPS rate,21471.53,130,MS DRG,17177.22,case rate,130% of CMS IPPS rate,3294.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3459.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16516.56,100,MS DRG,13213.25,case rate,100% of CMS IPPS rate,3294.81,100,,,case rate,100% of CMS IPPS rate,16516.56,100,MS DRG,13213.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3294.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,298280.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16516.56,100,MS DRG,13213.25,case rate,100% of CMS IPPS rate,16516.56,100,MS DRG,13213.25,case rate,100% of CMS IPPS rate,3294.81,298280.9,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32548.8,100,MS DRG,26039.04,case rate,100% of CMS IPPS rate,52078.08,160,MS DRG,41662.46,case rate,160% of CMS IPPS rate,42313.44,130,MS DRG,33850.75,case rate,130% of CMS IPPS rate,8688.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9123.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32548.8,100,MS DRG,26039.04,case rate,100% of CMS IPPS rate,8688.82,100,,,case rate,100% of CMS IPPS rate,32548.8,100,MS DRG,26039.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8688.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,926187.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32548.8,100,MS DRG,26039.04,case rate,100% of CMS IPPS rate,32548.8,100,MS DRG,26039.04,case rate,100% of CMS IPPS rate,8688.82,926187.2,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23331.05,100,MS DRG,18664.84,case rate,100% of CMS IPPS rate,37329.68,160,MS DRG,29863.74,case rate,160% of CMS IPPS rate,30330.37,130,MS DRG,24264.3,case rate,130% of CMS IPPS rate,5463.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5736.56,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23331.05,100,MS DRG,18664.84,case rate,100% of CMS IPPS rate,5463.4,100,,,case rate,100% of CMS IPPS rate,23331.05,100,MS DRG,18664.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5463.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1272933.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23331.05,100,MS DRG,18664.84,case rate,100% of CMS IPPS rate,23331.05,100,MS DRG,18664.84,case rate,100% of CMS IPPS rate,5463.4,1272933,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52667.82,100,MS DRG,42134.26,case rate,100% of CMS IPPS rate,84268.51,160,MS DRG,67414.81,case rate,160% of CMS IPPS rate,68468.17,130,MS DRG,54774.54,case rate,130% of CMS IPPS rate,14735.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15472.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,52667.82,100,MS DRG,42134.26,case rate,100% of CMS IPPS rate,14735.54,100,,,case rate,100% of CMS IPPS rate,52667.82,100,MS DRG,42134.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14735.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352958.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,52667.82,100,MS DRG,42134.26,case rate,100% of CMS IPPS rate,52667.82,100,MS DRG,42134.26,case rate,100% of CMS IPPS rate,14735.54,352958.8,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29388.12,100,MS DRG,23510.5,case rate,100% of CMS IPPS rate,47020.99,160,MS DRG,37616.79,case rate,160% of CMS IPPS rate,38204.56,130,MS DRG,30563.65,case rate,130% of CMS IPPS rate,7364.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7732.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29388.12,100,MS DRG,23510.5,case rate,100% of CMS IPPS rate,7364.34,100,,,case rate,100% of CMS IPPS rate,29388.12,100,MS DRG,23510.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7364.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,434262.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29388.12,100,MS DRG,23510.5,case rate,100% of CMS IPPS rate,29388.12,100,MS DRG,23510.5,case rate,100% of CMS IPPS rate,7364.34,434262,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19678.42,100,MS DRG,15742.74,case rate,100% of CMS IPPS rate,31485.47,160,MS DRG,25188.38,case rate,160% of CMS IPPS rate,25581.95,130,MS DRG,20465.56,case rate,130% of CMS IPPS rate,4747.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4984.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19678.42,100,MS DRG,15742.74,case rate,100% of CMS IPPS rate,4747.02,100,,,case rate,100% of CMS IPPS rate,19678.42,100,MS DRG,15742.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4747.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,476281.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19678.42,100,MS DRG,15742.74,case rate,100% of CMS IPPS rate,19678.42,100,MS DRG,15742.74,case rate,100% of CMS IPPS rate,4747.02,476281.6,
O.R. PROCEDURES FOR OBESITY WITH MCC,619,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36679.25,100,MS DRG,29343.4,case rate,100% of CMS IPPS rate,58686.8,160,MS DRG,46949.44,case rate,160% of CMS IPPS rate,47683.03,130,MS DRG,38146.42,case rate,130% of CMS IPPS rate,10394.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10914.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36679.25,100,MS DRG,29343.4,case rate,100% of CMS IPPS rate,10394.94,100,,,case rate,100% of CMS IPPS rate,36679.25,100,MS DRG,29343.4,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10394.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1048361.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36679.25,100,MS DRG,29343.4,case rate,100% of CMS IPPS rate,36679.25,100,MS DRG,29343.4,case rate,100% of CMS IPPS rate,10394.94,1048361,
O.R. PROCEDURES FOR OBESITY WITH CC,620,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25113.73,100,MS DRG,20090.98,case rate,100% of CMS IPPS rate,40181.97,160,MS DRG,32145.58,case rate,160% of CMS IPPS rate,32647.85,130,MS DRG,26118.28,case rate,130% of CMS IPPS rate,6088.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6393.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25113.73,100,MS DRG,20090.98,case rate,100% of CMS IPPS rate,6088.66,100,,,case rate,100% of CMS IPPS rate,25113.73,100,MS DRG,20090.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6088.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1380409.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25113.73,100,MS DRG,20090.98,case rate,100% of CMS IPPS rate,25113.73,100,MS DRG,20090.98,case rate,100% of CMS IPPS rate,6088.66,1380409,
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,621,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23876.13,100,MS DRG,19100.9,case rate,100% of CMS IPPS rate,38201.81,160,MS DRG,30561.45,case rate,160% of CMS IPPS rate,31038.97,130,MS DRG,24831.18,case rate,130% of CMS IPPS rate,5573.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5851.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23876.13,100,MS DRG,19100.9,case rate,100% of CMS IPPS rate,5573.2,100,,,case rate,100% of CMS IPPS rate,23876.13,100,MS DRG,19100.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5573.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276894.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23876.13,100,MS DRG,19100.9,case rate,100% of CMS IPPS rate,23876.13,100,MS DRG,19100.9,case rate,100% of CMS IPPS rate,5573.2,1276895,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51109.31,100,MS DRG,40887.45,case rate,100% of CMS IPPS rate,81774.9,160,MS DRG,65419.92,case rate,160% of CMS IPPS rate,66442.1,130,MS DRG,53153.68,case rate,130% of CMS IPPS rate,14266.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14979.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51109.31,100,MS DRG,40887.45,case rate,100% of CMS IPPS rate,14266.6,100,,,case rate,100% of CMS IPPS rate,51109.31,100,MS DRG,40887.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14266.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,477953.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,51109.31,100,MS DRG,40887.45,case rate,100% of CMS IPPS rate,51109.31,100,MS DRG,40887.45,case rate,100% of CMS IPPS rate,14266.6,477953.2,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27935.8,100,MS DRG,22348.64,case rate,100% of CMS IPPS rate,44697.28,160,MS DRG,35757.82,case rate,160% of CMS IPPS rate,36316.54,130,MS DRG,29053.23,case rate,130% of CMS IPPS rate,7292.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7657.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27935.8,100,MS DRG,22348.64,case rate,100% of CMS IPPS rate,7292.66,100,,,case rate,100% of CMS IPPS rate,27935.8,100,MS DRG,22348.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7292.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,417975.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27935.8,100,MS DRG,22348.64,case rate,100% of CMS IPPS rate,27935.8,100,MS DRG,22348.64,case rate,100% of CMS IPPS rate,7292.66,417975.9,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19123.92,100,MS DRG,15299.14,case rate,100% of CMS IPPS rate,30598.27,160,MS DRG,24478.62,case rate,160% of CMS IPPS rate,24861.1,130,MS DRG,19888.88,case rate,130% of CMS IPPS rate,3796.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3986.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19123.92,100,MS DRG,15299.14,case rate,100% of CMS IPPS rate,3796.93,100,,,case rate,100% of CMS IPPS rate,19123.92,100,MS DRG,15299.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3796.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,481700.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19123.92,100,MS DRG,15299.14,case rate,100% of CMS IPPS rate,19123.92,100,MS DRG,15299.14,case rate,100% of CMS IPPS rate,3796.93,481701,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40439.26,100,MS DRG,32351.41,case rate,100% of CMS IPPS rate,64702.82,160,MS DRG,51762.26,case rate,160% of CMS IPPS rate,52571.04,130,MS DRG,42056.83,case rate,130% of CMS IPPS rate,10930.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11477.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40439.26,100,MS DRG,32351.41,case rate,100% of CMS IPPS rate,10930.99,100,,,case rate,100% of CMS IPPS rate,40439.26,100,MS DRG,32351.41,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10930.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,955786.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40439.26,100,MS DRG,32351.41,case rate,100% of CMS IPPS rate,40439.26,100,MS DRG,32351.41,case rate,100% of CMS IPPS rate,10930.99,955786.3,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23576.46,100,MS DRG,18861.17,case rate,100% of CMS IPPS rate,37722.34,160,MS DRG,30177.87,case rate,160% of CMS IPPS rate,30649.4,130,MS DRG,24519.52,case rate,130% of CMS IPPS rate,5754.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6042,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23576.46,100,MS DRG,18861.17,case rate,100% of CMS IPPS rate,5754.3,100,,,case rate,100% of CMS IPPS rate,23576.46,100,MS DRG,18861.17,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5754.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1076325.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23576.46,100,MS DRG,18861.17,case rate,100% of CMS IPPS rate,23576.46,100,MS DRG,18861.17,case rate,100% of CMS IPPS rate,5754.3,1076325,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20557.36,100,MS DRG,16445.89,case rate,100% of CMS IPPS rate,32891.78,160,MS DRG,26313.42,case rate,160% of CMS IPPS rate,26724.57,130,MS DRG,21379.66,case rate,130% of CMS IPPS rate,4830.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5071.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20557.36,100,MS DRG,16445.89,case rate,100% of CMS IPPS rate,4830.13,100,,,case rate,100% of CMS IPPS rate,20557.36,100,MS DRG,16445.89,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4830.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1124612.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20557.36,100,MS DRG,16445.89,case rate,100% of CMS IPPS rate,20557.36,100,MS DRG,16445.89,case rate,100% of CMS IPPS rate,4830.13,1124613,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53337.94,100,MS DRG,42670.35,case rate,100% of CMS IPPS rate,85340.7,160,MS DRG,68272.56,case rate,160% of CMS IPPS rate,69339.32,130,MS DRG,55471.46,case rate,130% of CMS IPPS rate,15043.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15795.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53337.94,100,MS DRG,42670.35,case rate,100% of CMS IPPS rate,15043.22,100,,,case rate,100% of CMS IPPS rate,53337.94,100,MS DRG,42670.35,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15043.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,530571.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53337.94,100,MS DRG,42670.35,case rate,100% of CMS IPPS rate,53337.94,100,MS DRG,42670.35,case rate,100% of CMS IPPS rate,15043.22,530571.6,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32671.48,100,MS DRG,26137.18,case rate,100% of CMS IPPS rate,52274.37,160,MS DRG,41819.5,case rate,160% of CMS IPPS rate,42472.92,130,MS DRG,33978.34,case rate,130% of CMS IPPS rate,8574.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9003.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32671.48,100,MS DRG,26137.18,case rate,100% of CMS IPPS rate,8574.83,100,,,case rate,100% of CMS IPPS rate,32671.48,100,MS DRG,26137.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8574.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,454553.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32671.48,100,MS DRG,26137.18,case rate,100% of CMS IPPS rate,32671.48,100,MS DRG,26137.18,case rate,100% of CMS IPPS rate,8574.83,454553.2,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22448.58,100,MS DRG,17958.86,case rate,100% of CMS IPPS rate,35917.73,160,MS DRG,28734.18,case rate,160% of CMS IPPS rate,29183.15,130,MS DRG,23346.52,case rate,130% of CMS IPPS rate,5342.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5609.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22448.58,100,MS DRG,17958.86,case rate,100% of CMS IPPS rate,5342.54,100,,,case rate,100% of CMS IPPS rate,22448.58,100,MS DRG,17958.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5342.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,797480.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22448.58,100,MS DRG,17958.86,case rate,100% of CMS IPPS rate,22448.58,100,MS DRG,17958.86,case rate,100% of CMS IPPS rate,5342.54,797480.5,
DIABETES WITH MCC,637,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23073.87,100,MS DRG,18459.1,case rate,100% of CMS IPPS rate,36918.19,160,MS DRG,29534.55,case rate,160% of CMS IPPS rate,29996.03,130,MS DRG,23996.82,case rate,130% of CMS IPPS rate,5552.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5829.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23073.87,100,MS DRG,18459.1,case rate,100% of CMS IPPS rate,5552.23,100,,,case rate,100% of CMS IPPS rate,23073.87,100,MS DRG,18459.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5552.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410811.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23073.87,100,MS DRG,18459.1,case rate,100% of CMS IPPS rate,23073.87,100,MS DRG,18459.1,case rate,100% of CMS IPPS rate,5552.23,410811.2,
DIABETES WITH CC,638,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16586.18,100,MS DRG,13268.94,case rate,100% of CMS IPPS rate,26537.89,160,MS DRG,21230.31,case rate,160% of CMS IPPS rate,21562.03,130,MS DRG,17249.62,case rate,130% of CMS IPPS rate,3496.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3671.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16586.18,100,MS DRG,13268.94,case rate,100% of CMS IPPS rate,3496.88,100,,,case rate,100% of CMS IPPS rate,16586.18,100,MS DRG,13268.94,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3496.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,339895.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16586.18,100,MS DRG,13268.94,case rate,100% of CMS IPPS rate,16586.18,100,MS DRG,13268.94,case rate,100% of CMS IPPS rate,3496.88,339895.1,
DIABETES WITHOUT CC/MCC,639,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13319.32,100,MS DRG,10655.46,case rate,100% of CMS IPPS rate,21310.91,160,MS DRG,17048.73,case rate,160% of CMS IPPS rate,17315.12,130,MS DRG,13852.1,case rate,130% of CMS IPPS rate,2388.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2508.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13319.32,100,MS DRG,10655.46,case rate,100% of CMS IPPS rate,2388.95,100,,,case rate,100% of CMS IPPS rate,13319.32,100,MS DRG,10655.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2388.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326103.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13319.32,100,MS DRG,10655.46,case rate,100% of CMS IPPS rate,13319.32,100,MS DRG,10655.46,case rate,100% of CMS IPPS rate,2388.95,326103.1,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21491.76,100,MS DRG,17193.41,case rate,100% of CMS IPPS rate,34386.82,160,MS DRG,27509.46,case rate,160% of CMS IPPS rate,27939.29,130,MS DRG,22351.43,case rate,130% of CMS IPPS rate,5063.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5316.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21491.76,100,MS DRG,17193.41,case rate,100% of CMS IPPS rate,5063.08,100,,,case rate,100% of CMS IPPS rate,21491.76,100,MS DRG,17193.41,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5063.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,347156.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21491.76,100,MS DRG,17193.41,case rate,100% of CMS IPPS rate,21491.76,100,MS DRG,17193.41,case rate,100% of CMS IPPS rate,5063.08,347156,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15194.02,100,MS DRG,12155.22,case rate,100% of CMS IPPS rate,24310.43,160,MS DRG,19448.34,case rate,160% of CMS IPPS rate,19752.23,130,MS DRG,15801.78,case rate,130% of CMS IPPS rate,2979.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3128.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15194.02,100,MS DRG,12155.22,case rate,100% of CMS IPPS rate,2979.13,100,,,case rate,100% of CMS IPPS rate,15194.02,100,MS DRG,12155.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2979.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336329.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15194.02,100,MS DRG,12155.22,case rate,100% of CMS IPPS rate,15194.02,100,MS DRG,12155.22,case rate,100% of CMS IPPS rate,2979.13,336329.6,
INBORN AND OTHER DISORDERS OF METABOLISM,642,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21351.37,100,MS DRG,17081.1,case rate,100% of CMS IPPS rate,34162.19,160,MS DRG,27329.75,case rate,160% of CMS IPPS rate,27756.78,130,MS DRG,22205.42,case rate,130% of CMS IPPS rate,4731.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4968.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21351.37,100,MS DRG,17081.1,case rate,100% of CMS IPPS rate,4731.77,100,,,case rate,100% of CMS IPPS rate,21351.37,100,MS DRG,17081.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4731.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367724.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21351.37,100,MS DRG,17081.1,case rate,100% of CMS IPPS rate,21351.37,100,MS DRG,17081.1,case rate,100% of CMS IPPS rate,4731.77,367725,
ENDOCRINE DISORDERS WITH MCC,643,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25383.9,100,MS DRG,20307.12,case rate,100% of CMS IPPS rate,40614.24,160,MS DRG,32491.39,case rate,160% of CMS IPPS rate,32999.07,130,MS DRG,26399.26,case rate,130% of CMS IPPS rate,6318.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6634.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25383.9,100,MS DRG,20307.12,case rate,100% of CMS IPPS rate,6318.56,100,,,case rate,100% of CMS IPPS rate,25383.9,100,MS DRG,20307.12,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6318.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,338966.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25383.9,100,MS DRG,20307.12,case rate,100% of CMS IPPS rate,25383.9,100,MS DRG,20307.12,case rate,100% of CMS IPPS rate,6318.56,338966.7,
ENDOCRINE DISORDERS WITH CC,644,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18500.99,100,MS DRG,14800.79,case rate,100% of CMS IPPS rate,29601.58,160,MS DRG,23681.26,case rate,160% of CMS IPPS rate,24051.29,130,MS DRG,19241.03,case rate,130% of CMS IPPS rate,3939.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4136.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18500.99,100,MS DRG,14800.79,case rate,100% of CMS IPPS rate,3939.9,100,,,case rate,100% of CMS IPPS rate,18500.99,100,MS DRG,14800.79,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3939.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352887.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18500.99,100,MS DRG,14800.79,case rate,100% of CMS IPPS rate,18500.99,100,MS DRG,14800.79,case rate,100% of CMS IPPS rate,3939.9,352887.5,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14952.16,100,MS DRG,11961.73,case rate,100% of CMS IPPS rate,23923.46,160,MS DRG,19138.77,case rate,160% of CMS IPPS rate,19437.81,130,MS DRG,15550.25,case rate,130% of CMS IPPS rate,2968.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3117.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14952.16,100,MS DRG,11961.73,case rate,100% of CMS IPPS rate,2968.84,100,,,case rate,100% of CMS IPPS rate,14952.16,100,MS DRG,11961.73,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2968.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,311972.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14952.16,100,MS DRG,11961.73,case rate,100% of CMS IPPS rate,14952.16,100,MS DRG,11961.73,case rate,100% of CMS IPPS rate,2968.84,311972.2,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59036.35,100,MS DRG,47229.08,case rate,100% of CMS IPPS rate,94458.16,160,MS DRG,75566.53,case rate,160% of CMS IPPS rate,76747.26,130,MS DRG,61397.81,case rate,130% of CMS IPPS rate,17565.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18443.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59036.35,100,MS DRG,47229.08,case rate,100% of CMS IPPS rate,17565.61,100,,,case rate,100% of CMS IPPS rate,59036.35,100,MS DRG,47229.08,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17565.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228068.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59036.35,100,MS DRG,47229.08,case rate,100% of CMS IPPS rate,59036.35,100,MS DRG,47229.08,case rate,100% of CMS IPPS rate,17565.61,228068.6,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46777.11,100,MS DRG,37421.69,case rate,100% of CMS IPPS rate,74843.38,160,MS DRG,59874.7,case rate,160% of CMS IPPS rate,60810.24,130,MS DRG,48648.19,case rate,130% of CMS IPPS rate,13239.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13901.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46777.11,100,MS DRG,37421.69,case rate,100% of CMS IPPS rate,13239.11,100,,,case rate,100% of CMS IPPS rate,46777.11,100,MS DRG,37421.69,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13239.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,483418.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46777.11,100,MS DRG,37421.69,case rate,100% of CMS IPPS rate,46777.11,100,MS DRG,37421.69,case rate,100% of CMS IPPS rate,13239.11,483418.7,
KIDNEY TRANSPLANT,652,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41420.84,100,MS DRG,33136.67,case rate,100% of CMS IPPS rate,66273.34,160,MS DRG,53018.67,case rate,160% of CMS IPPS rate,53847.09,130,MS DRG,43077.67,case rate,130% of CMS IPPS rate,11709.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12295.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41420.84,100,MS DRG,33136.67,case rate,100% of CMS IPPS rate,11709.9,100,,,case rate,100% of CMS IPPS rate,41420.84,100,MS DRG,33136.67,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11709.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1283633.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41420.84,100,MS DRG,33136.67,case rate,100% of CMS IPPS rate,41420.84,100,MS DRG,33136.67,case rate,100% of CMS IPPS rate,11709.9,1283634,
MAJOR BLADDER PROCEDURES WITH MCC,653,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69844.43,100,MS DRG,55875.54,case rate,100% of CMS IPPS rate,111751.09,160,MS DRG,89400.87,case rate,160% of CMS IPPS rate,90797.76,130,MS DRG,72638.21,case rate,130% of CMS IPPS rate,21253.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22316.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,69844.43,100,MS DRG,55875.54,case rate,100% of CMS IPPS rate,21253.5,100,,,case rate,100% of CMS IPPS rate,69844.43,100,MS DRG,55875.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21253.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,650926.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,69844.43,100,MS DRG,55875.54,case rate,100% of CMS IPPS rate,69844.43,100,MS DRG,55875.54,case rate,100% of CMS IPPS rate,21253.5,650926.9,
MAJOR BLADDER PROCEDURES WITH CC,654,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38271.97,100,MS DRG,30617.58,case rate,100% of CMS IPPS rate,61235.15,160,MS DRG,48988.12,case rate,160% of CMS IPPS rate,49753.56,130,MS DRG,39802.85,case rate,130% of CMS IPPS rate,10759.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11297.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38271.97,100,MS DRG,30617.58,case rate,100% of CMS IPPS rate,10759.43,100,,,case rate,100% of CMS IPPS rate,38271.97,100,MS DRG,30617.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10759.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,623796.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38271.97,100,MS DRG,30617.58,case rate,100% of CMS IPPS rate,38271.97,100,MS DRG,30617.58,case rate,100% of CMS IPPS rate,10759.43,623796.1,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30842.81,100,MS DRG,24674.25,case rate,100% of CMS IPPS rate,49348.5,160,MS DRG,39478.8,case rate,160% of CMS IPPS rate,40095.65,130,MS DRG,32076.52,case rate,130% of CMS IPPS rate,7919.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8315.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30842.81,100,MS DRG,24674.25,case rate,100% of CMS IPPS rate,7919.83,100,,,case rate,100% of CMS IPPS rate,30842.81,100,MS DRG,24674.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7919.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1249525.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30842.81,100,MS DRG,24674.25,case rate,100% of CMS IPPS rate,30842.81,100,MS DRG,24674.25,case rate,100% of CMS IPPS rate,7919.83,1249526,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42992.33,100,MS DRG,34393.86,case rate,100% of CMS IPPS rate,68787.73,160,MS DRG,55030.18,case rate,160% of CMS IPPS rate,55890.03,130,MS DRG,44712.02,case rate,130% of CMS IPPS rate,12421.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13042.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42992.33,100,MS DRG,34393.86,case rate,100% of CMS IPPS rate,12421.32,100,,,case rate,100% of CMS IPPS rate,42992.33,100,MS DRG,34393.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12421.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,773405.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42992.33,100,MS DRG,34393.86,case rate,100% of CMS IPPS rate,42992.33,100,MS DRG,34393.86,case rate,100% of CMS IPPS rate,12421.32,773405.3,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27732.87,100,MS DRG,22186.3,case rate,100% of CMS IPPS rate,44372.59,160,MS DRG,35498.07,case rate,160% of CMS IPPS rate,36052.73,130,MS DRG,28842.18,case rate,130% of CMS IPPS rate,6969.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7318.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27732.87,100,MS DRG,22186.3,case rate,100% of CMS IPPS rate,6969.74,100,,,case rate,100% of CMS IPPS rate,27732.87,100,MS DRG,22186.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6969.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,978372.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27732.87,100,MS DRG,22186.3,case rate,100% of CMS IPPS rate,27732.87,100,MS DRG,22186.3,case rate,100% of CMS IPPS rate,6969.74,978372.3,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23440.79,100,MS DRG,18752.63,case rate,100% of CMS IPPS rate,37505.26,160,MS DRG,30004.21,case rate,160% of CMS IPPS rate,30473.03,130,MS DRG,24378.42,case rate,130% of CMS IPPS rate,5734.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6020.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23440.79,100,MS DRG,18752.63,case rate,100% of CMS IPPS rate,5734.09,100,,,case rate,100% of CMS IPPS rate,23440.79,100,MS DRG,18752.63,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5734.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1409079.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23440.79,100,MS DRG,18752.63,case rate,100% of CMS IPPS rate,23440.79,100,MS DRG,18752.63,case rate,100% of CMS IPPS rate,5734.09,1409079,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36518.8,100,MS DRG,29215.04,case rate,100% of CMS IPPS rate,58430.08,160,MS DRG,46744.06,case rate,160% of CMS IPPS rate,47474.44,130,MS DRG,37979.55,case rate,130% of CMS IPPS rate,9852.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10345.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,36518.8,100,MS DRG,29215.04,case rate,100% of CMS IPPS rate,9852.8,100,,,case rate,100% of CMS IPPS rate,36518.8,100,MS DRG,29215.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9852.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,615276.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36518.8,100,MS DRG,29215.04,case rate,100% of CMS IPPS rate,36518.8,100,MS DRG,29215.04,case rate,100% of CMS IPPS rate,9852.8,615276.2,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21853.96,100,MS DRG,17483.17,case rate,100% of CMS IPPS rate,34966.34,160,MS DRG,27973.07,case rate,160% of CMS IPPS rate,28410.15,130,MS DRG,22728.12,case rate,130% of CMS IPPS rate,5108.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5364.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21853.96,100,MS DRG,17483.17,case rate,100% of CMS IPPS rate,5108.83,100,,,case rate,100% of CMS IPPS rate,21853.96,100,MS DRG,17483.17,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5108.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,733637.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21853.96,100,MS DRG,17483.17,case rate,100% of CMS IPPS rate,21853.96,100,MS DRG,17483.17,case rate,100% of CMS IPPS rate,5108.83,733637.9,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18344.07,100,MS DRG,14675.26,case rate,100% of CMS IPPS rate,29350.51,160,MS DRG,23480.41,case rate,160% of CMS IPPS rate,23847.29,130,MS DRG,19077.83,case rate,130% of CMS IPPS rate,3913.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4109.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18344.07,100,MS DRG,14675.26,case rate,100% of CMS IPPS rate,3913.97,100,,,case rate,100% of CMS IPPS rate,18344.07,100,MS DRG,14675.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3913.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,842739.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18344.07,100,MS DRG,14675.26,case rate,100% of CMS IPPS rate,18344.07,100,MS DRG,14675.26,case rate,100% of CMS IPPS rate,3913.97,842739.1,
MINOR BLADDER PROCEDURES WITH MCC,662,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41329.99,100,MS DRG,33063.99,case rate,100% of CMS IPPS rate,66127.98,160,MS DRG,52902.38,case rate,160% of CMS IPPS rate,53728.99,130,MS DRG,42983.19,case rate,130% of CMS IPPS rate,11893.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12488.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41329.99,100,MS DRG,33063.99,case rate,100% of CMS IPPS rate,11893.66,100,,,case rate,100% of CMS IPPS rate,41329.99,100,MS DRG,33063.99,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11893.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,479220.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41329.99,100,MS DRG,33063.99,case rate,100% of CMS IPPS rate,41329.99,100,MS DRG,33063.99,case rate,100% of CMS IPPS rate,11893.66,479221,
MINOR BLADDER PROCEDURES WITH CC,663,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23188.31,100,MS DRG,18550.65,case rate,100% of CMS IPPS rate,37101.3,160,MS DRG,29681.04,case rate,160% of CMS IPPS rate,30144.8,130,MS DRG,24115.84,case rate,130% of CMS IPPS rate,5823.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6114.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23188.31,100,MS DRG,18550.65,case rate,100% of CMS IPPS rate,5823.3,100,,,case rate,100% of CMS IPPS rate,23188.31,100,MS DRG,18550.65,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5823.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,496429.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23188.31,100,MS DRG,18550.65,case rate,100% of CMS IPPS rate,23188.31,100,MS DRG,18550.65,case rate,100% of CMS IPPS rate,5823.3,496429.4,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18499.8,100,MS DRG,14799.84,case rate,100% of CMS IPPS rate,29599.68,160,MS DRG,23679.74,case rate,160% of CMS IPPS rate,24049.74,130,MS DRG,19239.79,case rate,130% of CMS IPPS rate,4116.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4322.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18499.8,100,MS DRG,14799.84,case rate,100% of CMS IPPS rate,4116.8,100,,,case rate,100% of CMS IPPS rate,18499.8,100,MS DRG,14799.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4116.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,771692.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18499.8,100,MS DRG,14799.84,case rate,100% of CMS IPPS rate,18499.8,100,MS DRG,14799.84,case rate,100% of CMS IPPS rate,4116.8,771692.8,
PROSTATECTOMY WITH MCC,665,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42420.12,100,MS DRG,33936.1,case rate,100% of CMS IPPS rate,67872.19,160,MS DRG,54297.75,case rate,160% of CMS IPPS rate,55146.16,130,MS DRG,44116.93,case rate,130% of CMS IPPS rate,13090.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13745.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42420.12,100,MS DRG,33936.1,case rate,100% of CMS IPPS rate,13090.81,100,,,case rate,100% of CMS IPPS rate,42420.12,100,MS DRG,33936.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13090.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,466040.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42420.12,100,MS DRG,33936.1,case rate,100% of CMS IPPS rate,42420.12,100,MS DRG,33936.1,case rate,100% of CMS IPPS rate,13090.81,466040.2,
PROSTATECTOMY WITH CC,666,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26236.89,100,MS DRG,20989.51,case rate,100% of CMS IPPS rate,41979.02,160,MS DRG,33583.22,case rate,160% of CMS IPPS rate,34107.96,130,MS DRG,27286.37,case rate,130% of CMS IPPS rate,6280.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6594.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26236.89,100,MS DRG,20989.51,case rate,100% of CMS IPPS rate,6280.43,100,,,case rate,100% of CMS IPPS rate,26236.89,100,MS DRG,20989.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6280.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,549282.37,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26236.89,100,MS DRG,20989.51,case rate,100% of CMS IPPS rate,26236.89,100,MS DRG,20989.51,case rate,100% of CMS IPPS rate,6280.43,549282.4,
PROSTATECTOMY WITHOUT CC/MCC,667,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18358.23,100,MS DRG,14686.58,case rate,100% of CMS IPPS rate,29373.17,160,MS DRG,23498.54,case rate,160% of CMS IPPS rate,23865.7,130,MS DRG,19092.56,case rate,130% of CMS IPPS rate,3918.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4114.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18358.23,100,MS DRG,14686.58,case rate,100% of CMS IPPS rate,3918.55,100,,,case rate,100% of CMS IPPS rate,18358.23,100,MS DRG,14686.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3918.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,645601.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18358.23,100,MS DRG,14686.58,case rate,100% of CMS IPPS rate,18358.23,100,MS DRG,14686.58,case rate,100% of CMS IPPS rate,3918.55,645601.1,
TRANSURETHRAL PROCEDURES WITH MCC,668,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39221.71,100,MS DRG,31377.37,case rate,100% of CMS IPPS rate,62754.74,160,MS DRG,50203.79,case rate,160% of CMS IPPS rate,50988.22,130,MS DRG,40790.58,case rate,130% of CMS IPPS rate,11118.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11674.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39221.71,100,MS DRG,31377.37,case rate,100% of CMS IPPS rate,11118.57,100,,,case rate,100% of CMS IPPS rate,39221.71,100,MS DRG,31377.37,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11118.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459848.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39221.71,100,MS DRG,31377.37,case rate,100% of CMS IPPS rate,39221.71,100,MS DRG,31377.37,case rate,100% of CMS IPPS rate,11118.57,459848.8,
TRANSURETHRAL PROCEDURES WITH CC,669,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24080.23,100,MS DRG,19264.18,case rate,100% of CMS IPPS rate,38528.37,160,MS DRG,30822.7,case rate,160% of CMS IPPS rate,31304.3,130,MS DRG,25043.44,case rate,130% of CMS IPPS rate,5899.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6194.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24080.23,100,MS DRG,19264.18,case rate,100% of CMS IPPS rate,5899.94,100,,,case rate,100% of CMS IPPS rate,24080.23,100,MS DRG,19264.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5899.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,568151.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24080.23,100,MS DRG,19264.18,case rate,100% of CMS IPPS rate,24080.23,100,MS DRG,19264.18,case rate,100% of CMS IPPS rate,5899.94,568151.5,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17331.81,100,MS DRG,13865.45,case rate,100% of CMS IPPS rate,27730.9,160,MS DRG,22184.72,case rate,160% of CMS IPPS rate,22531.35,130,MS DRG,18025.08,case rate,130% of CMS IPPS rate,3643.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3825.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17331.81,100,MS DRG,13865.45,case rate,100% of CMS IPPS rate,3643.66,100,,,case rate,100% of CMS IPPS rate,17331.81,100,MS DRG,13865.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3643.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,615756.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17331.81,100,MS DRG,13865.45,case rate,100% of CMS IPPS rate,17331.81,100,MS DRG,13865.45,case rate,100% of CMS IPPS rate,3643.66,615756.4,
URETHRAL PROCEDURES WITH CC/MCC,671,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26172,100,MS DRG,20937.6,case rate,100% of CMS IPPS rate,41875.2,160,MS DRG,33500.16,case rate,160% of CMS IPPS rate,34023.6,130,MS DRG,27218.88,case rate,130% of CMS IPPS rate,6571.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6900.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26172,100,MS DRG,20937.6,case rate,100% of CMS IPPS rate,6571.71,100,,,case rate,100% of CMS IPPS rate,26172,100,MS DRG,20937.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6571.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,488861.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26172,100,MS DRG,20937.6,case rate,100% of CMS IPPS rate,26172,100,MS DRG,20937.6,case rate,100% of CMS IPPS rate,6571.71,488861.4,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17035.68,100,MS DRG,13628.54,case rate,100% of CMS IPPS rate,27257.09,160,MS DRG,21805.67,case rate,160% of CMS IPPS rate,22146.38,130,MS DRG,17717.1,case rate,130% of CMS IPPS rate,4172.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4381.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17035.68,100,MS DRG,13628.54,case rate,100% of CMS IPPS rate,4172.47,100,,,case rate,100% of CMS IPPS rate,17035.68,100,MS DRG,13628.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4172.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,749597.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17035.68,100,MS DRG,13628.54,case rate,100% of CMS IPPS rate,17035.68,100,MS DRG,13628.54,case rate,100% of CMS IPPS rate,4172.47,749597.7,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49603.89,100,MS DRG,39683.11,case rate,100% of CMS IPPS rate,79366.22,160,MS DRG,63492.98,case rate,160% of CMS IPPS rate,64485.06,130,MS DRG,51588.05,case rate,130% of CMS IPPS rate,15973.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16771.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49603.89,100,MS DRG,39683.11,case rate,100% of CMS IPPS rate,15973.1,100,,,case rate,100% of CMS IPPS rate,49603.89,100,MS DRG,39683.11,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15973.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,444153.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49603.89,100,MS DRG,39683.11,case rate,100% of CMS IPPS rate,49603.89,100,MS DRG,39683.11,case rate,100% of CMS IPPS rate,15973.1,444153.2,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34080.17,100,MS DRG,27264.14,case rate,100% of CMS IPPS rate,54528.27,160,MS DRG,43622.62,case rate,160% of CMS IPPS rate,44304.22,130,MS DRG,35443.38,case rate,130% of CMS IPPS rate,8800.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9240.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34080.17,100,MS DRG,27264.14,case rate,100% of CMS IPPS rate,8800.91,100,,,case rate,100% of CMS IPPS rate,34080.17,100,MS DRG,27264.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8800.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,441673.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34080.17,100,MS DRG,27264.14,case rate,100% of CMS IPPS rate,34080.17,100,MS DRG,27264.14,case rate,100% of CMS IPPS rate,8800.91,441673.3,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,39508.08,160,MS DRG,31606.46,case rate,160% of CMS IPPS rate,32100.32,130,MS DRG,25680.26,case rate,130% of CMS IPPS rate,5967.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6266.18,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,5967.8,100,,,case rate,100% of CMS IPPS rate,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5967.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,704743.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,24692.55,100,MS DRG,19754.04,case rate,100% of CMS IPPS rate,5967.8,704743.8,
RENAL FAILURE WITH MCC,682,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23681.45,100,MS DRG,18945.16,case rate,100% of CMS IPPS rate,37890.32,160,MS DRG,30312.26,case rate,160% of CMS IPPS rate,30785.89,130,MS DRG,24628.71,case rate,130% of CMS IPPS rate,5726.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6012.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23681.45,100,MS DRG,18945.16,case rate,100% of CMS IPPS rate,5726.08,100,,,case rate,100% of CMS IPPS rate,23681.45,100,MS DRG,18945.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5726.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364959.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23681.45,100,MS DRG,18945.16,case rate,100% of CMS IPPS rate,23681.45,100,MS DRG,18945.16,case rate,100% of CMS IPPS rate,5726.08,364959.9,
RENAL FAILURE WITH CC,683,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16602.69,100,MS DRG,13282.15,case rate,100% of CMS IPPS rate,26564.3,160,MS DRG,21251.44,case rate,160% of CMS IPPS rate,21583.5,130,MS DRG,17266.8,case rate,130% of CMS IPPS rate,3388.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3558.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16602.69,100,MS DRG,13282.15,case rate,100% of CMS IPPS rate,3388.98,100,,,case rate,100% of CMS IPPS rate,16602.69,100,MS DRG,13282.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3388.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319006.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16602.69,100,MS DRG,13282.15,case rate,100% of CMS IPPS rate,16602.69,100,MS DRG,13282.15,case rate,100% of CMS IPPS rate,3388.98,319006.5,
RENAL FAILURE WITHOUT CC/MCC,684,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13154.15,100,MS DRG,10523.32,case rate,100% of CMS IPPS rate,21046.64,160,MS DRG,16837.31,case rate,160% of CMS IPPS rate,17100.4,130,MS DRG,13680.32,case rate,130% of CMS IPPS rate,2315.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2431.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13154.15,100,MS DRG,10523.32,case rate,100% of CMS IPPS rate,2315.75,100,,,case rate,100% of CMS IPPS rate,13154.15,100,MS DRG,10523.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2315.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357106.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13154.15,100,MS DRG,10523.32,case rate,100% of CMS IPPS rate,13154.15,100,MS DRG,10523.32,case rate,100% of CMS IPPS rate,2315.75,357106.4,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27676.24,100,MS DRG,22140.99,case rate,100% of CMS IPPS rate,44281.98,160,MS DRG,35425.58,case rate,160% of CMS IPPS rate,35979.11,130,MS DRG,28783.29,case rate,130% of CMS IPPS rate,7189.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7548.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27676.24,100,MS DRG,22140.99,case rate,100% of CMS IPPS rate,7189.34,100,,,case rate,100% of CMS IPPS rate,27676.24,100,MS DRG,22140.99,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7189.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461790.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27676.24,100,MS DRG,22140.99,case rate,100% of CMS IPPS rate,27676.24,100,MS DRG,22140.99,case rate,100% of CMS IPPS rate,7189.34,461790.3,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18307.5,100,MS DRG,14646,case rate,100% of CMS IPPS rate,29292,160,MS DRG,23433.6,case rate,160% of CMS IPPS rate,23799.75,130,MS DRG,19039.8,case rate,130% of CMS IPPS rate,4013.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4214.15,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18307.5,100,MS DRG,14646,case rate,100% of CMS IPPS rate,4013.48,100,,,case rate,100% of CMS IPPS rate,18307.5,100,MS DRG,14646,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4013.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312920.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18307.5,100,MS DRG,14646,case rate,100% of CMS IPPS rate,18307.5,100,MS DRG,14646,case rate,100% of CMS IPPS rate,4013.48,312920.7,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15188.12,100,MS DRG,12150.5,case rate,100% of CMS IPPS rate,24300.99,160,MS DRG,19440.79,case rate,160% of CMS IPPS rate,19744.56,130,MS DRG,15795.65,case rate,130% of CMS IPPS rate,2761.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2899.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15188.12,100,MS DRG,12150.5,case rate,100% of CMS IPPS rate,2761.06,100,,,case rate,100% of CMS IPPS rate,15188.12,100,MS DRG,12150.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2761.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520333.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15188.12,100,MS DRG,12150.5,case rate,100% of CMS IPPS rate,15188.12,100,MS DRG,12150.5,case rate,100% of CMS IPPS rate,2761.06,520333.9,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19830.61,100,MS DRG,15864.49,case rate,100% of CMS IPPS rate,31728.98,160,MS DRG,25383.18,case rate,160% of CMS IPPS rate,25779.79,130,MS DRG,20623.83,case rate,130% of CMS IPPS rate,4461.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4684.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19830.61,100,MS DRG,15864.49,case rate,100% of CMS IPPS rate,4461.84,100,,,case rate,100% of CMS IPPS rate,19830.61,100,MS DRG,15864.49,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4461.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,317329.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19830.61,100,MS DRG,15864.49,case rate,100% of CMS IPPS rate,19830.61,100,MS DRG,15864.49,case rate,100% of CMS IPPS rate,4461.84,317329.2,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15494.87,100,MS DRG,12395.9,case rate,100% of CMS IPPS rate,24791.79,160,MS DRG,19833.43,case rate,160% of CMS IPPS rate,20143.33,130,MS DRG,16114.66,case rate,130% of CMS IPPS rate,3059.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3212.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15494.87,100,MS DRG,12395.9,case rate,100% of CMS IPPS rate,3059.96,100,,,case rate,100% of CMS IPPS rate,15494.87,100,MS DRG,12395.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3059.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346748.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15494.87,100,MS DRG,12395.9,case rate,100% of CMS IPPS rate,15494.87,100,MS DRG,12395.9,case rate,100% of CMS IPPS rate,3059.96,346748.4,
URINARY STONES WITH MCC,693,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22684.54,100,MS DRG,18147.63,case rate,100% of CMS IPPS rate,36295.26,160,MS DRG,29036.21,case rate,160% of CMS IPPS rate,29489.9,130,MS DRG,23591.92,case rate,130% of CMS IPPS rate,5605.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5886.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22684.54,100,MS DRG,18147.63,case rate,100% of CMS IPPS rate,5605.99,100,,,case rate,100% of CMS IPPS rate,22684.54,100,MS DRG,18147.63,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5605.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,475358.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22684.54,100,MS DRG,18147.63,case rate,100% of CMS IPPS rate,22684.54,100,MS DRG,18147.63,case rate,100% of CMS IPPS rate,5605.99,475358.1,
URINARY STONES WITHOUT MCC,694,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15209.36,100,MS DRG,12167.49,case rate,100% of CMS IPPS rate,24334.98,160,MS DRG,19467.98,case rate,160% of CMS IPPS rate,19772.17,130,MS DRG,15817.74,case rate,130% of CMS IPPS rate,2979.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3128.08,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15209.36,100,MS DRG,12167.49,case rate,100% of CMS IPPS rate,2979.13,100,,,case rate,100% of CMS IPPS rate,15209.36,100,MS DRG,12167.49,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2979.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393744.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15209.36,100,MS DRG,12167.49,case rate,100% of CMS IPPS rate,15209.36,100,MS DRG,12167.49,case rate,100% of CMS IPPS rate,2979.13,393744.1,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20085.45,100,MS DRG,16068.36,case rate,100% of CMS IPPS rate,32136.72,160,MS DRG,25709.38,case rate,160% of CMS IPPS rate,26111.09,130,MS DRG,20888.87,case rate,130% of CMS IPPS rate,4299.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4514.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20085.45,100,MS DRG,16068.36,case rate,100% of CMS IPPS rate,4299.81,100,,,case rate,100% of CMS IPPS rate,20085.45,100,MS DRG,16068.36,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4299.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,390342.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20085.45,100,MS DRG,16068.36,case rate,100% of CMS IPPS rate,20085.45,100,MS DRG,16068.36,case rate,100% of CMS IPPS rate,4299.81,390342.3,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14140.46,100,MS DRG,11312.37,case rate,100% of CMS IPPS rate,22624.74,160,MS DRG,18099.79,case rate,160% of CMS IPPS rate,18382.6,130,MS DRG,14706.08,case rate,130% of CMS IPPS rate,2637.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2769.4,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14140.46,100,MS DRG,11312.37,case rate,100% of CMS IPPS rate,2637.53,100,,,case rate,100% of CMS IPPS rate,14140.46,100,MS DRG,11312.37,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2637.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,477809.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14140.46,100,MS DRG,11312.37,case rate,100% of CMS IPPS rate,14140.46,100,MS DRG,11312.37,case rate,100% of CMS IPPS rate,2637.53,477809.1,
URETHRAL STRICTURE,697,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,30571.82,160,MS DRG,24457.46,case rate,160% of CMS IPPS rate,24839.61,130,MS DRG,19871.69,case rate,130% of CMS IPPS rate,3708.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3894.29,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,3708.86,100,,,case rate,100% of CMS IPPS rate,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3708.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,481077.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,19107.39,100,MS DRG,15285.91,case rate,100% of CMS IPPS rate,3708.86,481077.9,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25493.63,100,MS DRG,20394.9,case rate,100% of CMS IPPS rate,40789.81,160,MS DRG,32631.85,case rate,160% of CMS IPPS rate,33141.72,130,MS DRG,26513.38,case rate,130% of CMS IPPS rate,6408.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6728.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25493.63,100,MS DRG,20394.9,case rate,100% of CMS IPPS rate,6408.53,100,,,case rate,100% of CMS IPPS rate,25493.63,100,MS DRG,20394.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6408.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366494.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25493.63,100,MS DRG,20394.9,case rate,100% of CMS IPPS rate,25493.63,100,MS DRG,20394.9,case rate,100% of CMS IPPS rate,6408.53,366494.6,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18018.45,100,MS DRG,14414.76,case rate,100% of CMS IPPS rate,28829.52,160,MS DRG,23063.62,case rate,160% of CMS IPPS rate,23423.99,130,MS DRG,18739.19,case rate,130% of CMS IPPS rate,3888.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4082.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18018.45,100,MS DRG,14414.76,case rate,100% of CMS IPPS rate,3888.43,100,,,case rate,100% of CMS IPPS rate,18018.45,100,MS DRG,14414.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3888.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319547.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18018.45,100,MS DRG,14414.76,case rate,100% of CMS IPPS rate,18018.45,100,MS DRG,14414.76,case rate,100% of CMS IPPS rate,3888.43,319547.9,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14331.59,100,MS DRG,11465.27,case rate,100% of CMS IPPS rate,22930.54,160,MS DRG,18344.43,case rate,160% of CMS IPPS rate,18631.07,130,MS DRG,14904.86,case rate,130% of CMS IPPS rate,2646.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2779.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14331.59,100,MS DRG,11465.27,case rate,100% of CMS IPPS rate,2646.68,100,,,case rate,100% of CMS IPPS rate,14331.59,100,MS DRG,11465.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2646.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,464206.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14331.59,100,MS DRG,11465.27,case rate,100% of CMS IPPS rate,14331.59,100,MS DRG,11465.27,case rate,100% of CMS IPPS rate,2646.68,464206.5,
MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,707,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29121.49,100,MS DRG,23297.19,case rate,100% of CMS IPPS rate,46594.38,160,MS DRG,37275.5,case rate,160% of CMS IPPS rate,37857.94,130,MS DRG,30286.35,case rate,130% of CMS IPPS rate,7398.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7768.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29121.49,100,MS DRG,23297.19,case rate,100% of CMS IPPS rate,7398.65,100,,,case rate,100% of CMS IPPS rate,29121.49,100,MS DRG,23297.19,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7398.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1301795.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29121.49,100,MS DRG,23297.19,case rate,100% of CMS IPPS rate,29121.49,100,MS DRG,23297.19,case rate,100% of CMS IPPS rate,7398.65,1301795,
MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,708,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23182.4,100,MS DRG,18545.92,case rate,100% of CMS IPPS rate,37091.84,160,MS DRG,29673.47,case rate,160% of CMS IPPS rate,30137.12,130,MS DRG,24109.7,case rate,130% of CMS IPPS rate,5652.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5934.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23182.4,100,MS DRG,18545.92,case rate,100% of CMS IPPS rate,5652.12,100,,,case rate,100% of CMS IPPS rate,23182.4,100,MS DRG,18545.92,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5652.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1469877.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23182.4,100,MS DRG,18545.92,case rate,100% of CMS IPPS rate,23182.4,100,MS DRG,18545.92,case rate,100% of CMS IPPS rate,5652.12,1469877,
PENIS PROCEDURES WITH CC/MCC,709,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31586.08,100,MS DRG,25268.86,case rate,100% of CMS IPPS rate,50537.73,160,MS DRG,40430.18,case rate,160% of CMS IPPS rate,41061.9,130,MS DRG,32849.52,case rate,130% of CMS IPPS rate,8567.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8995.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31586.08,100,MS DRG,25268.86,case rate,100% of CMS IPPS rate,8567.2,100,,,case rate,100% of CMS IPPS rate,31586.08,100,MS DRG,25268.86,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8567.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,510517.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31586.08,100,MS DRG,25268.86,case rate,100% of CMS IPPS rate,31586.08,100,MS DRG,25268.86,case rate,100% of CMS IPPS rate,8567.2,510517.3,
PENIS PROCEDURES WITHOUT CC/MCC,710,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21280.57,100,MS DRG,17024.46,case rate,100% of CMS IPPS rate,34048.91,160,MS DRG,27239.13,case rate,160% of CMS IPPS rate,27664.74,130,MS DRG,22131.79,case rate,130% of CMS IPPS rate,5724.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6010.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21280.57,100,MS DRG,17024.46,case rate,100% of CMS IPPS rate,5724.18,100,,,case rate,100% of CMS IPPS rate,21280.57,100,MS DRG,17024.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5724.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1107108.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21280.57,100,MS DRG,17024.46,case rate,100% of CMS IPPS rate,21280.57,100,MS DRG,17024.46,case rate,100% of CMS IPPS rate,5724.18,1107108,
TESTES PROCEDURES WITH CC/MCC,711,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31020.96,100,MS DRG,24816.77,case rate,100% of CMS IPPS rate,49633.54,160,MS DRG,39706.83,case rate,160% of CMS IPPS rate,40327.25,130,MS DRG,32261.8,case rate,130% of CMS IPPS rate,7272.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7636.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31020.96,100,MS DRG,24816.77,case rate,100% of CMS IPPS rate,7272.84,100,,,case rate,100% of CMS IPPS rate,31020.96,100,MS DRG,24816.77,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7272.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,478151.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31020.96,100,MS DRG,24816.77,case rate,100% of CMS IPPS rate,31020.96,100,MS DRG,24816.77,case rate,100% of CMS IPPS rate,7272.84,478151,
TESTES PROCEDURES WITHOUT CC/MCC,712,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19995.78,100,MS DRG,15996.62,case rate,100% of CMS IPPS rate,31993.25,160,MS DRG,25594.6,case rate,160% of CMS IPPS rate,25994.51,130,MS DRG,20795.61,case rate,130% of CMS IPPS rate,3378.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3547.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19995.78,100,MS DRG,15996.62,case rate,100% of CMS IPPS rate,3378.31,100,,,case rate,100% of CMS IPPS rate,19995.78,100,MS DRG,15996.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3378.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,726834.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19995.78,100,MS DRG,15996.62,case rate,100% of CMS IPPS rate,19995.78,100,MS DRG,15996.62,case rate,100% of CMS IPPS rate,3378.31,726834.6,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23090.38,100,MS DRG,18472.3,case rate,100% of CMS IPPS rate,36944.61,160,MS DRG,29555.69,case rate,160% of CMS IPPS rate,30017.49,130,MS DRG,24013.99,case rate,130% of CMS IPPS rate,5512.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5788.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23090.38,100,MS DRG,18472.3,case rate,100% of CMS IPPS rate,5512.96,100,,,case rate,100% of CMS IPPS rate,23090.38,100,MS DRG,18472.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5512.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,594862.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23090.38,100,MS DRG,18472.3,case rate,100% of CMS IPPS rate,23090.38,100,MS DRG,18472.3,case rate,100% of CMS IPPS rate,5512.96,594862.5,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17283.44,100,MS DRG,13826.75,case rate,100% of CMS IPPS rate,27653.5,160,MS DRG,22122.8,case rate,160% of CMS IPPS rate,22468.47,130,MS DRG,17974.78,case rate,130% of CMS IPPS rate,3582.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3761.79,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17283.44,100,MS DRG,13826.75,case rate,100% of CMS IPPS rate,3582.66,100,,,case rate,100% of CMS IPPS rate,17283.44,100,MS DRG,13826.75,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3582.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,766381.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17283.44,100,MS DRG,13826.75,case rate,100% of CMS IPPS rate,17283.44,100,MS DRG,13826.75,case rate,100% of CMS IPPS rate,3582.66,766381.9,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32019.06,100,MS DRG,25615.25,case rate,100% of CMS IPPS rate,51230.5,160,MS DRG,40984.4,case rate,160% of CMS IPPS rate,41624.78,130,MS DRG,33299.82,case rate,130% of CMS IPPS rate,8609.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9040.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32019.06,100,MS DRG,25615.25,case rate,100% of CMS IPPS rate,8609.9,100,,,case rate,100% of CMS IPPS rate,32019.06,100,MS DRG,25615.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8609.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,458461.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32019.06,100,MS DRG,25615.25,case rate,100% of CMS IPPS rate,32019.06,100,MS DRG,25615.25,case rate,100% of CMS IPPS rate,8609.9,458461.6,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22754.14,100,MS DRG,18203.31,case rate,100% of CMS IPPS rate,36406.62,160,MS DRG,29125.3,case rate,160% of CMS IPPS rate,29580.38,130,MS DRG,23664.3,case rate,130% of CMS IPPS rate,5411.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5681.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22754.14,100,MS DRG,18203.31,case rate,100% of CMS IPPS rate,5411.17,100,,,case rate,100% of CMS IPPS rate,22754.14,100,MS DRG,18203.31,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5411.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1137146.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22754.14,100,MS DRG,18203.31,case rate,100% of CMS IPPS rate,22754.14,100,MS DRG,18203.31,case rate,100% of CMS IPPS rate,5411.17,1137147,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27373.03,100,MS DRG,21898.42,case rate,100% of CMS IPPS rate,43796.85,160,MS DRG,35037.48,case rate,160% of CMS IPPS rate,35584.94,130,MS DRG,28467.95,case rate,130% of CMS IPPS rate,7074.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7427.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27373.03,100,MS DRG,21898.42,case rate,100% of CMS IPPS rate,7074.21,100,,,case rate,100% of CMS IPPS rate,27373.03,100,MS DRG,21898.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7074.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,706387.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27373.03,100,MS DRG,21898.42,case rate,100% of CMS IPPS rate,27373.03,100,MS DRG,21898.42,case rate,100% of CMS IPPS rate,7074.21,706387.7,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19847.13,100,MS DRG,15877.7,case rate,100% of CMS IPPS rate,31755.41,160,MS DRG,25404.33,case rate,160% of CMS IPPS rate,25801.27,130,MS DRG,20641.02,case rate,130% of CMS IPPS rate,4696.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4931.52,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19847.13,100,MS DRG,15877.7,case rate,100% of CMS IPPS rate,4696.69,100,,,case rate,100% of CMS IPPS rate,19847.13,100,MS DRG,15877.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4696.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,817504.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19847.13,100,MS DRG,15877.7,case rate,100% of CMS IPPS rate,19847.13,100,MS DRG,15877.7,case rate,100% of CMS IPPS rate,4696.69,817504.9,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28093.89,100,MS DRG,22475.11,case rate,100% of CMS IPPS rate,44950.22,160,MS DRG,35960.18,case rate,160% of CMS IPPS rate,36522.06,130,MS DRG,29217.65,case rate,130% of CMS IPPS rate,6591.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6921.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28093.89,100,MS DRG,22475.11,case rate,100% of CMS IPPS rate,6591.53,100,,,case rate,100% of CMS IPPS rate,28093.89,100,MS DRG,22475.11,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6591.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384372.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28093.89,100,MS DRG,22475.11,case rate,100% of CMS IPPS rate,28093.89,100,MS DRG,22475.11,case rate,100% of CMS IPPS rate,6591.53,384372.1,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19121.55,100,MS DRG,15297.24,case rate,100% of CMS IPPS rate,30594.48,160,MS DRG,24475.58,case rate,160% of CMS IPPS rate,24858.02,130,MS DRG,19886.42,case rate,130% of CMS IPPS rate,4281.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4495.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19121.55,100,MS DRG,15297.24,case rate,100% of CMS IPPS rate,4281.12,100,,,case rate,100% of CMS IPPS rate,19121.55,100,MS DRG,15297.24,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4281.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379150.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19121.55,100,MS DRG,15297.24,case rate,100% of CMS IPPS rate,19121.55,100,MS DRG,15297.24,case rate,100% of CMS IPPS rate,4281.12,379150.1,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15525.54,100,MS DRG,12420.43,case rate,100% of CMS IPPS rate,24840.86,160,MS DRG,19872.69,case rate,160% of CMS IPPS rate,20183.2,130,MS DRG,16146.56,case rate,130% of CMS IPPS rate,2504.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2629.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15525.54,100,MS DRG,12420.43,case rate,100% of CMS IPPS rate,2504.47,100,,,case rate,100% of CMS IPPS rate,15525.54,100,MS DRG,12420.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2504.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380726.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15525.54,100,MS DRG,12420.43,case rate,100% of CMS IPPS rate,15525.54,100,MS DRG,12420.43,case rate,100% of CMS IPPS rate,2504.47,380726.9,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20615.16,100,MS DRG,16492.13,case rate,100% of CMS IPPS rate,32984.26,160,MS DRG,26387.41,case rate,160% of CMS IPPS rate,26799.71,130,MS DRG,21439.77,case rate,130% of CMS IPPS rate,4813.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5054.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20615.16,100,MS DRG,16492.13,case rate,100% of CMS IPPS rate,4813.74,100,,,case rate,100% of CMS IPPS rate,20615.16,100,MS DRG,16492.13,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4813.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,354361.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20615.16,100,MS DRG,16492.13,case rate,100% of CMS IPPS rate,20615.16,100,MS DRG,16492.13,case rate,100% of CMS IPPS rate,4813.74,354361.5,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14598.23,100,MS DRG,11678.58,case rate,100% of CMS IPPS rate,23357.17,160,MS DRG,18685.74,case rate,160% of CMS IPPS rate,18977.7,130,MS DRG,15182.16,case rate,130% of CMS IPPS rate,2838.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2979.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14598.23,100,MS DRG,11678.58,case rate,100% of CMS IPPS rate,2838.07,100,,,case rate,100% of CMS IPPS rate,14598.23,100,MS DRG,11678.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2838.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377045.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14598.23,100,MS DRG,11678.58,case rate,100% of CMS IPPS rate,14598.23,100,MS DRG,11678.58,case rate,100% of CMS IPPS rate,2838.07,377045.9,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,40159.31,160,MS DRG,32127.45,case rate,160% of CMS IPPS rate,32629.44,130,MS DRG,26103.55,case rate,130% of CMS IPPS rate,5602.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5882.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,5602.18,100,,,case rate,100% of CMS IPPS rate,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5602.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381214.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,25099.57,100,MS DRG,20079.66,case rate,100% of CMS IPPS rate,5602.18,381214.2,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15414.65,100,MS DRG,12331.72,case rate,100% of CMS IPPS rate,24663.44,160,MS DRG,19730.75,case rate,160% of CMS IPPS rate,20039.05,130,MS DRG,16031.24,case rate,130% of CMS IPPS rate,3115.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3271,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15414.65,100,MS DRG,12331.72,case rate,100% of CMS IPPS rate,3115.24,100,,,case rate,100% of CMS IPPS rate,15414.65,100,MS DRG,12331.72,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3115.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278535.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15414.65,100,MS DRG,12331.72,case rate,100% of CMS IPPS rate,15414.65,100,MS DRG,12331.72,case rate,100% of CMS IPPS rate,3115.24,278535.9,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17819.06,100,MS DRG,14255.25,case rate,100% of CMS IPPS rate,28510.5,160,MS DRG,22808.4,case rate,160% of CMS IPPS rate,23164.78,130,MS DRG,18531.82,case rate,130% of CMS IPPS rate,4197.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4407.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17819.06,100,MS DRG,14255.25,case rate,100% of CMS IPPS rate,4197.25,100,,,case rate,100% of CMS IPPS rate,17819.06,100,MS DRG,14255.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4197.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411634.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17819.06,100,MS DRG,14255.25,case rate,100% of CMS IPPS rate,17819.06,100,MS DRG,14255.25,case rate,100% of CMS IPPS rate,4197.25,411634.7,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13308.71,100,MS DRG,10646.97,case rate,100% of CMS IPPS rate,21293.94,160,MS DRG,17035.15,case rate,160% of CMS IPPS rate,17301.32,130,MS DRG,13841.06,case rate,130% of CMS IPPS rate,2313.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2429.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13308.71,100,MS DRG,10646.97,case rate,100% of CMS IPPS rate,2313.84,100,,,case rate,100% of CMS IPPS rate,13308.71,100,MS DRG,10646.97,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2313.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362408.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13308.71,100,MS DRG,10646.97,case rate,100% of CMS IPPS rate,13308.71,100,MS DRG,10646.97,case rate,100% of CMS IPPS rate,2313.84,362408.8,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31619.1,100,MS DRG,25295.28,case rate,100% of CMS IPPS rate,50590.56,160,MS DRG,40472.45,case rate,160% of CMS IPPS rate,41104.83,130,MS DRG,32883.86,case rate,130% of CMS IPPS rate,8017.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8417.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31619.1,100,MS DRG,25295.28,case rate,100% of CMS IPPS rate,8017.05,100,,,case rate,100% of CMS IPPS rate,31619.1,100,MS DRG,25295.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8017.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,614903.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31619.1,100,MS DRG,25295.28,case rate,100% of CMS IPPS rate,31619.1,100,MS DRG,25295.28,case rate,100% of CMS IPPS rate,8017.05,614903.1,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20842.88,100,MS DRG,16674.3,case rate,100% of CMS IPPS rate,33348.61,160,MS DRG,26678.89,case rate,160% of CMS IPPS rate,27095.74,130,MS DRG,21676.59,case rate,130% of CMS IPPS rate,4628.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4859.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20842.88,100,MS DRG,16674.3,case rate,100% of CMS IPPS rate,4628.07,100,,,case rate,100% of CMS IPPS rate,20842.88,100,MS DRG,16674.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4628.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1254492.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20842.88,100,MS DRG,16674.3,case rate,100% of CMS IPPS rate,20842.88,100,MS DRG,16674.3,case rate,100% of CMS IPPS rate,4628.07,1254492,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51836.06,100,MS DRG,41468.85,case rate,100% of CMS IPPS rate,82937.7,160,MS DRG,66350.16,case rate,160% of CMS IPPS rate,67386.88,130,MS DRG,53909.5,case rate,130% of CMS IPPS rate,15012.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15762.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51836.06,100,MS DRG,41468.85,case rate,100% of CMS IPPS rate,15012.34,100,,,case rate,100% of CMS IPPS rate,51836.06,100,MS DRG,41468.85,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15012.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,603528.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,51836.06,100,MS DRG,41468.85,case rate,100% of CMS IPPS rate,51836.06,100,MS DRG,41468.85,case rate,100% of CMS IPPS rate,15012.34,603528.6,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29261.9,100,MS DRG,23409.52,case rate,100% of CMS IPPS rate,46819.04,160,MS DRG,37455.23,case rate,160% of CMS IPPS rate,38040.47,130,MS DRG,30432.38,case rate,130% of CMS IPPS rate,7619.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7999.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29261.9,100,MS DRG,23409.52,case rate,100% of CMS IPPS rate,7619.02,100,,,case rate,100% of CMS IPPS rate,29261.9,100,MS DRG,23409.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7619.02,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,878411.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29261.9,100,MS DRG,23409.52,case rate,100% of CMS IPPS rate,29261.9,100,MS DRG,23409.52,case rate,100% of CMS IPPS rate,7619.02,878411.7,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22074.59,100,MS DRG,17659.67,case rate,100% of CMS IPPS rate,35319.34,160,MS DRG,28255.47,case rate,160% of CMS IPPS rate,28696.97,130,MS DRG,22957.58,case rate,130% of CMS IPPS rate,5783.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6072.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22074.59,100,MS DRG,17659.67,case rate,100% of CMS IPPS rate,5783.27,100,,,case rate,100% of CMS IPPS rate,22074.59,100,MS DRG,17659.67,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5783.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,916056.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22074.59,100,MS DRG,17659.67,case rate,100% of CMS IPPS rate,22074.59,100,MS DRG,17659.67,case rate,100% of CMS IPPS rate,5783.27,916056.5,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48640,100,MS DRG,38912,case rate,100% of CMS IPPS rate,77824,160,MS DRG,62259.2,case rate,160% of CMS IPPS rate,63232,130,MS DRG,50585.6,case rate,130% of CMS IPPS rate,15177.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15936.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,48640,100,MS DRG,38912,case rate,100% of CMS IPPS rate,15177.42,100,,,case rate,100% of CMS IPPS rate,48640,100,MS DRG,38912,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15177.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,642569.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,48640,100,MS DRG,38912,case rate,100% of CMS IPPS rate,48640,100,MS DRG,38912,case rate,100% of CMS IPPS rate,15177.42,642569.5,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27058.04,100,MS DRG,21646.43,case rate,100% of CMS IPPS rate,43292.86,160,MS DRG,34634.29,case rate,160% of CMS IPPS rate,35175.45,130,MS DRG,28140.36,case rate,130% of CMS IPPS rate,6932.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7278.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27058.04,100,MS DRG,21646.43,case rate,100% of CMS IPPS rate,6932.38,100,,,case rate,100% of CMS IPPS rate,27058.04,100,MS DRG,21646.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6932.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1065421.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27058.04,100,MS DRG,21646.43,case rate,100% of CMS IPPS rate,27058.04,100,MS DRG,21646.43,case rate,100% of CMS IPPS rate,6932.38,1065422,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21304.18,100,MS DRG,17043.34,case rate,100% of CMS IPPS rate,34086.69,160,MS DRG,27269.35,case rate,160% of CMS IPPS rate,27695.43,130,MS DRG,22156.34,case rate,130% of CMS IPPS rate,5236.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5498.77,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21304.18,100,MS DRG,17043.34,case rate,100% of CMS IPPS rate,5236.93,100,,,case rate,100% of CMS IPPS rate,21304.18,100,MS DRG,17043.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5236.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1092412.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21304.18,100,MS DRG,17043.34,case rate,100% of CMS IPPS rate,21304.18,100,MS DRG,17043.34,case rate,100% of CMS IPPS rate,5236.93,1092413,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26997.86,100,MS DRG,21598.29,case rate,100% of CMS IPPS rate,43196.58,160,MS DRG,34557.26,case rate,160% of CMS IPPS rate,35097.22,130,MS DRG,28077.78,case rate,130% of CMS IPPS rate,6964.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7312.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26997.86,100,MS DRG,21598.29,case rate,100% of CMS IPPS rate,6964.4,100,,,case rate,100% of CMS IPPS rate,26997.86,100,MS DRG,21598.29,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6964.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,894974.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26997.86,100,MS DRG,21598.29,case rate,100% of CMS IPPS rate,26997.86,100,MS DRG,21598.29,case rate,100% of CMS IPPS rate,6964.4,894974.6,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19684.32,100,MS DRG,15747.46,case rate,100% of CMS IPPS rate,31494.91,160,MS DRG,25195.93,case rate,160% of CMS IPPS rate,25589.62,130,MS DRG,20471.7,case rate,130% of CMS IPPS rate,4570.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4798.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19684.32,100,MS DRG,15747.46,case rate,100% of CMS IPPS rate,4570.12,100,,,case rate,100% of CMS IPPS rate,19684.32,100,MS DRG,15747.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4570.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,882502.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19684.32,100,MS DRG,15747.46,case rate,100% of CMS IPPS rate,19684.32,100,MS DRG,15747.46,case rate,100% of CMS IPPS rate,4570.12,882502.5,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28183.55,100,MS DRG,22546.84,case rate,100% of CMS IPPS rate,45093.68,160,MS DRG,36074.94,case rate,160% of CMS IPPS rate,36638.62,130,MS DRG,29310.9,case rate,130% of CMS IPPS rate,7449.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7822.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28183.55,100,MS DRG,22546.84,case rate,100% of CMS IPPS rate,7449.74,100,,,case rate,100% of CMS IPPS rate,28183.55,100,MS DRG,22546.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7449.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647740,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28183.55,100,MS DRG,22546.84,case rate,100% of CMS IPPS rate,28183.55,100,MS DRG,22546.84,case rate,100% of CMS IPPS rate,7449.74,647740,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18196.6,100,MS DRG,14557.28,case rate,100% of CMS IPPS rate,29114.56,160,MS DRG,23291.65,case rate,160% of CMS IPPS rate,23655.58,130,MS DRG,18924.46,case rate,130% of CMS IPPS rate,3907.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4102.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18196.6,100,MS DRG,14557.28,case rate,100% of CMS IPPS rate,3907.11,100,,,case rate,100% of CMS IPPS rate,18196.6,100,MS DRG,14557.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1079374.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18196.6,100,MS DRG,14557.28,case rate,100% of CMS IPPS rate,18196.6,100,MS DRG,14557.28,case rate,100% of CMS IPPS rate,3907.11,1079375,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25749.63,100,MS DRG,20599.7,case rate,100% of CMS IPPS rate,41199.41,160,MS DRG,32959.53,case rate,160% of CMS IPPS rate,33474.52,130,MS DRG,26779.62,case rate,130% of CMS IPPS rate,6384.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6703.73,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25749.63,100,MS DRG,20599.7,case rate,100% of CMS IPPS rate,6384.51,100,,,case rate,100% of CMS IPPS rate,25749.63,100,MS DRG,20599.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6384.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,863701.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25749.63,100,MS DRG,20599.7,case rate,100% of CMS IPPS rate,25749.63,100,MS DRG,20599.7,case rate,100% of CMS IPPS rate,6384.51,863701.4,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16442.25,100,MS DRG,13153.8,case rate,100% of CMS IPPS rate,26307.6,160,MS DRG,21046.08,case rate,160% of CMS IPPS rate,21374.93,130,MS DRG,17099.94,case rate,130% of CMS IPPS rate,3641.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3823.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16442.25,100,MS DRG,13153.8,case rate,100% of CMS IPPS rate,3641.76,100,,,case rate,100% of CMS IPPS rate,16442.25,100,MS DRG,13153.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3641.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1024988.05,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16442.25,100,MS DRG,13153.8,case rate,100% of CMS IPPS rate,16442.25,100,MS DRG,13153.8,case rate,100% of CMS IPPS rate,3641.76,1024988,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22550.03,100,MS DRG,18040.02,case rate,100% of CMS IPPS rate,36080.05,160,MS DRG,28864.04,case rate,160% of CMS IPPS rate,29315.04,130,MS DRG,23452.03,case rate,130% of CMS IPPS rate,5193.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5453.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22550.03,100,MS DRG,18040.02,case rate,100% of CMS IPPS rate,5193.85,100,,,case rate,100% of CMS IPPS rate,22550.03,100,MS DRG,18040.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5193.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1264144.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22550.03,100,MS DRG,18040.02,case rate,100% of CMS IPPS rate,22550.03,100,MS DRG,18040.02,case rate,100% of CMS IPPS rate,5193.85,1264145,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35672.88,100,MS DRG,28538.3,case rate,100% of CMS IPPS rate,57076.61,160,MS DRG,45661.29,case rate,160% of CMS IPPS rate,46374.74,130,MS DRG,37099.79,case rate,130% of CMS IPPS rate,9869.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10362.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35672.88,100,MS DRG,28538.3,case rate,100% of CMS IPPS rate,9869.19,100,,,case rate,100% of CMS IPPS rate,35672.88,100,MS DRG,28538.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9869.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,636893.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35672.88,100,MS DRG,28538.3,case rate,100% of CMS IPPS rate,35672.88,100,MS DRG,28538.3,case rate,100% of CMS IPPS rate,9869.19,636893.6,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22020.31,100,MS DRG,17616.25,case rate,100% of CMS IPPS rate,35232.5,160,MS DRG,28186,case rate,160% of CMS IPPS rate,28626.4,130,MS DRG,22901.12,case rate,130% of CMS IPPS rate,4916.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5162.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22020.31,100,MS DRG,17616.25,case rate,100% of CMS IPPS rate,4916.3,100,,,case rate,100% of CMS IPPS rate,22020.31,100,MS DRG,17616.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4916.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,863983.24,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22020.31,100,MS DRG,17616.25,case rate,100% of CMS IPPS rate,22020.31,100,MS DRG,17616.25,case rate,100% of CMS IPPS rate,4916.3,863983.2,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27830.8,100,MS DRG,22264.64,case rate,100% of CMS IPPS rate,44529.28,160,MS DRG,35623.42,case rate,160% of CMS IPPS rate,36180.04,130,MS DRG,28944.03,case rate,130% of CMS IPPS rate,6898.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7242.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27830.8,100,MS DRG,22264.64,case rate,100% of CMS IPPS rate,6898.06,100,,,case rate,100% of CMS IPPS rate,27830.8,100,MS DRG,22264.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6898.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305235.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27830.8,100,MS DRG,22264.64,case rate,100% of CMS IPPS rate,27830.8,100,MS DRG,22264.64,case rate,100% of CMS IPPS rate,6898.06,305235.1,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18772.35,100,MS DRG,15017.88,case rate,100% of CMS IPPS rate,30035.76,160,MS DRG,24028.61,case rate,160% of CMS IPPS rate,24404.06,130,MS DRG,19523.25,case rate,130% of CMS IPPS rate,4232.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4443.93,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18772.35,100,MS DRG,15017.88,case rate,100% of CMS IPPS rate,4232.32,100,,,case rate,100% of CMS IPPS rate,18772.35,100,MS DRG,15017.88,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4232.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,291222.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18772.35,100,MS DRG,15017.88,case rate,100% of CMS IPPS rate,18772.35,100,MS DRG,15017.88,case rate,100% of CMS IPPS rate,4232.32,291222.1,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17651.53,100,MS DRG,14121.22,case rate,100% of CMS IPPS rate,28242.45,160,MS DRG,22593.96,case rate,160% of CMS IPPS rate,22946.99,130,MS DRG,18357.59,case rate,130% of CMS IPPS rate,3640.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3823.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17651.53,100,MS DRG,14121.22,case rate,100% of CMS IPPS rate,3640.99,100,,,case rate,100% of CMS IPPS rate,17651.53,100,MS DRG,14121.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3640.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,633102.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17651.53,100,MS DRG,14121.22,case rate,100% of CMS IPPS rate,17651.53,100,MS DRG,14121.22,case rate,100% of CMS IPPS rate,3640.99,633102.5,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23572.92,100,MS DRG,18858.34,case rate,100% of CMS IPPS rate,37716.67,160,MS DRG,30173.34,case rate,160% of CMS IPPS rate,30644.8,130,MS DRG,24515.84,case rate,130% of CMS IPPS rate,5395.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5665.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23572.92,100,MS DRG,18858.34,case rate,100% of CMS IPPS rate,5395.92,100,,,case rate,100% of CMS IPPS rate,23572.92,100,MS DRG,18858.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5395.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384219.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23572.92,100,MS DRG,18858.34,case rate,100% of CMS IPPS rate,23572.92,100,MS DRG,18858.34,case rate,100% of CMS IPPS rate,5395.92,384219.4,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17685.75,100,MS DRG,14148.6,case rate,100% of CMS IPPS rate,28297.2,160,MS DRG,22637.76,case rate,160% of CMS IPPS rate,22991.48,130,MS DRG,18393.18,case rate,130% of CMS IPPS rate,3886.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4080.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17685.75,100,MS DRG,14148.6,case rate,100% of CMS IPPS rate,3886.14,100,,,case rate,100% of CMS IPPS rate,17685.75,100,MS DRG,14148.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3886.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332848.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17685.75,100,MS DRG,14148.6,case rate,100% of CMS IPPS rate,17685.75,100,MS DRG,14148.6,case rate,100% of CMS IPPS rate,3886.14,332848.8,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13598.94,100,MS DRG,10879.15,case rate,100% of CMS IPPS rate,21758.3,160,MS DRG,17406.64,case rate,160% of CMS IPPS rate,17678.62,130,MS DRG,14142.9,case rate,130% of CMS IPPS rate,2440.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2562.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13598.94,100,MS DRG,10879.15,case rate,100% of CMS IPPS rate,2440.04,100,,,case rate,100% of CMS IPPS rate,13598.94,100,MS DRG,10879.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2440.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,322597.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13598.94,100,MS DRG,10879.15,case rate,100% of CMS IPPS rate,13598.94,100,MS DRG,10879.15,case rate,100% of CMS IPPS rate,2440.04,322597.4,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17718.77,100,MS DRG,14175.02,case rate,100% of CMS IPPS rate,28350.03,160,MS DRG,22680.02,case rate,160% of CMS IPPS rate,23034.4,130,MS DRG,18427.52,case rate,130% of CMS IPPS rate,3757.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3945.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17718.77,100,MS DRG,14175.02,case rate,100% of CMS IPPS rate,3757.66,100,,,case rate,100% of CMS IPPS rate,17718.77,100,MS DRG,14175.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3757.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377202.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17718.77,100,MS DRG,14175.02,case rate,100% of CMS IPPS rate,17718.77,100,MS DRG,14175.02,case rate,100% of CMS IPPS rate,3757.66,377202.2,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13119.94,100,MS DRG,10495.95,case rate,100% of CMS IPPS rate,20991.9,160,MS DRG,16793.52,case rate,160% of CMS IPPS rate,17055.92,130,MS DRG,13644.74,case rate,130% of CMS IPPS rate,2416.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2537.62,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13119.94,100,MS DRG,10495.95,case rate,100% of CMS IPPS rate,2416.78,100,,,case rate,100% of CMS IPPS rate,13119.94,100,MS DRG,10495.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2416.78,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346056.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13119.94,100,MS DRG,10495.95,case rate,100% of CMS IPPS rate,13119.94,100,MS DRG,10495.95,case rate,100% of CMS IPPS rate,2416.78,346056.8,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20346.18,100,MS DRG,16276.94,case rate,100% of CMS IPPS rate,32553.89,160,MS DRG,26043.11,case rate,160% of CMS IPPS rate,26450.03,130,MS DRG,21160.02,case rate,130% of CMS IPPS rate,3855.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4048.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20346.18,100,MS DRG,16276.94,case rate,100% of CMS IPPS rate,3855.26,100,,,case rate,100% of CMS IPPS rate,20346.18,100,MS DRG,16276.94,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3855.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306703.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20346.18,100,MS DRG,16276.94,case rate,100% of CMS IPPS rate,20346.18,100,MS DRG,16276.94,case rate,100% of CMS IPPS rate,3855.26,306703.5,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24189.96,100,MS DRG,19351.97,case rate,100% of CMS IPPS rate,38703.94,160,MS DRG,30963.15,case rate,160% of CMS IPPS rate,31446.95,130,MS DRG,25157.56,case rate,130% of CMS IPPS rate,5247.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5509.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24189.96,100,MS DRG,19351.97,case rate,100% of CMS IPPS rate,5247.23,100,,,case rate,100% of CMS IPPS rate,24189.96,100,MS DRG,19351.97,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5247.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,675849.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24189.96,100,MS DRG,19351.97,case rate,100% of CMS IPPS rate,24189.96,100,MS DRG,19351.97,case rate,100% of CMS IPPS rate,5247.23,675849.7,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,24636.99,160,MS DRG,19709.59,case rate,160% of CMS IPPS rate,20017.56,130,MS DRG,16014.05,case rate,130% of CMS IPPS rate,4102.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4307.42,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,4102.31,100,,,case rate,100% of CMS IPPS rate,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4102.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,523479.38,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,15398.12,100,MS DRG,12318.5,case rate,100% of CMS IPPS rate,4102.31,523479.4,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14430.7,100,MS DRG,11544.56,case rate,100% of CMS IPPS rate,23089.12,160,MS DRG,18471.3,case rate,160% of CMS IPPS rate,18759.91,130,MS DRG,15007.93,case rate,130% of CMS IPPS rate,2720.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2856.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14430.7,100,MS DRG,11544.56,case rate,100% of CMS IPPS rate,2720.26,100,,,case rate,100% of CMS IPPS rate,14430.7,100,MS DRG,11544.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2720.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273482.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14430.7,100,MS DRG,11544.56,case rate,100% of CMS IPPS rate,14430.7,100,MS DRG,11544.56,case rate,100% of CMS IPPS rate,2720.26,273483,
ABORTION WITHOUT D&C,779,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17645.64,100,MS DRG,14116.51,case rate,100% of CMS IPPS rate,28233.02,160,MS DRG,22586.42,case rate,160% of CMS IPPS rate,22939.33,130,MS DRG,18351.46,case rate,130% of CMS IPPS rate,3563.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3742.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17645.64,100,MS DRG,14116.51,case rate,100% of CMS IPPS rate,3563.98,100,,,case rate,100% of CMS IPPS rate,17645.64,100,MS DRG,14116.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3563.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310183.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17645.64,100,MS DRG,14116.51,case rate,100% of CMS IPPS rate,17645.64,100,MS DRG,14116.51,case rate,100% of CMS IPPS rate,3563.98,310183.3,
CESAREAN SECTION WITH STERILIZATION WITH MCC,783,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26878.7,100,MS DRG,21502.96,case rate,100% of CMS IPPS rate,43005.92,160,MS DRG,34404.74,case rate,160% of CMS IPPS rate,34942.31,130,MS DRG,27953.85,case rate,130% of CMS IPPS rate,7023.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7374.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26878.7,100,MS DRG,21502.96,case rate,100% of CMS IPPS rate,7023.12,100,,,case rate,100% of CMS IPPS rate,26878.7,100,MS DRG,21502.96,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7023.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362229.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26878.7,100,MS DRG,21502.96,case rate,100% of CMS IPPS rate,26878.7,100,MS DRG,21502.96,case rate,100% of CMS IPPS rate,7023.12,362229.5,
CESAREAN SECTION WITH STERILIZATION WITH CC,784,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18057.38,100,MS DRG,14445.9,case rate,100% of CMS IPPS rate,28891.81,160,MS DRG,23113.45,case rate,160% of CMS IPPS rate,23474.59,130,MS DRG,18779.67,case rate,130% of CMS IPPS rate,4129,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4335.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18057.38,100,MS DRG,14445.9,case rate,100% of CMS IPPS rate,4129,100,,,case rate,100% of CMS IPPS rate,18057.38,100,MS DRG,14445.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4129,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443537.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18057.38,100,MS DRG,14445.9,case rate,100% of CMS IPPS rate,18057.38,100,MS DRG,14445.9,case rate,100% of CMS IPPS rate,4129,443537.8,
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,785,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16195.66,100,MS DRG,12956.53,case rate,100% of CMS IPPS rate,25913.06,160,MS DRG,20730.45,case rate,160% of CMS IPPS rate,21054.36,130,MS DRG,16843.49,case rate,130% of CMS IPPS rate,3330.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3496.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16195.66,100,MS DRG,12956.53,case rate,100% of CMS IPPS rate,3330.27,100,,,case rate,100% of CMS IPPS rate,16195.66,100,MS DRG,12956.53,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3330.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,454421.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16195.66,100,MS DRG,12956.53,case rate,100% of CMS IPPS rate,16195.66,100,MS DRG,12956.53,case rate,100% of CMS IPPS rate,3330.27,454421.7,
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,786,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26615.6,100,MS DRG,21292.48,case rate,100% of CMS IPPS rate,42584.96,160,MS DRG,34067.97,case rate,160% of CMS IPPS rate,34600.28,130,MS DRG,27680.22,case rate,130% of CMS IPPS rate,6160.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6468.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26615.6,100,MS DRG,21292.48,case rate,100% of CMS IPPS rate,6160.72,100,,,case rate,100% of CMS IPPS rate,26615.6,100,MS DRG,21292.48,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6160.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342118.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26615.6,100,MS DRG,21292.48,case rate,100% of CMS IPPS rate,26615.6,100,MS DRG,21292.48,case rate,100% of CMS IPPS rate,6160.72,342118.9,
CESAREAN SECTION WITHOUT STERILIZATION WITH CC,787,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18375.93,100,MS DRG,14700.74,case rate,100% of CMS IPPS rate,29401.49,160,MS DRG,23521.19,case rate,160% of CMS IPPS rate,23888.71,130,MS DRG,19110.97,case rate,130% of CMS IPPS rate,4048.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4250.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18375.93,100,MS DRG,14700.74,case rate,100% of CMS IPPS rate,4048.18,100,,,case rate,100% of CMS IPPS rate,18375.93,100,MS DRG,14700.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4048.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365156.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18375.93,100,MS DRG,14700.74,case rate,100% of CMS IPPS rate,18375.93,100,MS DRG,14700.74,case rate,100% of CMS IPPS rate,4048.18,365156.4,
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,788,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16062.34,100,MS DRG,12849.87,case rate,100% of CMS IPPS rate,25699.74,160,MS DRG,20559.79,case rate,160% of CMS IPPS rate,20881.04,130,MS DRG,16704.83,case rate,130% of CMS IPPS rate,3449.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3621.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16062.34,100,MS DRG,12849.87,case rate,100% of CMS IPPS rate,3449.22,100,,,case rate,100% of CMS IPPS rate,16062.34,100,MS DRG,12849.87,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3449.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,373539.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16062.34,100,MS DRG,12849.87,case rate,100% of CMS IPPS rate,16062.34,100,MS DRG,12849.87,case rate,100% of CMS IPPS rate,3449.22,373539.5,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27440.29,100,MS DRG,21952.23,case rate,100% of CMS IPPS rate,43904.46,160,MS DRG,35123.57,case rate,160% of CMS IPPS rate,35672.38,130,MS DRG,28537.9,case rate,130% of CMS IPPS rate,6872.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7216.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27440.29,100,MS DRG,21952.23,case rate,100% of CMS IPPS rate,6872.52,100,,,case rate,100% of CMS IPPS rate,27440.29,100,MS DRG,21952.23,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6872.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,351010.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27440.29,100,MS DRG,21952.23,case rate,100% of CMS IPPS rate,27440.29,100,MS DRG,21952.23,case rate,100% of CMS IPPS rate,6872.52,351010.4,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76763.94,100,MS DRG,61411.15,case rate,100% of CMS IPPS rate,122822.3,160,MS DRG,98257.84,case rate,160% of CMS IPPS rate,99793.12,130,MS DRG,79834.5,case rate,130% of CMS IPPS rate,22664.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23798.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,76763.94,100,MS DRG,61411.15,case rate,100% of CMS IPPS rate,22664.91,100,,,case rate,100% of CMS IPPS rate,76763.94,100,MS DRG,61411.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22664.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,251114.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,76763.94,100,MS DRG,61411.15,case rate,100% of CMS IPPS rate,76763.94,100,MS DRG,61411.15,case rate,100% of CMS IPPS rate,22664.91,251114.5,
PREMATURITY WITH MAJOR PROBLEMS,791,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54319.53,100,MS DRG,43455.62,case rate,100% of CMS IPPS rate,86911.25,160,MS DRG,69529,case rate,160% of CMS IPPS rate,70615.39,130,MS DRG,56492.31,case rate,130% of CMS IPPS rate,15478.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16252.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,54319.53,100,MS DRG,43455.62,case rate,100% of CMS IPPS rate,15478.61,100,,,case rate,100% of CMS IPPS rate,54319.53,100,MS DRG,43455.62,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15478.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167564.82,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,54319.53,100,MS DRG,43455.62,case rate,100% of CMS IPPS rate,54319.53,100,MS DRG,43455.62,case rate,100% of CMS IPPS rate,15478.61,167564.8,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35145.52,100,MS DRG,28116.42,case rate,100% of CMS IPPS rate,56232.83,160,MS DRG,44986.26,case rate,160% of CMS IPPS rate,45689.18,130,MS DRG,36551.34,case rate,130% of CMS IPPS rate,9339.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9806.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35145.52,100,MS DRG,28116.42,case rate,100% of CMS IPPS rate,9339.63,100,,,case rate,100% of CMS IPPS rate,35145.52,100,MS DRG,28116.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9339.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141257.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35145.52,100,MS DRG,28116.42,case rate,100% of CMS IPPS rate,35145.52,100,MS DRG,28116.42,case rate,100% of CMS IPPS rate,9339.63,141257.5,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55636.19,100,MS DRG,44508.95,case rate,100% of CMS IPPS rate,89017.9,160,MS DRG,71214.32,case rate,160% of CMS IPPS rate,72327.05,130,MS DRG,57861.64,case rate,130% of CMS IPPS rate,15900.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16695.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,55636.19,100,MS DRG,44508.95,case rate,100% of CMS IPPS rate,15900.28,100,,,case rate,100% of CMS IPPS rate,55636.19,100,MS DRG,44508.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15900.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1432211.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,55636.19,100,MS DRG,44508.95,case rate,100% of CMS IPPS rate,55636.19,100,MS DRG,44508.95,case rate,100% of CMS IPPS rate,15900.28,1432212,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23552.87,100,MS DRG,18842.3,case rate,100% of CMS IPPS rate,37684.59,160,MS DRG,30147.67,case rate,160% of CMS IPPS rate,30618.73,130,MS DRG,24494.98,case rate,130% of CMS IPPS rate,5628.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5909.49,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23552.87,100,MS DRG,18842.3,case rate,100% of CMS IPPS rate,5628.1,100,,,case rate,100% of CMS IPPS rate,23552.87,100,MS DRG,18842.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5628.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283490.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23552.87,100,MS DRG,18842.3,case rate,100% of CMS IPPS rate,23552.87,100,MS DRG,18842.3,case rate,100% of CMS IPPS rate,5628.1,283490.2,
NORMAL NEWBORN,795,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8354.76,100,MS DRG,6683.81,case rate,100% of CMS IPPS rate,13367.62,160,MS DRG,10694.1,case rate,160% of CMS IPPS rate,10861.19,130,MS DRG,8688.95,case rate,130% of CMS IPPS rate,761.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,799.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,8354.76,100,MS DRG,6683.81,case rate,100% of CMS IPPS rate,761.75,100,,,case rate,100% of CMS IPPS rate,8354.76,100,MS DRG,6683.81,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,761.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90908.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8354.76,100,MS DRG,6683.81,case rate,100% of CMS IPPS rate,8354.76,100,MS DRG,6683.81,case rate,100% of CMS IPPS rate,761.75,90908.35,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22709.31,100,MS DRG,18167.45,case rate,100% of CMS IPPS rate,36334.9,160,MS DRG,29067.92,case rate,160% of CMS IPPS rate,29522.1,130,MS DRG,23617.68,case rate,130% of CMS IPPS rate,4045.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4247.37,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22709.31,100,MS DRG,18167.45,case rate,100% of CMS IPPS rate,4045.13,100,,,case rate,100% of CMS IPPS rate,22709.31,100,MS DRG,18167.45,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4045.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,442583.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22709.31,100,MS DRG,18167.45,case rate,100% of CMS IPPS rate,22709.31,100,MS DRG,18167.45,case rate,100% of CMS IPPS rate,4045.13,442583.9,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17724.67,100,MS DRG,14179.74,case rate,100% of CMS IPPS rate,28359.47,160,MS DRG,22687.58,case rate,160% of CMS IPPS rate,23042.07,130,MS DRG,18433.66,case rate,130% of CMS IPPS rate,3691.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3875.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17724.67,100,MS DRG,14179.74,case rate,100% of CMS IPPS rate,3691.32,100,,,case rate,100% of CMS IPPS rate,17724.67,100,MS DRG,14179.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3691.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414202.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17724.67,100,MS DRG,14179.74,case rate,100% of CMS IPPS rate,17724.67,100,MS DRG,14179.74,case rate,100% of CMS IPPS rate,3691.32,414202.1,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15827.57,100,MS DRG,12662.06,case rate,100% of CMS IPPS rate,25324.11,160,MS DRG,20259.29,case rate,160% of CMS IPPS rate,20575.84,130,MS DRG,16460.67,case rate,130% of CMS IPPS rate,3691.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3875.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15827.57,100,MS DRG,12662.06,case rate,100% of CMS IPPS rate,3691.32,100,,,case rate,100% of CMS IPPS rate,15827.57,100,MS DRG,12662.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3691.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,509940.2,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15827.57,100,MS DRG,12662.06,case rate,100% of CMS IPPS rate,15827.57,100,MS DRG,12662.06,case rate,100% of CMS IPPS rate,3691.32,509940.2,
SPLENIC PROCEDURES WITH MCC,799,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64429.18,100,MS DRG,51543.34,case rate,100% of CMS IPPS rate,103086.69,160,MS DRG,82469.35,case rate,160% of CMS IPPS rate,83757.93,130,MS DRG,67006.34,case rate,130% of CMS IPPS rate,18127.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19034.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64429.18,100,MS DRG,51543.34,case rate,100% of CMS IPPS rate,18127.96,100,,,case rate,100% of CMS IPPS rate,64429.18,100,MS DRG,51543.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18127.96,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,990828.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,64429.18,100,MS DRG,51543.34,case rate,100% of CMS IPPS rate,64429.18,100,MS DRG,51543.34,case rate,100% of CMS IPPS rate,18127.96,990828.6,
SPLENIC PROCEDURES WITH CC,800,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39218.16,100,MS DRG,31374.53,case rate,100% of CMS IPPS rate,62749.06,160,MS DRG,50199.25,case rate,160% of CMS IPPS rate,50983.61,130,MS DRG,40786.89,case rate,130% of CMS IPPS rate,11109.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11664.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39218.16,100,MS DRG,31374.53,case rate,100% of CMS IPPS rate,11109.04,100,,,case rate,100% of CMS IPPS rate,39218.16,100,MS DRG,31374.53,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11109.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,767087.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39218.16,100,MS DRG,31374.53,case rate,100% of CMS IPPS rate,39218.16,100,MS DRG,31374.53,case rate,100% of CMS IPPS rate,11109.04,767087.8,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27089.88,100,MS DRG,21671.9,case rate,100% of CMS IPPS rate,43343.81,160,MS DRG,34675.05,case rate,160% of CMS IPPS rate,35216.84,130,MS DRG,28173.47,case rate,130% of CMS IPPS rate,6259.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6572.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27089.88,100,MS DRG,21671.9,case rate,100% of CMS IPPS rate,6259.08,100,,,case rate,100% of CMS IPPS rate,27089.88,100,MS DRG,21671.9,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6259.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1060037.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27089.88,100,MS DRG,21671.9,case rate,100% of CMS IPPS rate,27089.88,100,MS DRG,21671.9,case rate,100% of CMS IPPS rate,6259.08,1060037,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46451.48,100,MS DRG,37161.18,case rate,100% of CMS IPPS rate,74322.37,160,MS DRG,59457.9,case rate,160% of CMS IPPS rate,60386.92,130,MS DRG,48309.54,case rate,130% of CMS IPPS rate,13667.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14350.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,46451.48,100,MS DRG,37161.18,case rate,100% of CMS IPPS rate,13667.27,100,,,case rate,100% of CMS IPPS rate,46451.48,100,MS DRG,37161.18,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13667.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,943202.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,46451.48,100,MS DRG,37161.18,case rate,100% of CMS IPPS rate,46451.48,100,MS DRG,37161.18,case rate,100% of CMS IPPS rate,13667.27,943202.7,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27898.05,100,MS DRG,22318.44,case rate,100% of CMS IPPS rate,44636.88,160,MS DRG,35709.5,case rate,160% of CMS IPPS rate,36267.47,130,MS DRG,29013.98,case rate,130% of CMS IPPS rate,6786.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7125.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27898.05,100,MS DRG,22318.44,case rate,100% of CMS IPPS rate,6786.36,100,,,case rate,100% of CMS IPPS rate,27898.05,100,MS DRG,22318.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6786.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565511.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27898.05,100,MS DRG,22318.44,case rate,100% of CMS IPPS rate,27898.05,100,MS DRG,22318.44,case rate,100% of CMS IPPS rate,6786.36,565511.9,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20255.34,100,MS DRG,16204.27,case rate,100% of CMS IPPS rate,32408.54,160,MS DRG,25926.83,case rate,160% of CMS IPPS rate,26331.94,130,MS DRG,21065.55,case rate,130% of CMS IPPS rate,4215.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4425.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20255.34,100,MS DRG,16204.27,case rate,100% of CMS IPPS rate,4215.17,100,,,case rate,100% of CMS IPPS rate,20255.34,100,MS DRG,16204.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4215.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960505.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20255.34,100,MS DRG,16204.27,case rate,100% of CMS IPPS rate,20255.34,100,MS DRG,16204.27,case rate,100% of CMS IPPS rate,4215.17,960505.5,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17869.79,100,MS DRG,14295.83,case rate,100% of CMS IPPS rate,28591.66,160,MS DRG,22873.33,case rate,160% of CMS IPPS rate,23230.73,130,MS DRG,18584.58,case rate,130% of CMS IPPS rate,3804.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3995.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17869.79,100,MS DRG,14295.83,case rate,100% of CMS IPPS rate,3804.93,100,,,case rate,100% of CMS IPPS rate,17869.79,100,MS DRG,14295.83,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3804.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283098.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17869.79,100,MS DRG,14295.83,case rate,100% of CMS IPPS rate,17869.79,100,MS DRG,14295.83,case rate,100% of CMS IPPS rate,3804.93,283098.1,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14784.64,100,MS DRG,11827.71,case rate,100% of CMS IPPS rate,23655.42,160,MS DRG,18924.34,case rate,160% of CMS IPPS rate,19220.03,130,MS DRG,15376.02,case rate,130% of CMS IPPS rate,2758.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2896.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14784.64,100,MS DRG,11827.71,case rate,100% of CMS IPPS rate,2758.77,100,,,case rate,100% of CMS IPPS rate,14784.64,100,MS DRG,11827.71,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2758.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,307245.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14784.64,100,MS DRG,11827.71,case rate,100% of CMS IPPS rate,14784.64,100,MS DRG,11827.71,case rate,100% of CMS IPPS rate,2758.77,307245.5,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13694.5,100,MS DRG,10955.6,case rate,100% of CMS IPPS rate,21911.2,160,MS DRG,17528.96,case rate,160% of CMS IPPS rate,17802.85,130,MS DRG,14242.28,case rate,130% of CMS IPPS rate,2429.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2551.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13694.5,100,MS DRG,10955.6,case rate,100% of CMS IPPS rate,2429.74,100,,,case rate,100% of CMS IPPS rate,13694.5,100,MS DRG,10955.6,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2429.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,302259.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13694.5,100,MS DRG,10955.6,case rate,100% of CMS IPPS rate,13694.5,100,MS DRG,10955.6,case rate,100% of CMS IPPS rate,2429.74,302259.5,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31813.78,100,MS DRG,25451.02,case rate,100% of CMS IPPS rate,50902.05,160,MS DRG,40721.64,case rate,160% of CMS IPPS rate,41357.91,130,MS DRG,33086.33,case rate,130% of CMS IPPS rate,8731.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9168.48,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31813.78,100,MS DRG,25451.02,case rate,100% of CMS IPPS rate,8731.91,100,,,case rate,100% of CMS IPPS rate,31813.78,100,MS DRG,25451.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8731.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,489793.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31813.78,100,MS DRG,25451.02,case rate,100% of CMS IPPS rate,31813.78,100,MS DRG,25451.02,case rate,100% of CMS IPPS rate,8731.91,489794,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20184.56,100,MS DRG,16147.65,case rate,100% of CMS IPPS rate,32295.3,160,MS DRG,25836.24,case rate,160% of CMS IPPS rate,26239.93,130,MS DRG,20991.94,case rate,130% of CMS IPPS rate,4721.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4957.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20184.56,100,MS DRG,16147.65,case rate,100% of CMS IPPS rate,4721.86,100,,,case rate,100% of CMS IPPS rate,20184.56,100,MS DRG,16147.65,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4721.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368751.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20184.56,100,MS DRG,16147.65,case rate,100% of CMS IPPS rate,20184.56,100,MS DRG,16147.65,case rate,100% of CMS IPPS rate,4721.86,368751.3,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17826.14,100,MS DRG,14260.91,case rate,100% of CMS IPPS rate,28521.82,160,MS DRG,22817.46,case rate,160% of CMS IPPS rate,23173.98,130,MS DRG,18539.18,case rate,130% of CMS IPPS rate,3628.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3810.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17826.14,100,MS DRG,14260.91,case rate,100% of CMS IPPS rate,3628.79,100,,,case rate,100% of CMS IPPS rate,17826.14,100,MS DRG,14260.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3628.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424431.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17826.14,100,MS DRG,14260.91,case rate,100% of CMS IPPS rate,17826.14,100,MS DRG,14260.91,case rate,100% of CMS IPPS rate,3628.79,424431.1,
RED BLOOD CELL DISORDERS WITH MCC,811,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22534.7,100,MS DRG,18027.76,case rate,100% of CMS IPPS rate,36055.52,160,MS DRG,28844.42,case rate,160% of CMS IPPS rate,29295.11,130,MS DRG,23436.09,case rate,130% of CMS IPPS rate,5363.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5632.07,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22534.7,100,MS DRG,18027.76,case rate,100% of CMS IPPS rate,5363.89,100,,,case rate,100% of CMS IPPS rate,22534.7,100,MS DRG,18027.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5363.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396353.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22534.7,100,MS DRG,18027.76,case rate,100% of CMS IPPS rate,22534.7,100,MS DRG,18027.76,case rate,100% of CMS IPPS rate,5363.89,396353.4,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16601.52,100,MS DRG,13281.22,case rate,100% of CMS IPPS rate,26562.43,160,MS DRG,21249.94,case rate,160% of CMS IPPS rate,21581.98,130,MS DRG,17265.58,case rate,130% of CMS IPPS rate,3518.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3694.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16601.52,100,MS DRG,13281.22,case rate,100% of CMS IPPS rate,3518.61,100,,,case rate,100% of CMS IPPS rate,16601.52,100,MS DRG,13281.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3518.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360275.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16601.52,100,MS DRG,13281.22,case rate,100% of CMS IPPS rate,16601.52,100,MS DRG,13281.22,case rate,100% of CMS IPPS rate,3518.61,360275.1,
COAGULATION DISORDERS,813,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24379.91,100,MS DRG,19503.93,case rate,100% of CMS IPPS rate,39007.86,160,MS DRG,31206.29,case rate,160% of CMS IPPS rate,31693.88,130,MS DRG,25355.1,case rate,130% of CMS IPPS rate,5901.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6196.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24379.91,100,MS DRG,19503.93,case rate,100% of CMS IPPS rate,5901.84,100,,,case rate,100% of CMS IPPS rate,24379.91,100,MS DRG,19503.93,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5901.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,586057.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24379.91,100,MS DRG,19503.93,case rate,100% of CMS IPPS rate,24379.91,100,MS DRG,19503.93,case rate,100% of CMS IPPS rate,5901.84,586057.3,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31082.3,100,MS DRG,24865.84,case rate,100% of CMS IPPS rate,49731.68,160,MS DRG,39785.34,case rate,160% of CMS IPPS rate,40406.99,130,MS DRG,32325.59,case rate,130% of CMS IPPS rate,7970.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8368.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31082.3,100,MS DRG,24865.84,case rate,100% of CMS IPPS rate,7970.16,100,,,case rate,100% of CMS IPPS rate,31082.3,100,MS DRG,24865.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7970.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490216.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31082.3,100,MS DRG,24865.84,case rate,100% of CMS IPPS rate,31082.3,100,MS DRG,24865.84,case rate,100% of CMS IPPS rate,7970.16,490216.3,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17704.62,100,MS DRG,14163.7,case rate,100% of CMS IPPS rate,28327.39,160,MS DRG,22661.91,case rate,160% of CMS IPPS rate,23016.01,130,MS DRG,18412.81,case rate,130% of CMS IPPS rate,3873.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4067.63,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17704.62,100,MS DRG,14163.7,case rate,100% of CMS IPPS rate,3873.94,100,,,case rate,100% of CMS IPPS rate,17704.62,100,MS DRG,14163.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3873.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349043.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17704.62,100,MS DRG,14163.7,case rate,100% of CMS IPPS rate,17704.62,100,MS DRG,14163.7,case rate,100% of CMS IPPS rate,3873.94,349043,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14354.01,100,MS DRG,11483.21,case rate,100% of CMS IPPS rate,22966.42,160,MS DRG,18373.14,case rate,160% of CMS IPPS rate,18660.21,130,MS DRG,14928.17,case rate,130% of CMS IPPS rate,2514,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2639.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14354.01,100,MS DRG,11483.21,case rate,100% of CMS IPPS rate,2514,100,,,case rate,100% of CMS IPPS rate,14354.01,100,MS DRG,11483.21,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2514,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323970.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14354.01,100,MS DRG,11483.21,case rate,100% of CMS IPPS rate,14354.01,100,MS DRG,11483.21,case rate,100% of CMS IPPS rate,2514,323970.2,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39207.56,100,MS DRG,31366.05,case rate,100% of CMS IPPS rate,62732.1,160,MS DRG,50185.68,case rate,160% of CMS IPPS rate,50969.83,130,MS DRG,40775.86,case rate,130% of CMS IPPS rate,8333.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8750.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,39207.56,100,MS DRG,31366.05,case rate,100% of CMS IPPS rate,8333.87,100,,,case rate,100% of CMS IPPS rate,39207.56,100,MS DRG,31366.05,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8333.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,629021.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,39207.56,100,MS DRG,31366.05,case rate,100% of CMS IPPS rate,39207.56,100,MS DRG,31366.05,case rate,100% of CMS IPPS rate,8333.87,629021.2,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22859.14,100,MS DRG,18287.31,case rate,100% of CMS IPPS rate,36574.62,160,MS DRG,29259.7,case rate,160% of CMS IPPS rate,29716.88,130,MS DRG,23773.5,case rate,130% of CMS IPPS rate,3772.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3960.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22859.14,100,MS DRG,18287.31,case rate,100% of CMS IPPS rate,3772.15,100,,,case rate,100% of CMS IPPS rate,22859.14,100,MS DRG,18287.31,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3772.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,677694.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22859.14,100,MS DRG,18287.31,case rate,100% of CMS IPPS rate,22859.14,100,MS DRG,18287.31,case rate,100% of CMS IPPS rate,3772.15,677694.1,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16678.2,100,MS DRG,13342.56,case rate,100% of CMS IPPS rate,26685.12,160,MS DRG,21348.1,case rate,160% of CMS IPPS rate,21681.66,130,MS DRG,17345.33,case rate,130% of CMS IPPS rate,2575,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2703.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16678.2,100,MS DRG,13342.56,case rate,100% of CMS IPPS rate,2575,100,,,case rate,100% of CMS IPPS rate,16678.2,100,MS DRG,13342.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2575,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452740.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16678.2,100,MS DRG,13342.56,case rate,100% of CMS IPPS rate,16678.2,100,MS DRG,13342.56,case rate,100% of CMS IPPS rate,2575,452740.9,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77313.72,100,MS DRG,61850.98,case rate,100% of CMS IPPS rate,123701.95,160,MS DRG,98961.56,case rate,160% of CMS IPPS rate,100507.84,130,MS DRG,80406.27,case rate,130% of CMS IPPS rate,22197.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23307.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77313.72,100,MS DRG,61850.98,case rate,100% of CMS IPPS rate,22197.87,100,,,case rate,100% of CMS IPPS rate,77313.72,100,MS DRG,61850.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22197.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,700315.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,77313.72,100,MS DRG,61850.98,case rate,100% of CMS IPPS rate,77313.72,100,MS DRG,61850.98,case rate,100% of CMS IPPS rate,22197.87,700315.6,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32309.28,100,MS DRG,25847.42,case rate,100% of CMS IPPS rate,51694.85,160,MS DRG,41355.88,case rate,160% of CMS IPPS rate,42002.06,130,MS DRG,33601.65,case rate,130% of CMS IPPS rate,8511.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8936.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32309.28,100,MS DRG,25847.42,case rate,100% of CMS IPPS rate,8511.16,100,,,case rate,100% of CMS IPPS rate,32309.28,100,MS DRG,25847.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8511.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,535533.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32309.28,100,MS DRG,25847.42,case rate,100% of CMS IPPS rate,32309.28,100,MS DRG,25847.42,case rate,100% of CMS IPPS rate,8511.16,535533.7,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20590.39,100,MS DRG,16472.31,case rate,100% of CMS IPPS rate,32944.62,160,MS DRG,26355.7,case rate,160% of CMS IPPS rate,26767.51,130,MS DRG,21414.01,case rate,130% of CMS IPPS rate,4360.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4578.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20590.39,100,MS DRG,16472.31,case rate,100% of CMS IPPS rate,4360.42,100,,,case rate,100% of CMS IPPS rate,20590.39,100,MS DRG,16472.31,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4360.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,897978.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20590.39,100,MS DRG,16472.31,case rate,100% of CMS IPPS rate,20590.39,100,MS DRG,16472.31,case rate,100% of CMS IPPS rate,4360.42,897978.1,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59088.26,100,MS DRG,47270.61,case rate,100% of CMS IPPS rate,94541.22,160,MS DRG,75632.98,case rate,160% of CMS IPPS rate,76814.74,130,MS DRG,61451.79,case rate,130% of CMS IPPS rate,17840.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18732.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,59088.26,100,MS DRG,47270.61,case rate,100% of CMS IPPS rate,17840.87,100,,,case rate,100% of CMS IPPS rate,59088.26,100,MS DRG,47270.61,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17840.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,477948.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,59088.26,100,MS DRG,47270.61,case rate,100% of CMS IPPS rate,59088.26,100,MS DRG,47270.61,case rate,100% of CMS IPPS rate,17840.87,477948.1,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32318.73,100,MS DRG,25854.98,case rate,100% of CMS IPPS rate,51709.97,160,MS DRG,41367.98,case rate,160% of CMS IPPS rate,42014.35,130,MS DRG,33611.48,case rate,130% of CMS IPPS rate,8385.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8804.59,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32318.73,100,MS DRG,25854.98,case rate,100% of CMS IPPS rate,8385.34,100,,,case rate,100% of CMS IPPS rate,32318.73,100,MS DRG,25854.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8385.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,584755.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32318.73,100,MS DRG,25854.98,case rate,100% of CMS IPPS rate,32318.73,100,MS DRG,25854.98,case rate,100% of CMS IPPS rate,8385.34,584755.9,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21210.98,100,MS DRG,16968.78,case rate,100% of CMS IPPS rate,33937.57,160,MS DRG,27150.06,case rate,160% of CMS IPPS rate,27574.27,130,MS DRG,22059.42,case rate,130% of CMS IPPS rate,4692.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4927.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21210.98,100,MS DRG,16968.78,case rate,100% of CMS IPPS rate,4692.5,100,,,case rate,100% of CMS IPPS rate,21210.98,100,MS DRG,16968.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4692.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,893298.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21210.98,100,MS DRG,16968.78,case rate,100% of CMS IPPS rate,21210.98,100,MS DRG,16968.78,case rate,100% of CMS IPPS rate,4692.5,893298.4,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60572.44,100,MS DRG,48457.95,case rate,100% of CMS IPPS rate,96915.9,160,MS DRG,77532.72,case rate,160% of CMS IPPS rate,78744.17,130,MS DRG,62995.34,case rate,130% of CMS IPPS rate,18206.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19117.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,60572.44,100,MS DRG,48457.95,case rate,100% of CMS IPPS rate,18206.88,100,,,case rate,100% of CMS IPPS rate,60572.44,100,MS DRG,48457.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18206.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,611992.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,60572.44,100,MS DRG,48457.95,case rate,100% of CMS IPPS rate,60572.44,100,MS DRG,48457.95,case rate,100% of CMS IPPS rate,18206.88,611992.4,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33313.29,100,MS DRG,26650.63,case rate,100% of CMS IPPS rate,53301.26,160,MS DRG,42641.01,case rate,160% of CMS IPPS rate,43307.28,130,MS DRG,34645.82,case rate,130% of CMS IPPS rate,8997.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9447.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,33313.29,100,MS DRG,26650.63,case rate,100% of CMS IPPS rate,8997.26,100,,,case rate,100% of CMS IPPS rate,33313.29,100,MS DRG,26650.63,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8997.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,595358.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,33313.29,100,MS DRG,26650.63,case rate,100% of CMS IPPS rate,33313.29,100,MS DRG,26650.63,case rate,100% of CMS IPPS rate,8997.26,595358,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25328.45,100,MS DRG,20262.76,case rate,100% of CMS IPPS rate,40525.52,160,MS DRG,32420.42,case rate,160% of CMS IPPS rate,32926.99,130,MS DRG,26341.59,case rate,130% of CMS IPPS rate,6111.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6416.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25328.45,100,MS DRG,20262.76,case rate,100% of CMS IPPS rate,6111.15,100,,,case rate,100% of CMS IPPS rate,25328.45,100,MS DRG,20262.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6111.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,974844.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25328.45,100,MS DRG,20262.76,case rate,100% of CMS IPPS rate,25328.45,100,MS DRG,20262.76,case rate,100% of CMS IPPS rate,6111.15,974844.6,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43183.45,100,MS DRG,34546.76,case rate,100% of CMS IPPS rate,69093.52,160,MS DRG,55274.82,case rate,160% of CMS IPPS rate,56138.49,130,MS DRG,44910.79,case rate,130% of CMS IPPS rate,11757.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12345.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43183.45,100,MS DRG,34546.76,case rate,100% of CMS IPPS rate,11757.17,100,,,case rate,100% of CMS IPPS rate,43183.45,100,MS DRG,34546.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11757.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,548968.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43183.45,100,MS DRG,34546.76,case rate,100% of CMS IPPS rate,43183.45,100,MS DRG,34546.76,case rate,100% of CMS IPPS rate,11757.17,548968.7,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24630.01,100,MS DRG,19704.01,case rate,100% of CMS IPPS rate,39408.02,160,MS DRG,31526.42,case rate,160% of CMS IPPS rate,32019.01,130,MS DRG,25615.21,case rate,130% of CMS IPPS rate,5575.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5854.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24630.01,100,MS DRG,19704.01,case rate,100% of CMS IPPS rate,5575.87,100,,,case rate,100% of CMS IPPS rate,24630.01,100,MS DRG,19704.01,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5575.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,637964.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24630.01,100,MS DRG,19704.01,case rate,100% of CMS IPPS rate,24630.01,100,MS DRG,19704.01,case rate,100% of CMS IPPS rate,5575.87,637964.6,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18661.43,100,MS DRG,14929.14,case rate,100% of CMS IPPS rate,29858.29,160,MS DRG,23886.63,case rate,160% of CMS IPPS rate,24259.86,130,MS DRG,19407.89,case rate,130% of CMS IPPS rate,4388.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4607.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18661.43,100,MS DRG,14929.14,case rate,100% of CMS IPPS rate,4388.26,100,,,case rate,100% of CMS IPPS rate,18661.43,100,MS DRG,14929.14,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4388.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257798.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18661.43,100,MS DRG,14929.14,case rate,100% of CMS IPPS rate,18661.43,100,MS DRG,14929.14,case rate,100% of CMS IPPS rate,4388.26,257798.5,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14678.45,100,MS DRG,11742.76,case rate,100% of CMS IPPS rate,23485.52,160,MS DRG,18788.42,case rate,160% of CMS IPPS rate,19081.99,130,MS DRG,15265.59,case rate,130% of CMS IPPS rate,2849.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2991.98,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14678.45,100,MS DRG,11742.76,case rate,100% of CMS IPPS rate,2849.51,100,,,case rate,100% of CMS IPPS rate,14678.45,100,MS DRG,11742.76,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2849.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241206.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14678.45,100,MS DRG,11742.76,case rate,100% of CMS IPPS rate,14678.45,100,MS DRG,11742.76,case rate,100% of CMS IPPS rate,2849.51,241206.9,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12013.3,100,MS DRG,9610.64,case rate,100% of CMS IPPS rate,19221.28,160,MS DRG,15377.02,case rate,160% of CMS IPPS rate,15617.29,130,MS DRG,12493.83,case rate,130% of CMS IPPS rate,1981.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2080.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12013.3,100,MS DRG,9610.64,case rate,100% of CMS IPPS rate,1981.77,100,,,case rate,100% of CMS IPPS rate,12013.3,100,MS DRG,9610.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1981.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215168.97,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12013.3,100,MS DRG,9610.64,case rate,100% of CMS IPPS rate,12013.3,100,MS DRG,9610.64,case rate,100% of CMS IPPS rate,1981.77,215169,
ACUTE LEUKEMIA WITH MCC,834,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72031.79,100,MS DRG,57625.43,case rate,100% of CMS IPPS rate,115250.86,160,MS DRG,92200.69,case rate,160% of CMS IPPS rate,93641.33,130,MS DRG,74913.06,case rate,130% of CMS IPPS rate,21073.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22126.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,72031.79,100,MS DRG,57625.43,case rate,100% of CMS IPPS rate,21073.16,100,,,case rate,100% of CMS IPPS rate,72031.79,100,MS DRG,57625.43,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21073.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521632.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,72031.79,100,MS DRG,57625.43,case rate,100% of CMS IPPS rate,72031.79,100,MS DRG,57625.43,case rate,100% of CMS IPPS rate,21073.16,521632.9,
ACUTE LEUKEMIA WITH CC,835,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32349.4,100,MS DRG,25879.52,case rate,100% of CMS IPPS rate,51759.04,160,MS DRG,41407.23,case rate,160% of CMS IPPS rate,42054.22,130,MS DRG,33643.38,case rate,130% of CMS IPPS rate,8143.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8550.39,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,32349.4,100,MS DRG,25879.52,case rate,100% of CMS IPPS rate,8143.25,100,,,case rate,100% of CMS IPPS rate,32349.4,100,MS DRG,25879.52,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8143.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,341240.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,32349.4,100,MS DRG,25879.52,case rate,100% of CMS IPPS rate,32349.4,100,MS DRG,25879.52,case rate,100% of CMS IPPS rate,8143.25,341240.8,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22632.61,100,MS DRG,18106.09,case rate,100% of CMS IPPS rate,36212.18,160,MS DRG,28969.74,case rate,160% of CMS IPPS rate,29422.39,130,MS DRG,23537.91,case rate,130% of CMS IPPS rate,4736.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4973.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22632.61,100,MS DRG,18106.09,case rate,100% of CMS IPPS rate,4736.72,100,,,case rate,100% of CMS IPPS rate,22632.61,100,MS DRG,18106.09,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4736.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,444257.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22632.61,100,MS DRG,18106.09,case rate,100% of CMS IPPS rate,22632.61,100,MS DRG,18106.09,case rate,100% of CMS IPPS rate,4736.72,444257.2,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63124.33,100,MS DRG,50499.46,case rate,100% of CMS IPPS rate,100998.93,160,MS DRG,80799.14,case rate,160% of CMS IPPS rate,82061.63,130,MS DRG,65649.3,case rate,130% of CMS IPPS rate,19090.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20044.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,63124.33,100,MS DRG,50499.46,case rate,100% of CMS IPPS rate,19090.25,100,,,case rate,100% of CMS IPPS rate,63124.33,100,MS DRG,50499.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19090.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456416.64,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,63124.33,100,MS DRG,50499.46,case rate,100% of CMS IPPS rate,63124.33,100,MS DRG,50499.46,case rate,100% of CMS IPPS rate,19090.25,456416.6,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29591.05,100,MS DRG,23672.84,case rate,100% of CMS IPPS rate,47345.68,160,MS DRG,37876.54,case rate,160% of CMS IPPS rate,38468.37,130,MS DRG,30774.7,case rate,130% of CMS IPPS rate,7732.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8119.25,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29591.05,100,MS DRG,23672.84,case rate,100% of CMS IPPS rate,7732.63,100,,,case rate,100% of CMS IPPS rate,29591.05,100,MS DRG,23672.84,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7732.63,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357924.61,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29591.05,100,MS DRG,23672.84,case rate,100% of CMS IPPS rate,29591.05,100,MS DRG,23672.84,case rate,100% of CMS IPPS rate,7732.63,357924.6,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21349.01,100,MS DRG,17079.21,case rate,100% of CMS IPPS rate,34158.42,160,MS DRG,27326.74,case rate,160% of CMS IPPS rate,27753.71,130,MS DRG,22202.97,case rate,130% of CMS IPPS rate,5224.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5485.96,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21349.01,100,MS DRG,17079.21,case rate,100% of CMS IPPS rate,5224.73,100,,,case rate,100% of CMS IPPS rate,21349.01,100,MS DRG,17079.21,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5224.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443343.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21349.01,100,MS DRG,17079.21,case rate,100% of CMS IPPS rate,21349.01,100,MS DRG,17079.21,case rate,100% of CMS IPPS rate,5224.73,443343.6,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42846.03,100,MS DRG,34276.82,case rate,100% of CMS IPPS rate,68553.65,160,MS DRG,54842.92,case rate,160% of CMS IPPS rate,55699.84,130,MS DRG,44559.87,case rate,130% of CMS IPPS rate,12158.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12766.14,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,42846.03,100,MS DRG,34276.82,case rate,100% of CMS IPPS rate,12158.25,100,,,case rate,100% of CMS IPPS rate,42846.03,100,MS DRG,34276.82,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12158.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,481356.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,42846.03,100,MS DRG,34276.82,case rate,100% of CMS IPPS rate,42846.03,100,MS DRG,34276.82,case rate,100% of CMS IPPS rate,12158.25,481356.1,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24539.17,100,MS DRG,19631.34,case rate,100% of CMS IPPS rate,39262.67,160,MS DRG,31410.14,case rate,160% of CMS IPPS rate,31900.92,130,MS DRG,25520.74,case rate,130% of CMS IPPS rate,5978.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6276.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24539.17,100,MS DRG,19631.34,case rate,100% of CMS IPPS rate,5978.09,100,,,case rate,100% of CMS IPPS rate,24539.17,100,MS DRG,19631.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5978.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422308.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24539.17,100,MS DRG,19631.34,case rate,100% of CMS IPPS rate,24539.17,100,MS DRG,19631.34,case rate,100% of CMS IPPS rate,5978.09,422308.6,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18556.44,100,MS DRG,14845.15,case rate,100% of CMS IPPS rate,29690.3,160,MS DRG,23752.24,case rate,160% of CMS IPPS rate,24123.37,130,MS DRG,19298.7,case rate,130% of CMS IPPS rate,4010.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4210.95,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18556.44,100,MS DRG,14845.15,case rate,100% of CMS IPPS rate,4010.43,100,,,case rate,100% of CMS IPPS rate,18556.44,100,MS DRG,14845.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4010.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,382290.5,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18556.44,100,MS DRG,14845.15,case rate,100% of CMS IPPS rate,18556.44,100,MS DRG,14845.15,case rate,100% of CMS IPPS rate,4010.43,382290.5,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27926.36,100,MS DRG,22341.09,case rate,100% of CMS IPPS rate,44682.18,160,MS DRG,35745.74,case rate,160% of CMS IPPS rate,36304.27,130,MS DRG,29043.42,case rate,130% of CMS IPPS rate,7218.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7579.22,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27926.36,100,MS DRG,22341.09,case rate,100% of CMS IPPS rate,7218.32,100,,,case rate,100% of CMS IPPS rate,27926.36,100,MS DRG,22341.09,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7218.32,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,394525.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27926.36,100,MS DRG,22341.09,case rate,100% of CMS IPPS rate,27926.36,100,MS DRG,22341.09,case rate,100% of CMS IPPS rate,7218.32,394525.1,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19627.69,100,MS DRG,15702.15,case rate,100% of CMS IPPS rate,31404.3,160,MS DRG,25123.44,case rate,160% of CMS IPPS rate,25516,130,MS DRG,20412.8,case rate,130% of CMS IPPS rate,4556.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4784.6,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,19627.69,100,MS DRG,15702.15,case rate,100% of CMS IPPS rate,4556.77,100,,,case rate,100% of CMS IPPS rate,19627.69,100,MS DRG,15702.15,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4556.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428158.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19627.69,100,MS DRG,15702.15,case rate,100% of CMS IPPS rate,19627.69,100,MS DRG,15702.15,case rate,100% of CMS IPPS rate,4556.77,428158.9,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16179.16,100,MS DRG,12943.33,case rate,100% of CMS IPPS rate,25886.66,160,MS DRG,20709.33,case rate,160% of CMS IPPS rate,21032.91,130,MS DRG,16826.33,case rate,130% of CMS IPPS rate,3190.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3349.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16179.16,100,MS DRG,12943.33,case rate,100% of CMS IPPS rate,3190.35,100,,,case rate,100% of CMS IPPS rate,16179.16,100,MS DRG,12943.33,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3190.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384187.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16179.16,100,MS DRG,12943.33,case rate,100% of CMS IPPS rate,16179.16,100,MS DRG,12943.33,case rate,100% of CMS IPPS rate,3190.35,384187.4,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34809.28,100,MS DRG,27847.42,case rate,100% of CMS IPPS rate,55694.85,160,MS DRG,44555.88,case rate,160% of CMS IPPS rate,45252.06,130,MS DRG,36201.65,case rate,130% of CMS IPPS rate,9736.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10223.32,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,34809.28,100,MS DRG,27847.42,case rate,100% of CMS IPPS rate,9736.52,100,,,case rate,100% of CMS IPPS rate,34809.28,100,MS DRG,27847.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9736.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424109.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,34809.28,100,MS DRG,27847.42,case rate,100% of CMS IPPS rate,34809.28,100,MS DRG,27847.42,case rate,100% of CMS IPPS rate,9736.52,424109.9,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20281.28,100,MS DRG,16225.02,case rate,100% of CMS IPPS rate,32450.05,160,MS DRG,25960.04,case rate,160% of CMS IPPS rate,26365.66,130,MS DRG,21092.53,case rate,130% of CMS IPPS rate,4844.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5086.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20281.28,100,MS DRG,16225.02,case rate,100% of CMS IPPS rate,4844.62,100,,,case rate,100% of CMS IPPS rate,20281.28,100,MS DRG,16225.02,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4844.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422125.93,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20281.28,100,MS DRG,16225.02,case rate,100% of CMS IPPS rate,20281.28,100,MS DRG,16225.02,case rate,100% of CMS IPPS rate,4844.62,422125.9,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15840.55,100,MS DRG,12672.44,case rate,100% of CMS IPPS rate,25344.88,160,MS DRG,20275.9,case rate,160% of CMS IPPS rate,20592.72,130,MS DRG,16474.18,case rate,130% of CMS IPPS rate,3122.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3278.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15840.55,100,MS DRG,12672.44,case rate,100% of CMS IPPS rate,3122.11,100,,,case rate,100% of CMS IPPS rate,15840.55,100,MS DRG,12672.44,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3122.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389490.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15840.55,100,MS DRG,12672.44,case rate,100% of CMS IPPS rate,15840.55,100,MS DRG,12672.44,case rate,100% of CMS IPPS rate,3122.11,389490.9,
RADIOTHERAPY,849,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37728.09,100,MS DRG,30182.47,case rate,100% of CMS IPPS rate,60364.94,160,MS DRG,48291.95,case rate,160% of CMS IPPS rate,49046.52,130,MS DRG,39237.22,case rate,130% of CMS IPPS rate,10183.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10692.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,37728.09,100,MS DRG,30182.47,case rate,100% of CMS IPPS rate,10183.73,100,,,case rate,100% of CMS IPPS rate,37728.09,100,MS DRG,30182.47,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10183.73,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413855.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,37728.09,100,MS DRG,30182.47,case rate,100% of CMS IPPS rate,37728.09,100,MS DRG,30182.47,case rate,100% of CMS IPPS rate,10183.73,413855.8,
ACUTE LEUKEMIA WITH OTHER PROCEDURES,850,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35120.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,36876.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35120.92,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35120.92,100,,,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,35120.92,36876.89,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64956.56,100,MS DRG,51965.25,case rate,100% of CMS IPPS rate,103930.5,160,MS DRG,83144.4,case rate,160% of CMS IPPS rate,84443.53,130,MS DRG,67554.82,case rate,130% of CMS IPPS rate,19067.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20021.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,64956.56,100,MS DRG,51965.25,case rate,100% of CMS IPPS rate,19067.76,100,,,case rate,100% of CMS IPPS rate,64956.56,100,MS DRG,51965.25,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19067.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574303.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,64956.56,100,MS DRG,51965.25,case rate,100% of CMS IPPS rate,64956.56,100,MS DRG,51965.25,case rate,100% of CMS IPPS rate,19067.76,574303,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30021.67,100,MS DRG,24017.34,case rate,100% of CMS IPPS rate,48034.67,160,MS DRG,38427.74,case rate,160% of CMS IPPS rate,39028.17,130,MS DRG,31222.54,case rate,130% of CMS IPPS rate,7617.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7998.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30021.67,100,MS DRG,24017.34,case rate,100% of CMS IPPS rate,7617.88,100,,,case rate,100% of CMS IPPS rate,30021.67,100,MS DRG,24017.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7617.88,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,508411.51,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30021.67,100,MS DRG,24017.34,case rate,100% of CMS IPPS rate,30021.67,100,MS DRG,24017.34,case rate,100% of CMS IPPS rate,7617.88,508411.5,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26052.84,100,MS DRG,20842.27,case rate,100% of CMS IPPS rate,41684.54,160,MS DRG,33347.63,case rate,160% of CMS IPPS rate,33868.69,130,MS DRG,27094.95,case rate,130% of CMS IPPS rate,6197.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6507.57,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26052.84,100,MS DRG,20842.27,case rate,100% of CMS IPPS rate,6197.7,100,,,case rate,100% of CMS IPPS rate,26052.84,100,MS DRG,20842.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6197.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,604775.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26052.84,100,MS DRG,20842.27,case rate,100% of CMS IPPS rate,26052.84,100,MS DRG,20842.27,case rate,100% of CMS IPPS rate,6197.7,604775,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58221.11,100,MS DRG,46576.89,case rate,100% of CMS IPPS rate,93153.78,160,MS DRG,74523.02,case rate,160% of CMS IPPS rate,75687.44,130,MS DRG,60549.95,case rate,130% of CMS IPPS rate,17200.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18060.75,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,58221.11,100,MS DRG,46576.89,case rate,100% of CMS IPPS rate,17200.75,100,,,case rate,100% of CMS IPPS rate,58221.11,100,MS DRG,46576.89,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17200.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486237.21,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,58221.11,100,MS DRG,46576.89,case rate,100% of CMS IPPS rate,58221.11,100,MS DRG,46576.89,case rate,100% of CMS IPPS rate,17200.75,486237.2,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31171.97,100,MS DRG,24937.58,case rate,100% of CMS IPPS rate,49875.15,160,MS DRG,39900.12,case rate,160% of CMS IPPS rate,40523.56,130,MS DRG,32418.85,case rate,130% of CMS IPPS rate,8307.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8722.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31171.97,100,MS DRG,24937.58,case rate,100% of CMS IPPS rate,8307.19,100,,,case rate,100% of CMS IPPS rate,31171.97,100,MS DRG,24937.58,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8307.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,458200,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31171.97,100,MS DRG,24937.58,case rate,100% of CMS IPPS rate,31171.97,100,MS DRG,24937.58,case rate,100% of CMS IPPS rate,8307.19,458200,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21116.58,100,MS DRG,16893.26,case rate,100% of CMS IPPS rate,33786.53,160,MS DRG,27029.22,case rate,160% of CMS IPPS rate,27451.55,130,MS DRG,21961.24,case rate,130% of CMS IPPS rate,4912.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5157.7,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21116.58,100,MS DRG,16893.26,case rate,100% of CMS IPPS rate,4912.1,100,,,case rate,100% of CMS IPPS rate,21116.58,100,MS DRG,16893.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4912.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,453267.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21116.58,100,MS DRG,16893.26,case rate,100% of CMS IPPS rate,21116.58,100,MS DRG,16893.26,case rate,100% of CMS IPPS rate,4912.1,453267.3,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27706.91,100,MS DRG,22165.53,case rate,100% of CMS IPPS rate,44331.06,160,MS DRG,35464.85,case rate,160% of CMS IPPS rate,36018.98,130,MS DRG,28815.18,case rate,130% of CMS IPPS rate,7010.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7360.65,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27706.91,100,MS DRG,22165.53,case rate,100% of CMS IPPS rate,7010.15,100,,,case rate,100% of CMS IPPS rate,27706.91,100,MS DRG,22165.53,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7010.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349450.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27706.91,100,MS DRG,22165.53,case rate,100% of CMS IPPS rate,27706.91,100,MS DRG,22165.53,case rate,100% of CMS IPPS rate,7010.15,349450.5,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17837.94,100,MS DRG,14270.35,case rate,100% of CMS IPPS rate,28540.7,160,MS DRG,22832.56,case rate,160% of CMS IPPS rate,23189.32,130,MS DRG,18551.46,case rate,130% of CMS IPPS rate,3812.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4002.78,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17837.94,100,MS DRG,14270.35,case rate,100% of CMS IPPS rate,3812.18,100,,,case rate,100% of CMS IPPS rate,17837.94,100,MS DRG,14270.35,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3812.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295426.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17837.94,100,MS DRG,14270.35,case rate,100% of CMS IPPS rate,17837.94,100,MS DRG,14270.35,case rate,100% of CMS IPPS rate,3812.18,295426.4,
FEVER AND INFLAMMATORY CONDITIONS,864,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16390.34,100,MS DRG,13112.27,case rate,100% of CMS IPPS rate,26224.54,160,MS DRG,20979.63,case rate,160% of CMS IPPS rate,21307.44,130,MS DRG,17045.95,case rate,130% of CMS IPPS rate,3423.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3594.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16390.34,100,MS DRG,13112.27,case rate,100% of CMS IPPS rate,3423.68,100,,,case rate,100% of CMS IPPS rate,16390.34,100,MS DRG,13112.27,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3423.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413370.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16390.34,100,MS DRG,13112.27,case rate,100% of CMS IPPS rate,16390.34,100,MS DRG,13112.27,case rate,100% of CMS IPPS rate,3423.68,413370.9,
VIRAL ILLNESS WITH MCC,865,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25322.54,100,MS DRG,20258.03,case rate,100% of CMS IPPS rate,40516.06,160,MS DRG,32412.85,case rate,160% of CMS IPPS rate,32919.3,130,MS DRG,26335.44,case rate,130% of CMS IPPS rate,5530.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5806.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25322.54,100,MS DRG,20258.03,case rate,100% of CMS IPPS rate,5530.12,100,,,case rate,100% of CMS IPPS rate,25322.54,100,MS DRG,20258.03,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5530.12,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412737.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25322.54,100,MS DRG,20258.03,case rate,100% of CMS IPPS rate,25322.54,100,MS DRG,20258.03,case rate,100% of CMS IPPS rate,5530.12,412737.4,
VIRAL ILLNESS WITHOUT MCC,866,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16802.08,100,MS DRG,13441.66,case rate,100% of CMS IPPS rate,26883.33,160,MS DRG,21506.66,case rate,160% of CMS IPPS rate,21842.7,130,MS DRG,17474.16,case rate,130% of CMS IPPS rate,3373.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3542.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16802.08,100,MS DRG,13441.66,case rate,100% of CMS IPPS rate,3373.35,100,,,case rate,100% of CMS IPPS rate,16802.08,100,MS DRG,13441.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3373.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383333.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16802.08,100,MS DRG,13441.66,case rate,100% of CMS IPPS rate,16802.08,100,MS DRG,13441.66,case rate,100% of CMS IPPS rate,3373.35,383333.7,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30659.94,100,MS DRG,24527.95,case rate,100% of CMS IPPS rate,49055.9,160,MS DRG,39244.72,case rate,160% of CMS IPPS rate,39857.92,130,MS DRG,31886.34,case rate,130% of CMS IPPS rate,8175.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8584.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30659.94,100,MS DRG,24527.95,case rate,100% of CMS IPPS rate,8175.27,100,,,case rate,100% of CMS IPPS rate,30659.94,100,MS DRG,24527.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8175.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,498542.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30659.94,100,MS DRG,24527.95,case rate,100% of CMS IPPS rate,30659.94,100,MS DRG,24527.95,case rate,100% of CMS IPPS rate,8175.27,498542.6,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18781.78,100,MS DRG,15025.42,case rate,100% of CMS IPPS rate,30050.85,160,MS DRG,24040.68,case rate,160% of CMS IPPS rate,24416.31,130,MS DRG,19533.05,case rate,130% of CMS IPPS rate,4003.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4203.74,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18781.78,100,MS DRG,15025.42,case rate,100% of CMS IPPS rate,4003.57,100,,,case rate,100% of CMS IPPS rate,18781.78,100,MS DRG,15025.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4003.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,375166.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18781.78,100,MS DRG,15025.42,case rate,100% of CMS IPPS rate,18781.78,100,MS DRG,15025.42,case rate,100% of CMS IPPS rate,4003.57,375166.8,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14123.95,100,MS DRG,11299.16,case rate,100% of CMS IPPS rate,22598.32,160,MS DRG,18078.66,case rate,160% of CMS IPPS rate,18361.14,130,MS DRG,14688.91,case rate,130% of CMS IPPS rate,2743.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2880.69,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14123.95,100,MS DRG,11299.16,case rate,100% of CMS IPPS rate,2743.52,100,,,case rate,100% of CMS IPPS rate,14123.95,100,MS DRG,11299.16,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2743.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264513.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14123.95,100,MS DRG,11299.16,case rate,100% of CMS IPPS rate,14123.95,100,MS DRG,11299.16,case rate,100% of CMS IPPS rate,2743.52,264513,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88146.58,100,MS DRG,70517.26,case rate,100% of CMS IPPS rate,141034.53,160,MS DRG,112827.62,case rate,160% of CMS IPPS rate,114590.55,130,MS DRG,91672.44,case rate,130% of CMS IPPS rate,26522.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27848.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,88146.58,100,MS DRG,70517.26,case rate,100% of CMS IPPS rate,26522.07,100,,,case rate,100% of CMS IPPS rate,88146.58,100,MS DRG,70517.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26522.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,651310.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,88146.58,100,MS DRG,70517.26,case rate,100% of CMS IPPS rate,88146.58,100,MS DRG,70517.26,case rate,100% of CMS IPPS rate,26522.07,651310.5,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29365.7,100,MS DRG,23492.56,case rate,100% of CMS IPPS rate,46985.12,160,MS DRG,37588.1,case rate,160% of CMS IPPS rate,38175.41,130,MS DRG,30540.33,case rate,130% of CMS IPPS rate,7480.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7854.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29365.7,100,MS DRG,23492.56,case rate,100% of CMS IPPS rate,7480.62,100,,,case rate,100% of CMS IPPS rate,29365.7,100,MS DRG,23492.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7480.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424957.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29365.7,100,MS DRG,23492.56,case rate,100% of CMS IPPS rate,29365.7,100,MS DRG,23492.56,case rate,100% of CMS IPPS rate,7480.62,424957.7,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18125.8,100,MS DRG,14500.64,case rate,100% of CMS IPPS rate,29001.28,160,MS DRG,23201.02,case rate,160% of CMS IPPS rate,23563.54,130,MS DRG,18850.83,case rate,130% of CMS IPPS rate,3930.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4127.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18125.8,100,MS DRG,14500.64,case rate,100% of CMS IPPS rate,3930.75,100,,,case rate,100% of CMS IPPS rate,18125.8,100,MS DRG,14500.64,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3930.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,355242.4,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18125.8,100,MS DRG,14500.64,case rate,100% of CMS IPPS rate,18125.8,100,MS DRG,14500.64,case rate,100% of CMS IPPS rate,3930.75,355242.4,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49999.13,100,MS DRG,39999.3,case rate,100% of CMS IPPS rate,79998.61,160,MS DRG,63998.89,case rate,160% of CMS IPPS rate,64998.87,130,MS DRG,51999.1,case rate,130% of CMS IPPS rate,14981.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15730.9,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49999.13,100,MS DRG,39999.3,case rate,100% of CMS IPPS rate,14981.84,100,,,case rate,100% of CMS IPPS rate,49999.13,100,MS DRG,39999.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14981.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,885792.14,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49999.13,100,MS DRG,39999.3,case rate,100% of CMS IPPS rate,49999.13,100,MS DRG,39999.3,case rate,100% of CMS IPPS rate,14981.84,885792.1,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17237.42,100,MS DRG,13789.94,case rate,100% of CMS IPPS rate,27579.87,160,MS DRG,22063.9,case rate,160% of CMS IPPS rate,22408.65,130,MS DRG,17926.92,case rate,130% of CMS IPPS rate,3654.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3837.45,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17237.42,100,MS DRG,13789.94,case rate,100% of CMS IPPS rate,3654.72,100,,,case rate,100% of CMS IPPS rate,17237.42,100,MS DRG,13789.94,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3654.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213371.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17237.42,100,MS DRG,13789.94,case rate,100% of CMS IPPS rate,17237.42,100,MS DRG,13789.94,case rate,100% of CMS IPPS rate,3654.72,213371,
DEPRESSIVE NEUROSES,881,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16669.94,100,MS DRG,13335.95,case rate,100% of CMS IPPS rate,26671.9,160,MS DRG,21337.52,case rate,160% of CMS IPPS rate,21670.92,130,MS DRG,17336.74,case rate,130% of CMS IPPS rate,3485.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3659.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16669.94,100,MS DRG,13335.95,case rate,100% of CMS IPPS rate,3485.06,100,,,case rate,100% of CMS IPPS rate,16669.94,100,MS DRG,13335.95,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3485.06,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125312.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16669.94,100,MS DRG,13335.95,case rate,100% of CMS IPPS rate,16669.94,100,MS DRG,13335.95,case rate,100% of CMS IPPS rate,3485.06,125312.9,
NEUROSES EXCEPT DEPRESSIVE,882,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17056.91,100,MS DRG,13645.53,case rate,100% of CMS IPPS rate,27291.06,160,MS DRG,21832.85,case rate,160% of CMS IPPS rate,22173.98,130,MS DRG,17739.18,case rate,130% of CMS IPPS rate,3667.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3851.06,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17056.91,100,MS DRG,13645.53,case rate,100% of CMS IPPS rate,3667.68,100,,,case rate,100% of CMS IPPS rate,17056.91,100,MS DRG,13645.53,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3667.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116305.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17056.91,100,MS DRG,13645.53,case rate,100% of CMS IPPS rate,17056.91,100,MS DRG,13645.53,case rate,100% of CMS IPPS rate,3667.68,116305.5,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28100.96,100,MS DRG,22480.77,case rate,100% of CMS IPPS rate,44961.54,160,MS DRG,35969.23,case rate,160% of CMS IPPS rate,36531.25,130,MS DRG,29225,case rate,130% of CMS IPPS rate,7068.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7421.5,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28100.96,100,MS DRG,22480.77,case rate,100% of CMS IPPS rate,7068.1,100,,,case rate,100% of CMS IPPS rate,28100.96,100,MS DRG,22480.77,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7068.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123112,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28100.96,100,MS DRG,22480.77,case rate,100% of CMS IPPS rate,28100.96,100,MS DRG,22480.77,case rate,100% of CMS IPPS rate,7068.1,123112,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26702.9,100,MS DRG,21362.32,case rate,100% of CMS IPPS rate,42724.64,160,MS DRG,34179.71,case rate,160% of CMS IPPS rate,34713.77,130,MS DRG,27771.02,case rate,130% of CMS IPPS rate,6367.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6686.11,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26702.9,100,MS DRG,21362.32,case rate,100% of CMS IPPS rate,6367.74,100,,,case rate,100% of CMS IPPS rate,26702.9,100,MS DRG,21362.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6367.74,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161973.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26702.9,100,MS DRG,21362.32,case rate,100% of CMS IPPS rate,26702.9,100,MS DRG,21362.32,case rate,100% of CMS IPPS rate,6367.74,161973.5,
PSYCHOSES,885,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22095.81,100,MS DRG,17676.65,case rate,100% of CMS IPPS rate,35353.3,160,MS DRG,28282.64,case rate,160% of CMS IPPS rate,28724.55,130,MS DRG,22979.64,case rate,130% of CMS IPPS rate,5374.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5642.88,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22095.81,100,MS DRG,17676.65,case rate,100% of CMS IPPS rate,5374.18,100,,,case rate,100% of CMS IPPS rate,22095.81,100,MS DRG,17676.65,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5374.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119770.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22095.81,100,MS DRG,17676.65,case rate,100% of CMS IPPS rate,22095.81,100,MS DRG,17676.65,case rate,100% of CMS IPPS rate,5374.18,119770.4,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25815.71,100,MS DRG,20652.57,case rate,100% of CMS IPPS rate,41305.14,160,MS DRG,33044.11,case rate,160% of CMS IPPS rate,33560.42,130,MS DRG,26848.34,case rate,130% of CMS IPPS rate,6849.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7191.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25815.71,100,MS DRG,20652.57,case rate,100% of CMS IPPS rate,6849.26,100,,,case rate,100% of CMS IPPS rate,25815.71,100,MS DRG,20652.57,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6849.26,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133685.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25815.71,100,MS DRG,20652.57,case rate,100% of CMS IPPS rate,25815.71,100,MS DRG,20652.57,case rate,100% of CMS IPPS rate,6849.26,133685.2,
OTHER MENTAL DISORDER DIAGNOSES,887,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21260.52,100,MS DRG,17008.42,case rate,100% of CMS IPPS rate,34016.83,160,MS DRG,27213.46,case rate,160% of CMS IPPS rate,27638.68,130,MS DRG,22110.94,case rate,130% of CMS IPPS rate,4534.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4761.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21260.52,100,MS DRG,17008.42,case rate,100% of CMS IPPS rate,4534.66,100,,,case rate,100% of CMS IPPS rate,21260.52,100,MS DRG,17008.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4534.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113891.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21260.52,100,MS DRG,17008.42,case rate,100% of CMS IPPS rate,21260.52,100,MS DRG,17008.42,case rate,100% of CMS IPPS rate,4534.66,113891.4,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12753.03,100,MS DRG,10202.42,case rate,100% of CMS IPPS rate,20404.85,160,MS DRG,16323.88,case rate,160% of CMS IPPS rate,16578.94,130,MS DRG,13263.15,case rate,130% of CMS IPPS rate,2379.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2498.38,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12753.03,100,MS DRG,10202.42,case rate,100% of CMS IPPS rate,2379.42,100,,,case rate,100% of CMS IPPS rate,12753.03,100,MS DRG,10202.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2379.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196160.69,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12753.03,100,MS DRG,10202.42,case rate,100% of CMS IPPS rate,12753.03,100,MS DRG,10202.42,case rate,100% of CMS IPPS rate,2379.42,196160.7,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24955.64,100,MS DRG,19964.51,case rate,100% of CMS IPPS rate,39929.02,160,MS DRG,31943.22,case rate,160% of CMS IPPS rate,32442.33,130,MS DRG,25953.86,case rate,130% of CMS IPPS rate,5350.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5617.66,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24955.64,100,MS DRG,19964.51,case rate,100% of CMS IPPS rate,5350.17,100,,,case rate,100% of CMS IPPS rate,24955.64,100,MS DRG,19964.51,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5350.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98891.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24955.64,100,MS DRG,19964.51,case rate,100% of CMS IPPS rate,24955.64,100,MS DRG,19964.51,case rate,100% of CMS IPPS rate,5350.17,98891.72,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26953.03,100,MS DRG,21562.42,case rate,100% of CMS IPPS rate,43124.85,160,MS DRG,34499.88,case rate,160% of CMS IPPS rate,35038.94,130,MS DRG,28031.15,case rate,130% of CMS IPPS rate,6789.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7128.86,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26953.03,100,MS DRG,21562.42,case rate,100% of CMS IPPS rate,6789.41,100,,,case rate,100% of CMS IPPS rate,26953.03,100,MS DRG,21562.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6789.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,334921.04,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26953.03,100,MS DRG,21562.42,case rate,100% of CMS IPPS rate,26953.03,100,MS DRG,21562.42,case rate,100% of CMS IPPS rate,6789.41,334921,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16069.43,100,MS DRG,12855.54,case rate,100% of CMS IPPS rate,25711.09,160,MS DRG,20568.87,case rate,160% of CMS IPPS rate,20890.26,130,MS DRG,16712.21,case rate,130% of CMS IPPS rate,3363.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3531.61,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16069.43,100,MS DRG,12855.54,case rate,100% of CMS IPPS rate,3363.44,100,,,case rate,100% of CMS IPPS rate,16069.43,100,MS DRG,12855.54,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3363.44,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16069.43,100,MS DRG,12855.54,case rate,100% of CMS IPPS rate,16069.43,100,MS DRG,12855.54,case rate,100% of CMS IPPS rate,3363.44,25711.09,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57034.24,100,MS DRG,45627.39,case rate,100% of CMS IPPS rate,91254.78,160,MS DRG,73003.82,case rate,160% of CMS IPPS rate,74144.51,130,MS DRG,59315.61,case rate,130% of CMS IPPS rate,16891.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17736.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,57034.24,100,MS DRG,45627.39,case rate,100% of CMS IPPS rate,16891.55,100,,,case rate,100% of CMS IPPS rate,57034.24,100,MS DRG,45627.39,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16891.55,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,470815.81,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,57034.24,100,MS DRG,45627.39,case rate,100% of CMS IPPS rate,57034.24,100,MS DRG,45627.39,case rate,100% of CMS IPPS rate,16891.55,470815.8,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28210.69,100,MS DRG,22568.55,case rate,100% of CMS IPPS rate,45137.1,160,MS DRG,36109.68,case rate,160% of CMS IPPS rate,36673.9,130,MS DRG,29339.12,case rate,130% of CMS IPPS rate,7234.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7596.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28210.69,100,MS DRG,22568.55,case rate,100% of CMS IPPS rate,7234.71,100,,,case rate,100% of CMS IPPS rate,28210.69,100,MS DRG,22568.55,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7234.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,572576.48,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28210.69,100,MS DRG,22568.55,case rate,100% of CMS IPPS rate,28210.69,100,MS DRG,22568.55,case rate,100% of CMS IPPS rate,7234.71,572576.5,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20622.25,100,MS DRG,16497.8,case rate,100% of CMS IPPS rate,32995.6,160,MS DRG,26396.48,case rate,160% of CMS IPPS rate,26808.93,130,MS DRG,21447.14,case rate,130% of CMS IPPS rate,4647.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4880.28,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20622.25,100,MS DRG,16497.8,case rate,100% of CMS IPPS rate,4647.89,100,,,case rate,100% of CMS IPPS rate,20622.25,100,MS DRG,16497.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4647.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,515333.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20622.25,100,MS DRG,16497.8,case rate,100% of CMS IPPS rate,20622.25,100,MS DRG,16497.8,case rate,100% of CMS IPPS rate,4647.89,515333.2,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44391.57,100,MS DRG,35513.26,case rate,100% of CMS IPPS rate,71026.51,160,MS DRG,56821.21,case rate,160% of CMS IPPS rate,57709.04,130,MS DRG,46167.23,case rate,130% of CMS IPPS rate,14720.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15456.68,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,44391.57,100,MS DRG,35513.26,case rate,100% of CMS IPPS rate,14720.68,100,,,case rate,100% of CMS IPPS rate,44391.57,100,MS DRG,35513.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14720.68,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,586918.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,44391.57,100,MS DRG,35513.26,case rate,100% of CMS IPPS rate,44391.57,100,MS DRG,35513.26,case rate,100% of CMS IPPS rate,14720.68,586918.9,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24659.51,100,MS DRG,19727.61,case rate,100% of CMS IPPS rate,39455.22,160,MS DRG,31564.18,case rate,160% of CMS IPPS rate,32057.36,130,MS DRG,25645.89,case rate,130% of CMS IPPS rate,6283.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6598.04,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24659.51,100,MS DRG,19727.61,case rate,100% of CMS IPPS rate,6283.86,100,,,case rate,100% of CMS IPPS rate,24659.51,100,MS DRG,19727.61,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6283.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,538853.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24659.51,100,MS DRG,19727.61,case rate,100% of CMS IPPS rate,24659.51,100,MS DRG,19727.61,case rate,100% of CMS IPPS rate,6283.86,538853.5,
HAND PROCEDURES FOR INJURIES,906,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28174.12,100,MS DRG,22539.3,case rate,100% of CMS IPPS rate,45078.59,160,MS DRG,36062.87,case rate,160% of CMS IPPS rate,36626.36,130,MS DRG,29301.09,case rate,130% of CMS IPPS rate,8320.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8736.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,28174.12,100,MS DRG,22539.3,case rate,100% of CMS IPPS rate,8320.91,100,,,case rate,100% of CMS IPPS rate,28174.12,100,MS DRG,22539.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8320.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,636045.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,28174.12,100,MS DRG,22539.3,case rate,100% of CMS IPPS rate,28174.12,100,MS DRG,22539.3,case rate,100% of CMS IPPS rate,8320.91,636045.5,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49857.55,100,MS DRG,39886.04,case rate,100% of CMS IPPS rate,79772.08,160,MS DRG,63817.66,case rate,160% of CMS IPPS rate,64814.82,130,MS DRG,51851.86,case rate,130% of CMS IPPS rate,15188.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15947.47,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,49857.55,100,MS DRG,39886.04,case rate,100% of CMS IPPS rate,15188.1,100,,,case rate,100% of CMS IPPS rate,49857.55,100,MS DRG,39886.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15188.1,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,546055.49,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,49857.55,100,MS DRG,39886.04,case rate,100% of CMS IPPS rate,49857.55,100,MS DRG,39886.04,case rate,100% of CMS IPPS rate,15188.1,546055.5,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29619.36,100,MS DRG,23695.49,case rate,100% of CMS IPPS rate,47390.98,160,MS DRG,37912.78,case rate,160% of CMS IPPS rate,38505.17,130,MS DRG,30804.14,case rate,130% of CMS IPPS rate,7690.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8074.81,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,29619.36,100,MS DRG,23695.49,case rate,100% of CMS IPPS rate,7690.31,100,,,case rate,100% of CMS IPPS rate,29619.36,100,MS DRG,23695.49,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7690.31,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,625521.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29619.36,100,MS DRG,23695.49,case rate,100% of CMS IPPS rate,29619.36,100,MS DRG,23695.49,case rate,100% of CMS IPPS rate,7690.31,625521.2,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21976.66,100,MS DRG,17581.33,case rate,100% of CMS IPPS rate,35162.66,160,MS DRG,28130.13,case rate,160% of CMS IPPS rate,28569.66,130,MS DRG,22855.73,case rate,130% of CMS IPPS rate,4835.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5077.23,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,21976.66,100,MS DRG,17581.33,case rate,100% of CMS IPPS rate,4835.47,100,,,case rate,100% of CMS IPPS rate,21976.66,100,MS DRG,17581.33,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4835.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,821560.8,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,21976.66,100,MS DRG,17581.33,case rate,100% of CMS IPPS rate,21976.66,100,MS DRG,17581.33,case rate,100% of CMS IPPS rate,4835.47,821560.8,
TRAUMATIC INJURY WITH MCC,913,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23607.13,100,MS DRG,18885.7,case rate,100% of CMS IPPS rate,37771.41,160,MS DRG,30217.13,case rate,160% of CMS IPPS rate,30689.27,130,MS DRG,24551.42,case rate,130% of CMS IPPS rate,6169.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6478.35,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23607.13,100,MS DRG,18885.7,case rate,100% of CMS IPPS rate,6169.87,100,,,case rate,100% of CMS IPPS rate,23607.13,100,MS DRG,18885.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6169.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,419295.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23607.13,100,MS DRG,18885.7,case rate,100% of CMS IPPS rate,23607.13,100,MS DRG,18885.7,case rate,100% of CMS IPPS rate,6169.87,419295.1,
TRAUMATIC INJURY WITHOUT MCC,914,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16684.1,100,MS DRG,13347.28,case rate,100% of CMS IPPS rate,26694.56,160,MS DRG,21355.65,case rate,160% of CMS IPPS rate,21689.33,130,MS DRG,17351.46,case rate,130% of CMS IPPS rate,3493.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3668.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16684.1,100,MS DRG,13347.28,case rate,100% of CMS IPPS rate,3493.83,100,,,case rate,100% of CMS IPPS rate,16684.1,100,MS DRG,13347.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3493.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516389.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16684.1,100,MS DRG,13347.28,case rate,100% of CMS IPPS rate,16684.1,100,MS DRG,13347.28,case rate,100% of CMS IPPS rate,3493.83,516389.1,
ALLERGIC REACTIONS WITH MCC,915,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26904.66,100,MS DRG,21523.73,case rate,100% of CMS IPPS rate,43047.46,160,MS DRG,34437.97,case rate,160% of CMS IPPS rate,34976.06,130,MS DRG,27980.85,case rate,130% of CMS IPPS rate,6625.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6957.13,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26904.66,100,MS DRG,21523.73,case rate,100% of CMS IPPS rate,6625.85,100,,,case rate,100% of CMS IPPS rate,26904.66,100,MS DRG,21523.73,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6625.85,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,481081.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26904.66,100,MS DRG,21523.73,case rate,100% of CMS IPPS rate,26904.66,100,MS DRG,21523.73,case rate,100% of CMS IPPS rate,6625.85,481081,
ALLERGIC REACTIONS WITHOUT MCC,916,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13747.59,100,MS DRG,10998.07,case rate,100% of CMS IPPS rate,21996.14,160,MS DRG,17596.91,case rate,160% of CMS IPPS rate,17871.87,130,MS DRG,14297.5,case rate,130% of CMS IPPS rate,2531.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2658.51,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13747.59,100,MS DRG,10998.07,case rate,100% of CMS IPPS rate,2531.92,100,,,case rate,100% of CMS IPPS rate,13747.59,100,MS DRG,10998.07,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2531.92,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,309102.79,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13747.59,100,MS DRG,10998.07,case rate,100% of CMS IPPS rate,13747.59,100,MS DRG,10998.07,case rate,100% of CMS IPPS rate,2531.92,309102.8,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24803.44,100,MS DRG,19842.75,case rate,100% of CMS IPPS rate,39685.5,160,MS DRG,31748.4,case rate,160% of CMS IPPS rate,32244.47,130,MS DRG,25795.58,case rate,130% of CMS IPPS rate,6251.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6564.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,24803.44,100,MS DRG,19842.75,case rate,100% of CMS IPPS rate,6251.45,100,,,case rate,100% of CMS IPPS rate,24803.44,100,MS DRG,19842.75,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6251.45,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431367.52,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,24803.44,100,MS DRG,19842.75,case rate,100% of CMS IPPS rate,24803.44,100,MS DRG,19842.75,case rate,100% of CMS IPPS rate,6251.45,431367.5,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16131.96,100,MS DRG,12905.57,case rate,100% of CMS IPPS rate,25811.14,160,MS DRG,20648.91,case rate,160% of CMS IPPS rate,20971.55,130,MS DRG,16777.24,case rate,130% of CMS IPPS rate,3372.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3541.21,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,16131.96,100,MS DRG,12905.57,case rate,100% of CMS IPPS rate,3372.59,100,,,case rate,100% of CMS IPPS rate,16131.96,100,MS DRG,12905.57,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3372.59,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320369.62,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16131.96,100,MS DRG,12905.57,case rate,100% of CMS IPPS rate,16131.96,100,MS DRG,12905.57,case rate,100% of CMS IPPS rate,3372.59,320369.6,
COMPLICATIONS OF TREATMENT WITH MCC,919,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27502.82,100,MS DRG,22002.26,case rate,100% of CMS IPPS rate,44004.51,160,MS DRG,35203.61,case rate,160% of CMS IPPS rate,35753.67,130,MS DRG,28602.94,case rate,130% of CMS IPPS rate,6952.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7300.2,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27502.82,100,MS DRG,22002.26,case rate,100% of CMS IPPS rate,6952.58,100,,,case rate,100% of CMS IPPS rate,27502.82,100,MS DRG,22002.26,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6952.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,388939.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27502.82,100,MS DRG,22002.26,case rate,100% of CMS IPPS rate,27502.82,100,MS DRG,22002.26,case rate,100% of CMS IPPS rate,6952.58,388939.2,
COMPLICATIONS OF TREATMENT WITH CC,920,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18171.82,100,MS DRG,14537.46,case rate,100% of CMS IPPS rate,29074.91,160,MS DRG,23259.93,case rate,160% of CMS IPPS rate,23623.37,130,MS DRG,18898.7,case rate,130% of CMS IPPS rate,3873.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4066.83,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18171.82,100,MS DRG,14537.46,case rate,100% of CMS IPPS rate,3873.18,100,,,case rate,100% of CMS IPPS rate,18171.82,100,MS DRG,14537.46,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3873.18,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361398.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18171.82,100,MS DRG,14537.46,case rate,100% of CMS IPPS rate,18171.82,100,MS DRG,14537.46,case rate,100% of CMS IPPS rate,3873.18,361398.1,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14207.71,100,MS DRG,11366.17,case rate,100% of CMS IPPS rate,22732.34,160,MS DRG,18185.87,case rate,160% of CMS IPPS rate,18470.02,130,MS DRG,14776.02,case rate,130% of CMS IPPS rate,2621.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2752.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,14207.71,100,MS DRG,11366.17,case rate,100% of CMS IPPS rate,2621.9,100,,,case rate,100% of CMS IPPS rate,14207.71,100,MS DRG,11366.17,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2621.9,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,351675.56,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14207.71,100,MS DRG,11366.17,case rate,100% of CMS IPPS rate,14207.71,100,MS DRG,11366.17,case rate,100% of CMS IPPS rate,2621.9,351675.6,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26561.33,100,MS DRG,21249.06,case rate,100% of CMS IPPS rate,42498.13,160,MS DRG,33998.5,case rate,160% of CMS IPPS rate,34529.73,130,MS DRG,27623.78,case rate,130% of CMS IPPS rate,6440.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6762.97,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,26561.33,100,MS DRG,21249.06,case rate,100% of CMS IPPS rate,6440.94,100,,,case rate,100% of CMS IPPS rate,26561.33,100,MS DRG,21249.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6440.94,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520183.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26561.33,100,MS DRG,21249.06,case rate,100% of CMS IPPS rate,26561.33,100,MS DRG,21249.06,case rate,100% of CMS IPPS rate,6440.94,520183.8,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17907.55,100,MS DRG,14326.04,case rate,100% of CMS IPPS rate,28652.08,160,MS DRG,22921.66,case rate,160% of CMS IPPS rate,23279.82,130,MS DRG,18623.86,case rate,130% of CMS IPPS rate,3888.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4082.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17907.55,100,MS DRG,14326.04,case rate,100% of CMS IPPS rate,3888.43,100,,,case rate,100% of CMS IPPS rate,17907.55,100,MS DRG,14326.04,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3888.43,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406540.15,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17907.55,100,MS DRG,14326.04,case rate,100% of CMS IPPS rate,17907.55,100,MS DRG,14326.04,case rate,100% of CMS IPPS rate,3888.43,406540.2,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316953.5,100,MS DRG,253562.8,case rate,100% of CMS IPPS rate,507125.6,160,MS DRG,405700.48,case rate,160% of CMS IPPS rate,412039.55,130,MS DRG,329631.64,case rate,130% of CMS IPPS rate,76679.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,80513.16,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,316953.5,100,MS DRG,253562.8,case rate,100% of CMS IPPS rate,76679.35,100,,,case rate,100% of CMS IPPS rate,316953.5,100,MS DRG,253562.8,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76679.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1170899.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,316953.5,100,MS DRG,253562.8,case rate,100% of CMS IPPS rate,316953.5,100,MS DRG,253562.8,case rate,100% of CMS IPPS rate,76679.35,1170899,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87613.32,100,MS DRG,70090.66,case rate,100% of CMS IPPS rate,140181.31,160,MS DRG,112145.05,case rate,160% of CMS IPPS rate,113897.32,130,MS DRG,91117.86,case rate,130% of CMS IPPS rate,25463.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,26736.84,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87613.32,100,MS DRG,70090.66,case rate,100% of CMS IPPS rate,25463.71,100,,,case rate,100% of CMS IPPS rate,87613.32,100,MS DRG,70090.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25463.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564291.16,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,87613.32,100,MS DRG,70090.66,case rate,100% of CMS IPPS rate,87613.32,100,MS DRG,70090.66,case rate,100% of CMS IPPS rate,25463.71,564291.2,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43911.39,100,MS DRG,35129.11,case rate,100% of CMS IPPS rate,70258.22,160,MS DRG,56206.58,case rate,160% of CMS IPPS rate,57084.81,130,MS DRG,45667.85,case rate,130% of CMS IPPS rate,12125.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12731.71,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43911.39,100,MS DRG,35129.11,case rate,100% of CMS IPPS rate,12125.47,100,,,case rate,100% of CMS IPPS rate,43911.39,100,MS DRG,35129.11,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12125.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379061.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43911.39,100,MS DRG,35129.11,case rate,100% of CMS IPPS rate,43911.39,100,MS DRG,35129.11,case rate,100% of CMS IPPS rate,12125.47,379061.1,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41746.46,100,MS DRG,33397.17,case rate,100% of CMS IPPS rate,66794.34,160,MS DRG,53435.47,case rate,160% of CMS IPPS rate,54270.4,130,MS DRG,43416.32,case rate,130% of CMS IPPS rate,16496.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17321.36,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,41746.46,100,MS DRG,33397.17,case rate,100% of CMS IPPS rate,16496.57,100,,,case rate,100% of CMS IPPS rate,41746.46,100,MS DRG,33397.17,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16496.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,969737.09,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,41746.46,100,MS DRG,33397.17,case rate,100% of CMS IPPS rate,41746.46,100,MS DRG,33397.17,case rate,100% of CMS IPPS rate,16496.57,969737.1,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30662.31,100,MS DRG,24529.85,case rate,100% of CMS IPPS rate,49059.7,160,MS DRG,39247.76,case rate,160% of CMS IPPS rate,39861,130,MS DRG,31888.8,case rate,130% of CMS IPPS rate,8180.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8590.02,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30662.31,100,MS DRG,24529.85,case rate,100% of CMS IPPS rate,8180.99,100,,,case rate,100% of CMS IPPS rate,30662.31,100,MS DRG,24529.85,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8180.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389169.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30662.31,100,MS DRG,24529.85,case rate,100% of CMS IPPS rate,30662.31,100,MS DRG,24529.85,case rate,100% of CMS IPPS rate,8180.99,389169.9,
NON-EXTENSIVE BURNS,935,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30055.88,100,MS DRG,24044.7,case rate,100% of CMS IPPS rate,48089.41,160,MS DRG,38471.53,case rate,160% of CMS IPPS rate,39072.64,130,MS DRG,31258.11,case rate,130% of CMS IPPS rate,8373.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8792.58,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,30055.88,100,MS DRG,24044.7,case rate,100% of CMS IPPS rate,8373.91,100,,,case rate,100% of CMS IPPS rate,30055.88,100,MS DRG,24044.7,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8373.91,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,613284.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,30055.88,100,MS DRG,24044.7,case rate,100% of CMS IPPS rate,30055.88,100,MS DRG,24044.7,case rate,100% of CMS IPPS rate,8373.91,613284.5,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43909.03,100,MS DRG,35127.22,case rate,100% of CMS IPPS rate,70254.45,160,MS DRG,56203.56,case rate,160% of CMS IPPS rate,57081.74,130,MS DRG,45665.39,case rate,130% of CMS IPPS rate,12101.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12706.09,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,43909.03,100,MS DRG,35127.22,case rate,100% of CMS IPPS rate,12101.07,100,,,case rate,100% of CMS IPPS rate,43909.03,100,MS DRG,35127.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12101.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,547007.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,43909.03,100,MS DRG,35127.22,case rate,100% of CMS IPPS rate,43909.03,100,MS DRG,35127.22,case rate,100% of CMS IPPS rate,12101.07,547007.3,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31536.53,100,MS DRG,25229.22,case rate,100% of CMS IPPS rate,50458.45,160,MS DRG,40366.76,case rate,160% of CMS IPPS rate,40997.49,130,MS DRG,32797.99,case rate,130% of CMS IPPS rate,8049.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,8452.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,31536.53,100,MS DRG,25229.22,case rate,100% of CMS IPPS rate,8049.84,100,,,case rate,100% of CMS IPPS rate,31536.53,100,MS DRG,25229.22,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8049.84,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,603866.36,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,31536.53,100,MS DRG,25229.22,case rate,100% of CMS IPPS rate,31536.53,100,MS DRG,25229.22,case rate,100% of CMS IPPS rate,8049.84,603866.4,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27872.1,100,MS DRG,22297.68,case rate,100% of CMS IPPS rate,44595.36,160,MS DRG,35676.29,case rate,160% of CMS IPPS rate,36233.73,130,MS DRG,28986.98,case rate,130% of CMS IPPS rate,7450.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,7823.41,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,27872.1,100,MS DRG,22297.68,case rate,100% of CMS IPPS rate,7450.89,100,,,case rate,100% of CMS IPPS rate,27872.1,100,MS DRG,22297.68,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7450.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1727330.7,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27872.1,100,MS DRG,22297.68,case rate,100% of CMS IPPS rate,27872.1,100,MS DRG,22297.68,case rate,100% of CMS IPPS rate,7450.89,1727331,
REHABILITATION WITH CC/MCC,945,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23784.1,100,MS DRG,19027.28,case rate,100% of CMS IPPS rate,38054.56,160,MS DRG,30443.65,case rate,160% of CMS IPPS rate,30919.33,130,MS DRG,24735.46,case rate,130% of CMS IPPS rate,5819.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6110.85,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23784.1,100,MS DRG,19027.28,case rate,100% of CMS IPPS rate,5819.87,100,,,case rate,100% of CMS IPPS rate,23784.1,100,MS DRG,19027.28,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5819.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360283.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23784.1,100,MS DRG,19027.28,case rate,100% of CMS IPPS rate,23784.1,100,MS DRG,19027.28,case rate,100% of CMS IPPS rate,5819.87,360283.2,
REHABILITATION WITHOUT CC/MCC,946,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17922.88,100,MS DRG,14338.3,case rate,100% of CMS IPPS rate,28676.61,160,MS DRG,22941.29,case rate,160% of CMS IPPS rate,23299.74,130,MS DRG,18639.79,case rate,130% of CMS IPPS rate,4256.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4469.55,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17922.88,100,MS DRG,14338.3,case rate,100% of CMS IPPS rate,4256.72,100,,,case rate,100% of CMS IPPS rate,17922.88,100,MS DRG,14338.3,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4256.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359887.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17922.88,100,MS DRG,14338.3,case rate,100% of CMS IPPS rate,17922.88,100,MS DRG,14338.3,case rate,100% of CMS IPPS rate,4256.72,359887.6,
SIGNS AND SYMPTOMS WITH MCC,947,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20741.41,100,MS DRG,16593.13,case rate,100% of CMS IPPS rate,33186.26,160,MS DRG,26549.01,case rate,160% of CMS IPPS rate,26963.83,130,MS DRG,21571.06,case rate,130% of CMS IPPS rate,4903.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5148.89,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,20741.41,100,MS DRG,16593.13,case rate,100% of CMS IPPS rate,4903.71,100,,,case rate,100% of CMS IPPS rate,20741.41,100,MS DRG,16593.13,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4903.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380075.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,20741.41,100,MS DRG,16593.13,case rate,100% of CMS IPPS rate,20741.41,100,MS DRG,16593.13,case rate,100% of CMS IPPS rate,4903.71,380075.4,
SIGNS AND SYMPTOMS WITHOUT MCC,948,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15425.26,100,MS DRG,12340.21,case rate,100% of CMS IPPS rate,24680.42,160,MS DRG,19744.34,case rate,160% of CMS IPPS rate,20052.84,130,MS DRG,16042.27,case rate,130% of CMS IPPS rate,3029.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3180.53,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15425.26,100,MS DRG,12340.21,case rate,100% of CMS IPPS rate,3029.08,100,,,case rate,100% of CMS IPPS rate,15425.26,100,MS DRG,12340.21,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3029.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250095.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15425.26,100,MS DRG,12340.21,case rate,100% of CMS IPPS rate,15425.26,100,MS DRG,12340.21,case rate,100% of CMS IPPS rate,3029.08,250095.3,
AFTERCARE WITH CC/MCC,949,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18631.95,100,MS DRG,14905.56,case rate,100% of CMS IPPS rate,29811.12,160,MS DRG,23848.9,case rate,160% of CMS IPPS rate,24221.54,130,MS DRG,19377.23,case rate,130% of CMS IPPS rate,4113.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4319.43,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18631.95,100,MS DRG,14905.56,case rate,100% of CMS IPPS rate,4113.75,100,,,case rate,100% of CMS IPPS rate,18631.95,100,MS DRG,14905.56,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4113.75,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179701.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18631.95,100,MS DRG,14905.56,case rate,100% of CMS IPPS rate,18631.95,100,MS DRG,14905.56,case rate,100% of CMS IPPS rate,4113.75,179701.6,
AFTERCARE WITHOUT CC/MCC,950,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13509.28,100,MS DRG,10807.42,case rate,100% of CMS IPPS rate,21614.85,160,MS DRG,17291.88,case rate,160% of CMS IPPS rate,17562.06,130,MS DRG,14049.65,case rate,130% of CMS IPPS rate,2234.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2346.26,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,13509.28,100,MS DRG,10807.42,case rate,100% of CMS IPPS rate,2234.54,100,,,case rate,100% of CMS IPPS rate,13509.28,100,MS DRG,10807.42,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2234.54,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125675.76,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,13509.28,100,MS DRG,10807.42,case rate,100% of CMS IPPS rate,13509.28,100,MS DRG,10807.42,case rate,100% of CMS IPPS rate,2234.54,125675.8,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12935.89,100,MS DRG,10348.71,case rate,100% of CMS IPPS rate,20697.42,160,MS DRG,16557.94,case rate,160% of CMS IPPS rate,16816.66,130,MS DRG,13453.33,case rate,130% of CMS IPPS rate,2161.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,2269.8,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,12935.89,100,MS DRG,10348.71,case rate,100% of CMS IPPS rate,2161.72,100,,,case rate,100% of CMS IPPS rate,12935.89,100,MS DRG,10348.71,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2161.72,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280720.95,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,12935.89,100,MS DRG,10348.71,case rate,100% of CMS IPPS rate,12935.89,100,MS DRG,10348.71,case rate,100% of CMS IPPS rate,2161.72,280721,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77826.94,100,MS DRG,62261.55,case rate,100% of CMS IPPS rate,124523.1,160,MS DRG,99618.48,case rate,160% of CMS IPPS rate,101175.02,130,MS DRG,80940.02,case rate,130% of CMS IPPS rate,26033.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,27334.91,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,77826.94,100,MS DRG,62261.55,case rate,100% of CMS IPPS rate,26033.3,100,,,case rate,100% of CMS IPPS rate,77826.94,100,MS DRG,62261.55,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26033.3,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,668693.46,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,77826.94,100,MS DRG,62261.55,case rate,100% of CMS IPPS rate,77826.94,100,MS DRG,62261.55,case rate,100% of CMS IPPS rate,26033.3,668693.5,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51729.89,100,MS DRG,41383.91,case rate,100% of CMS IPPS rate,82767.82,160,MS DRG,66214.26,case rate,160% of CMS IPPS rate,67248.86,130,MS DRG,53799.09,case rate,130% of CMS IPPS rate,14573.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15301.76,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,51729.89,100,MS DRG,41383.91,case rate,100% of CMS IPPS rate,14573.13,100,,,case rate,100% of CMS IPPS rate,51729.89,100,MS DRG,41383.91,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14573.13,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1093906.89,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,51729.89,100,MS DRG,41383.91,case rate,100% of CMS IPPS rate,51729.89,100,MS DRG,41383.91,case rate,100% of CMS IPPS rate,14573.13,1093907,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91303.72,100,MS DRG,73042.98,case rate,100% of CMS IPPS rate,146085.95,160,MS DRG,116868.76,case rate,160% of CMS IPPS rate,118694.84,130,MS DRG,94955.87,case rate,130% of CMS IPPS rate,28457.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,29880.54,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,91303.72,100,MS DRG,73042.98,case rate,100% of CMS IPPS rate,28457.71,100,,,case rate,100% of CMS IPPS rate,91303.72,100,MS DRG,73042.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28457.71,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,851455.39,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,91303.72,100,MS DRG,73042.98,case rate,100% of CMS IPPS rate,91303.72,100,MS DRG,73042.98,case rate,100% of CMS IPPS rate,28457.71,851455.4,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53695.43,100,MS DRG,42956.34,case rate,100% of CMS IPPS rate,85912.69,160,MS DRG,68730.15,case rate,160% of CMS IPPS rate,69804.06,130,MS DRG,55843.25,case rate,130% of CMS IPPS rate,15668.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,16452.27,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,53695.43,100,MS DRG,42956.34,case rate,100% of CMS IPPS rate,15668.86,100,,,case rate,100% of CMS IPPS rate,53695.43,100,MS DRG,42956.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15668.86,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,799538.01,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,53695.43,100,MS DRG,42956.34,case rate,100% of CMS IPPS rate,53695.43,100,MS DRG,42956.34,case rate,100% of CMS IPPS rate,15668.86,799538,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35852.22,100,MS DRG,28681.78,case rate,100% of CMS IPPS rate,57363.55,160,MS DRG,45890.84,case rate,160% of CMS IPPS rate,46607.89,130,MS DRG,37286.31,case rate,130% of CMS IPPS rate,10080.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10584.01,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35852.22,100,MS DRG,28681.78,case rate,100% of CMS IPPS rate,10080.03,100,,,case rate,100% of CMS IPPS rate,35852.22,100,MS DRG,28681.78,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10080.03,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,929960.6,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35852.22,100,MS DRG,28681.78,case rate,100% of CMS IPPS rate,35852.22,100,MS DRG,28681.78,case rate,100% of CMS IPPS rate,10080.03,929960.6,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38234.22,100,MS DRG,30587.38,case rate,100% of CMS IPPS rate,61174.75,160,MS DRG,48939.8,case rate,160% of CMS IPPS rate,49704.49,130,MS DRG,39763.59,case rate,130% of CMS IPPS rate,10357.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10875.44,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38234.22,100,MS DRG,30587.38,case rate,100% of CMS IPPS rate,10357.58,100,,,case rate,100% of CMS IPPS rate,38234.22,100,MS DRG,30587.38,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10357.58,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516481.83,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38234.22,100,MS DRG,30587.38,case rate,100% of CMS IPPS rate,38234.22,100,MS DRG,30587.38,case rate,100% of CMS IPPS rate,10357.58,516481.8,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23683.82,100,MS DRG,18947.06,case rate,100% of CMS IPPS rate,37894.11,160,MS DRG,30315.29,case rate,160% of CMS IPPS rate,30788.97,130,MS DRG,24631.18,case rate,130% of CMS IPPS rate,5719.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6005.17,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,23683.82,100,MS DRG,18947.06,case rate,100% of CMS IPPS rate,5719.22,100,,,case rate,100% of CMS IPPS rate,23683.82,100,MS DRG,18947.06,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5719.22,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,353290.27,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,23683.82,100,MS DRG,18947.06,case rate,100% of CMS IPPS rate,23683.82,100,MS DRG,18947.06,case rate,100% of CMS IPPS rate,5719.22,353290.3,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17252.76,100,MS DRG,13802.21,case rate,100% of CMS IPPS rate,27604.42,160,MS DRG,22083.54,case rate,160% of CMS IPPS rate,22428.59,130,MS DRG,17942.87,case rate,130% of CMS IPPS rate,3479.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,3653.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,17252.76,100,MS DRG,13802.21,case rate,100% of CMS IPPS rate,3479.34,100,,,case rate,100% of CMS IPPS rate,17252.76,100,MS DRG,13802.21,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3479.34,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401301.23,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,17252.76,100,MS DRG,13802.21,case rate,100% of CMS IPPS rate,17252.76,100,MS DRG,13802.21,case rate,100% of CMS IPPS rate,3479.34,401301.2,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87057.63,100,MS DRG,69646.1,case rate,100% of CMS IPPS rate,139292.21,160,MS DRG,111433.77,case rate,160% of CMS IPPS rate,113174.92,130,MS DRG,90539.94,case rate,130% of CMS IPPS rate,24111.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25317.31,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,87057.63,100,MS DRG,69646.1,case rate,100% of CMS IPPS rate,24111.77,100,,,case rate,100% of CMS IPPS rate,87057.63,100,MS DRG,69646.1,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24111.77,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,544086.42,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,87057.63,100,MS DRG,69646.1,case rate,100% of CMS IPPS rate,87057.63,100,MS DRG,69646.1,case rate,100% of CMS IPPS rate,24111.77,544086.4,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38768.66,100,MS DRG,31014.93,case rate,100% of CMS IPPS rate,62029.86,160,MS DRG,49623.89,case rate,160% of CMS IPPS rate,50399.26,130,MS DRG,40319.41,case rate,130% of CMS IPPS rate,10115.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,10621.64,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,38768.66,100,MS DRG,31014.93,case rate,100% of CMS IPPS rate,10115.87,100,,,case rate,100% of CMS IPPS rate,38768.66,100,MS DRG,31014.93,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10115.87,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,548783.28,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,38768.66,100,MS DRG,31014.93,case rate,100% of CMS IPPS rate,38768.66,100,MS DRG,31014.93,case rate,100% of CMS IPPS rate,10115.87,548783.3,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40383.81,100,MS DRG,32307.05,case rate,100% of CMS IPPS rate,64614.1,160,MS DRG,51691.28,case rate,160% of CMS IPPS rate,52498.95,130,MS DRG,41999.16,case rate,130% of CMS IPPS rate,11385.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,11954.3,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,40383.81,100,MS DRG,32307.05,case rate,100% of CMS IPPS rate,11385.07,100,,,case rate,100% of CMS IPPS rate,40383.81,100,MS DRG,32307.05,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11385.07,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423077.08,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,40383.81,100,MS DRG,32307.05,case rate,100% of CMS IPPS rate,40383.81,100,MS DRG,32307.05,case rate,100% of CMS IPPS rate,11385.07,423077.1,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22059.24,100,MS DRG,17647.39,case rate,100% of CMS IPPS rate,35294.78,160,MS DRG,28235.82,case rate,160% of CMS IPPS rate,28677.01,130,MS DRG,22941.61,case rate,130% of CMS IPPS rate,5419.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5690.12,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22059.24,100,MS DRG,17647.39,case rate,100% of CMS IPPS rate,5419.17,100,,,case rate,100% of CMS IPPS rate,22059.24,100,MS DRG,17647.39,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5419.17,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368845.66,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22059.24,100,MS DRG,17647.39,case rate,100% of CMS IPPS rate,22059.24,100,MS DRG,17647.39,case rate,100% of CMS IPPS rate,5419.17,368845.7,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15947.9,100,MS DRG,12758.32,case rate,100% of CMS IPPS rate,25516.64,160,MS DRG,20413.31,case rate,160% of CMS IPPS rate,20732.27,130,MS DRG,16585.82,case rate,130% of CMS IPPS rate,3824,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4015.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,15947.9,100,MS DRG,12758.32,case rate,100% of CMS IPPS rate,3824,100,,,case rate,100% of CMS IPPS rate,15947.9,100,MS DRG,12758.32,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3824,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,375503.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,15947.9,100,MS DRG,12758.32,case rate,100% of CMS IPPS rate,15947.9,100,MS DRG,12758.32,case rate,100% of CMS IPPS rate,3824,375503.2,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22682.18,100,MS DRG,18145.74,case rate,100% of CMS IPPS rate,36291.49,160,MS DRG,29033.19,case rate,160% of CMS IPPS rate,29486.83,130,MS DRG,23589.46,case rate,130% of CMS IPPS rate,5497.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,5772.19,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,22682.18,100,MS DRG,18145.74,case rate,100% of CMS IPPS rate,5497.33,100,,,case rate,100% of CMS IPPS rate,22682.18,100,MS DRG,18145.74,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5497.33,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365264.65,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,22682.18,100,MS DRG,18145.74,case rate,100% of CMS IPPS rate,22682.18,100,MS DRG,18145.74,case rate,100% of CMS IPPS rate,5497.33,365264.7,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61902.07,100,MS DRG,49521.66,case rate,100% of CMS IPPS rate,99043.31,160,MS DRG,79234.65,case rate,160% of CMS IPPS rate,80472.69,130,MS DRG,64378.15,case rate,130% of CMS IPPS rate,18124.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,19030.72,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,61902.07,100,MS DRG,49521.66,case rate,100% of CMS IPPS rate,18124.53,100,,,case rate,100% of CMS IPPS rate,61902.07,100,MS DRG,49521.66,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18124.53,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503685.19,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,61902.07,100,MS DRG,49521.66,case rate,100% of CMS IPPS rate,61902.07,100,MS DRG,49521.66,case rate,100% of CMS IPPS rate,18124.53,503685.2,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35304.79,100,MS DRG,28243.83,case rate,100% of CMS IPPS rate,56487.66,160,MS DRG,45190.13,case rate,160% of CMS IPPS rate,45896.23,130,MS DRG,36716.98,case rate,130% of CMS IPPS rate,9334.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,9800.99,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,35304.79,100,MS DRG,28243.83,case rate,100% of CMS IPPS rate,9334.29,100,,,case rate,100% of CMS IPPS rate,35304.79,100,MS DRG,28243.83,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9334.29,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,547569.99,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,35304.79,100,MS DRG,28243.83,case rate,100% of CMS IPPS rate,35304.79,100,MS DRG,28243.83,case rate,100% of CMS IPPS rate,9334.29,547570,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25267.11,100,MS DRG,20213.69,case rate,100% of CMS IPPS rate,40427.38,160,MS DRG,32341.9,case rate,160% of CMS IPPS rate,32847.24,130,MS DRG,26277.79,case rate,130% of CMS IPPS rate,6360.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6678.1,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25267.11,100,MS DRG,20213.69,case rate,100% of CMS IPPS rate,6360.11,100,,,case rate,100% of CMS IPPS rate,25267.11,100,MS DRG,20213.69,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6360.11,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,925411.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25267.11,100,MS DRG,20213.69,case rate,100% of CMS IPPS rate,25267.11,100,MS DRG,20213.69,case rate,100% of CMS IPPS rate,6360.11,925411.5,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45813.21,100,MS DRG,36650.57,case rate,100% of CMS IPPS rate,73301.14,160,MS DRG,58640.91,case rate,160% of CMS IPPS rate,59557.17,130,MS DRG,47645.74,case rate,130% of CMS IPPS rate,13354.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,14021.94,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,45813.21,100,MS DRG,36650.57,case rate,100% of CMS IPPS rate,13354.25,100,,,case rate,100% of CMS IPPS rate,45813.21,100,MS DRG,36650.57,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13354.25,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424270.98,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,45813.21,100,MS DRG,36650.57,case rate,100% of CMS IPPS rate,45813.21,100,MS DRG,36650.57,case rate,100% of CMS IPPS rate,13354.25,424271,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25996.22,100,MS DRG,20796.98,case rate,100% of CMS IPPS rate,41593.95,160,MS DRG,33275.16,case rate,160% of CMS IPPS rate,33795.09,130,MS DRG,27036.07,case rate,130% of CMS IPPS rate,6542.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,6869.46,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,25996.22,100,MS DRG,20796.98,case rate,100% of CMS IPPS rate,6542.35,100,,,case rate,100% of CMS IPPS rate,25996.22,100,MS DRG,20796.98,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6542.35,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,434534.57,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,25996.22,100,MS DRG,20796.98,case rate,100% of CMS IPPS rate,25996.22,100,MS DRG,20796.98,case rate,100% of CMS IPPS rate,6542.35,434534.6,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18720.42,100,MS DRG,14976.34,case rate,100% of CMS IPPS rate,29952.67,160,MS DRG,23962.14,case rate,160% of CMS IPPS rate,24336.55,130,MS DRG,19469.24,case rate,130% of CMS IPPS rate,4405.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,4625.67,100,,,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other,not seperately reimbursable,,,,,other,not seperately reimbursable,18720.42,100,MS DRG,14976.34,case rate,100% of CMS IPPS rate,4405.41,100,,,case rate,100% of CMS IPPS rate,18720.42,100,MS DRG,14976.34,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4405.41,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,642553.47,100,,,case rate,100% of CMS IPPS rate,,,,,other ,not seperately reimbursable,18720.42,100,MS DRG,14976.34,case rate,100% of CMS IPPS rate,18720.42,100,MS DRG,14976.34,case rate,100% of CMS IPPS rate,4405.41,642553.5,
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,998,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,9560.18,160,MS DRG,7648.14,case rate,160% of CMS IPPS rate,7767.64,130,MS DRG,6214.11,case rate,130% 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,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5975.11,100,MS DRG,4780.09,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,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,5975.11,9560.18,
UNGROUPABLE,999,MS-DRG,,,,,inpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,9560.18,160,MS DRG,7648.14,case rate,160% of CMS IPPS rate,7767.64,130,MS DRG,6214.11,case rate,130% 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,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,,,,,other,not seperately reimbursable,5975.11,100,MS DRG,4780.09,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,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,5975.11,100,MS DRG,4780.09,case rate,100% of CMS IPPS rate,5975.11,9560.18,